title: Clinical and oncological effects of triplet chemotherapy followed by radical esophagectomy for resectable esophageal cancer associated with unfavorable prognostic factors.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the hypothesis that the survival of patients undergoing R0 resection after triplet chemotherapy for resectable esophageal cancer with unfavorable prognostic factors (Category 3) would be similar to that of patients undergoing esophagectomy for esophageal cancer without such factors (Category 1).
  
  
  METHODS
  Patients with Category 3 tumors were assigned to receive triplet chemotherapy consisting of 5-fluorouracil, doxorubicin and nedaplatin (FAN) followed by radical esophagectomy. The outcomes of the bimodality treatment for Category 3 patients (n = 25) were compared with those of Category 1 patients (n = 41) in a prospective cohort study.
  
  
  RESULTS
  Grade 3 or higher toxicity developed during chemotherapy in 32 % of the Category 3 patients, with no treatment-related deaths. No significant difference was detected in the surgery-related mortality and morbidity rates between the two groups. The recurrence-free survival was significantly worse in Category 3 than in Category 1 patients (p = 0.002), although the overall survival was not significantly different (p = 0.085) between the two groups in cases of R0 resection (5-year survival rates: 34.4 vs. 66.5 %).
  
  
  CONCLUSIONS
  Although FAN chemotherapy followed by radical esophagectomy can be safely performed, this treatment modality may not have sufficient power to cure Category 3 disease.
authors: Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan, hshimoji@med.u-ryukyu.ac.jp.
authors: Hideaki
authors: H
authors: Shimoji
authors: Tatsuya
authors: T
authors: Kinjo
authors: Hiroyuki
authors: H
authors: Karimata
authors: Masayoshi
authors: M
authors: Nagahama
authors: Tadashi
authors: T
authors: Nishimaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D004317:Doxorubicin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate
chemical_list: D009944:Organoplatinum Compounds; D004317:Doxorubicin; C053989:nedaplatin; D005472:Fluorouracil
references: Cancer. 1994 Jul 1;74(1):4-11
references: 8004581
references: Ann Surg. 2010 Jan;251(1):46-50
references: 20032718
references: J Surg Oncol. 2012 Sep 15;106(4):441-7
references: 22371189
references: World J Surg. 1996 Jan;20(1):32-7
references: 8588409
references: Scand J Gastroenterol. 2005 Aug;40(8):886-92
references: 16170897
references: Ann Surg. 2008 Dec;248(6):979-85
references: 19092342
references: Ann Surg Oncol. 2012 Jan;19(1):68-74
references: 21879261
references: Cancer. 2001 Jun 1;91(11):2165-74
references: 11391598
references: Br J Surg. 2009 Nov;96(11):1300-7
references: 19847875
references: N Engl J Med. 1998 Dec 31;339(27):1979-84
references: 9869669
references: J Thorac Cardiovasc Surg. 1997 Aug;114(2):210-7
references: 9270638
references: Lancet Oncol. 2011 Jul;12(7):681-92
references: 21684205
references: J Am Coll Surg. 1998 Mar;186(3):306-12
references: 9510261
references: Ann Thorac Surg. 1999 Dec;68(6):2059-64
references: 10616977
references: Surg Today. 2012 Aug;42(8):734-40
references: 22278622
references: Ann Thorac Cardiovasc Surg. 2004 Dec;10(6):324-32
references: 15658903
references: Surgery. 2000 Jan;127(1):40-6
references: 10660757
references: N Engl J Med. 2006 Feb 9;354(6):567-78
references: 16467544