Trimodality therapy of esophagectomy plus neoadjuvant chemoradiotherapy             improves the survival of clinical stage II/III esophageal squamous cell carcinoma             patients.
The prognosis of advanced esophageal cancer patients is poor. Trimodality             therapy of surgical resection plus neoadjuvant chemoradiotherapy (CRT) has been             developed to improve survival through locoregional control, leading to prevention             of micrometastasis. We investigated whether or not neoadjuvant CRT led to survival             benefits in TNM stage II/III esophageal cancer patients. We retrospectively reviewed             62 patients with stage II or III esophageal squamous cell carcinoma (ESCC) treated             with neoadjuvant CRT. All patients received esophagectomy 4-7 weeks after CRT             consisting of 40 Gy irradiation and chemotherapy (5-FU, 500 mg/m2/day, days 1-5             and cisplatin, 10-20 mg/body, days 1-5). Clinical response and survival rates             were analyzed using Kaplan-Meier methods, with p<0.05 considered as significant.             The clinical effect rate of CRT for both primary tumors and metastatic nodes was             82.3%. Operative and hospital mortality rates were 1.65 and 6.5%, respectively.             The 3-year overall survival (OS) and disease-free survival (DFS) rates were 52.6             and 49.2%, respectively. A significant difference was noted between stages II             and III for both OS and DFS. The 5-year OS rates were 64.2% for stage II, 33.1%             for stage III (T4 and non-T4) and 46.9% for stage III (non-T4 only) patients.             The depth of tumor invasion (T3 vs. T4), resectability (R0 vs. R1, R2), lymph             node metastasis (positive vs. negative), and the effect of CRT were proven to             be independent prognostic factors for univariate analysis, with resectability             and the effect of CRT for multivariate analysis. These data suggest that CRT in             stage II/III (non-T4) ESCC patient contributed to tumor shrinkage, leading to             higher resectability and longer survival. Neoadjuvant CRT appears to be a promising             option for these patients.
Department of Digestive Surgery, Nara Hospital, Kinki University School of Medicine, Nara, Japan. yyfujiwara@nifty.com
Yoshinori
Y
Fujiwara
Reigetsu
R
Yoshikawa
Norihiko
N
Kamikonya
Tsuyoshi
T
Nakayama
Kotaro
K
Kitani
Masanori
M
Tsujie
Masao
M
Yukawa
Masatoshi
M
Inoue
Takehira
T
Yamamura
D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome