title: Role of preoperative chemotherapy in squamous cell carcinoma of esophagus in kashmir, a cancer belt - a pilot study.
abstract: BACKGROUND
  Esophageal carcinoma is the fifth leading gastrointestinal malignancy and is one of the leading causes of cancer related death. Despite improvements in surgical technique over the last few decades, the outcome has been dismal, with overall 5 year survival not exceeding 15%-25%.
  
  
  OBJECTIVE
  To evaluate the effect of preoperative chemotherapy on resectability, complication rate and overall survival in patients with squamous cell carcinoma esophagus.
  
  
  METHODS
  50 patients with histologically confirmed squamous cell carcinoma (SCC), with localised or loco-regional disease (stage 4 excluded) were divided into 2 groups. Group A patients were subjected to 2-3 cycles of pre-operative chemotherapy (5FU-CDDP), whereas Group B patients were directly operated on.
  
  
  METHODS
  3 (12%) patients in group A showed complete pathological response to chemotherapy and 18 (72%) showed a partial response, with four patients (16%) showing resistance to chemotherapy. There was no statistically significant difference in terms of response to chemotherapy with respect to degree of differentiation of tumor. There was no significant difference in the overall resectability rates between the two groups (p > 0.05), but R0 resection was achieved in 20 (80%) of group A and only 10 (40%) of group B, the difference being statistically significant (p < 0.05). The rate of overall complications was also much higher in the control group. Initially there was no significant difference in the survival between the two groups, but later (20 months) the study group showed a slight non-significant advantage.
  
  
  CONCLUSIONS
  Preoperative chemotherapy significantly increases the rate of R0 resection without significantly increasing postoperative morbidity and mortality in patients with squamous cell carcinoma of esophagus. However, to assess the impact on survival the study period needs to be extended.
authors.affiliation: Department of Cardio-vascular and Thoracic Surgery, Sheri-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India.
authors.forename: Ghulam Nabi
authors.initials: GN
authors.lastname: Lone
authors.forename: Ajaz Aziz
authors.initials: AA
authors.lastname: Sheikh
authors.forename: Zahoor Ahmad
authors.initials: ZA
authors.lastname: Sheikh
authors.forename: Khalil M
authors.initials: KM
authors.lastname: Baba
authors.forename: Mariya Amin
authors.initials: MA
authors.lastname: Qurieshi
authors.forename: Gowhar Nazir
authors.initials: GN
authors.lastname: Mufti
authors.forename: Zahoor Ahmed
authors.initials: ZA
authors.lastname: Naikoo
authors.forename: Abir Ahmed
authors.initials: AA
authors.lastname: Syed
authors.forename: A G
authors.initials: AG
authors.lastname: Ahangar
authors.forename: Reyaz A
authors.initials: RA
authors.lastname: Lone
authors.forename: M L
authors.initials: ML
authors.lastname: Sharma
authors.forename: Shyam
authors.initials: S
authors.lastname: Singh
authors.forename: M A
authors.initials: MA
authors.lastname: Bhat
authors.forename: A M
authors.initials: AM
authors.lastname: Dar
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010865:Pilot Projects; D011300:Preoperative Care; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D002945:Cisplatin; D005472:Fluorouracil