title: Tumor response after low-dose preoperative radiotherapy combined with chemotherapy for squamous cell esophageal carcinoma.
abstract: OBJECTIVE
  Patients with T3 or more squamous cell esophageal cancer underwent low-dose preoperative radiotherapy with chemotherapy, to reduce local recurrence, followed by surgery. The aim was to ascertain tumor response and assess prognostic factors.
  
  
  METHODS
  Between May 2002 and June 2011, 37 consecutive patients with esophageal cancer underwent chemoradiotherapy followed by surgery. The numbers of patients in clinical stages IIA/IIIA/IIIB/IIIC were 2/24/7/4, respectively. All were given a dose of 30 Gy in 15 fractions, with concurrent chemotherapy using cisplatin and fluorouracil. Curative surgery was performed a median of 1.2 months after completion of chemoradiotherapy.
  
  
  RESULTS
  Based on the findings from surgery, 26 patients (70%) achieved a stage reduction and six patients (16%) had a complete pathological response. The numbers of patients undergoing resections microscopically complete, with microscopically positive margins, and macroscopically positive margins were 33, 3, and 1, respectively. During a median follow-up period of 22.5 months, the two-year progression-free survival and overall survival were 62.1% [95% confidence interval (CI)=45.8 to 78.4%] and 71.9% [95% CI=55.1 to 88.7%], respectively. Statistically significant prognostic factors for overall survival were age [hazard ratio=6.6; 95% CI=1.1 to 38; p=0.04] and pathological T factor [hazard ratio=10.2; 95% CI=1.4 to 77; p=0.02]. No patients died as a result of surgery.
  
  
  CONCLUSIONS
  Seventy percent of patients with esophageal cancer who received radiotherapy dose of 30 Gy in 15 fractions combined with chemotherapy achieved a stage reduction with low toxicity.
authors.affiliation: Department of Radiology, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku, Tokyo, 160-0023, Japan. hnakayam@tokyo-med.ac.jp
authors.forename: Noriko
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Hidetsugu
authors.initials: H
authors.lastname: Nakayama
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Osaka
authors.forename: Shingo
authors.initials: S
authors.lastname: Tachibana
authors.forename: Sachika
authors.initials: S
authors.lastname: Nogi
authors.forename: Yu
authors.initials: Y
authors.lastname: Tajima
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Okubo
authors.forename: Ryuji
authors.initials: R
authors.lastname: Mikami
authors.forename: Naoto
authors.initials: N
authors.lastname: Kanesaka
authors.forename: Shinji
authors.initials: S
authors.lastname: Sugahara
authors.forename: Sumito
authors.initials: S
authors.lastname: Hoshino
authors.forename: Akihiko
authors.initials: A
authors.lastname: Tsuchida
authors.forename: Koichi
authors.initials: K
authors.lastname: Tokuuye
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011829:Radiation Dosage