title: Utility of preoperative chemoradiotherapy for advanced esophageal carcinoma.
abstract: OBJECTIVE
  The most effective treatment would be neoadjuvant chemoradiotherapy (NACRT) plus surgery with three-field lymphadenectomy, if tolerability and complications are acceptable. The aim of this prospective study was to evaluate the tolerability of NACRT+ systematic three-field lymphadenectomy.
  
  
  METHODS
  A total of 127 cases of advanced esophageal carcinoma were objected, among which 32 had NACRT, being the cases suspected to cT3-T4 or, < cT3 with multiple lymph node metastasis. ≥ T2 of 95 cases were treated by surgery alone (NACRT [-] case). The effect of NACRT was evaluated by histological examination and corrected with the clinicopathologic factors, including postoperative prognosis. After reports JCOG9907, we treated eight cases with neoadjuvant chemotherapy at stages II and III. We examined Musashi-1 staining for these eight cases.
  
  
  RESULTS
  Histological good response to NACRT group showed good prognosis. Lymph node metastasis is a predictive factor for prognosis. In this additional study, Musashi-1 was positive after neoadjuvant chemotherapy in three cases. The histological response was grade 1 in all of them and recurrence was observed within a short period of time. Two cases of grade 3 were negative staining to Musashi-1 and showed no recurrence.
  
  
  CONCLUSIONS
  This study shows that NACRT plus surgery with three-field lymphadenectomy is a feasible therapeutic approach for the cases with multiple lymph node metastases. Prognosis was significantly better in cases with marked histological improvement. It is important to find the predictive factors of histological improvement. Musashi-1 might be a candidate maker for histological response and prognosis, and further studies are needed to prove it.
authors.affiliation: Department of Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan. j.kuroda@iuhw.ac.jp
authors.forename: Junko
authors.initials: J
authors.lastname: Kuroda
authors.forename: Masashi
authors.initials: M
authors.lastname: Yoshida
authors.forename: Masaki
authors.initials: M
authors.lastname: Kitajima
authors.forename: Akio
authors.initials: A
authors.lastname: Yanagisawa
authors.forename: Toshiki
authors.initials: T
authors.lastname: Matsubara
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Osamura
authors.forename: Keiichirou
authors.initials: K
authors.lastname: Ohta
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kubota
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Beck
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yamashita
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D002277:Carcinoma / Q000737:chemistry / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000737:chemistry / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000009:adverse effects; D008207:Lymphatic Metastasis; D008297:Male; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009419:Nerve Tissue Proteins / Q000032:analysis; D011446:Prospective Studies; D016601:RNA-Binding Proteins / Q000032:analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; C491297:MSI1 protein, human; D009419:Nerve Tissue Proteins; D016601:RNA-Binding Proteins