title: Efficacy and drawbacks of neoadjuvant chemoradiotherapy in squamous cell carcinoma of the thoracic esophagus.
abstract: OBJECTIVE
  Neoadjuvant chemoradiotherapy (CRT) is widely applied in locally advanced esophageal tumors to improve resectability and local tumor control. In this study, we retrospectively analyzed the perioperative course of patients who underwent esophagectomy or esophagectomy following CRT.
  
  
  METHODS
  Forty one patients were admitted with non-advanced disease (T1-2, N0), and primary resection was performed. Additional 21 patients received neoadjuvant CRT because of locally advanced, T2-4, N0-1 disease. To investigate predictive factors for responsiveness to CRT, we determined the p53, p21 and Ki67 oncogene expressions in the biopsy samples from the CRT patients.
  
  
  RESULTS
  Following primary esophagectomy and esophagogastrostomy, the postoperative course was in most cases uneventful. Anastomotic leaks developed in 3 of the 41 cases (7.3%), and postoperative death in 1 case (2.4%). In response to CRT, significant down-staging was observed in 11 of the 21 patients (58%); in these cases esophagectomy was performed. However, in this group the rates of anastomotic leak (2 patients) and postoperative death (2 patients) were higher than in the first group (18% each).
  
  
  CONCLUSIONS
  Preoperative CRT is a good option for patients with locally advanced tumors, when primary R0 resection is hopeless. However, the rate and risk of postoperative complications are higher than after primary resection of non-advanced tumors.
authors.affiliation: Department of Surgeru, University of Szegedc, Hungary. wolfard@freemail.hu
authors.forename: Antal
authors.initials: A
authors.lastname: Wolfárd
authors.forename: Attila
authors.initials: A
authors.lastname: Paszt
authors.forename: Károly
authors.initials: K
authors.lastname: Szentpáli
authors.forename: Katalin
authors.initials: K
authors.lastname: Hideghéthy
authors.forename: Gabriella
authors.initials: G
authors.lastname: Uhercsák
authors.forename: István
authors.initials: I
authors.lastname: Németh
authors.forename: László
authors.initials: L
authors.lastname: Tiszlavicz
authors.forename: György
authors.initials: G
authors.lastname: Lázár
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy / Q000009:adverse effects; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies