title: Multimodal approach for cervical esophageal carcinoma: role of neoadjuvant chemotherapy.
abstract: OBJECTIVE
  To examine the outcome of patients with cervical esophageal cancer treated by a multimodal protocol.
  
  
  METHODS
  We retrospectively analyzed the outcome and prognostic factors for 20 patients with cervical esophageal cancer who received multimodal treatment at the Kurume University Hospital between 2003 and 2009. One case of stage I, seven of stage II and 12 of stage III disease (2 T1, 3 T2, 4 T3, 11 T4 and 14 N1) were included. Radiotherapy was administered at a median dose of 60 Gy (range=30-70 Gy). The median follow-up time was 32 months for surviving patients (14-94 months). Platinum-based neoadjuvant chemotherapy (NAC) was performed in 14 cases and all received chemoradiotherapy.
  
  
  RESULTS
  median survival was 20 months and overall survival rates at 1, 2, and 5-years were 70%, 60% and 30%, respectively. T-Category, length of the primary lesion, N-category, stage, hemoglobin levels and response to induction chemotherapy were statistically significant predisposing factors for overall survival rate. According to NAC response, 10 good responders (complete response or partial response) showed 2-year survival rates of 80% (5 survivors), whereas that for poor responder (stable disease and progressive disease) was 0% (p=0.006), respectively. Response to NAC was the only statistically significant predisposing factor for increased progression-free survival (p=0.03). Severe acute toxicities of grade 3 or more appeared in 5 patients; two grade 5 (esophageal perforations and lung fistula), one grade 4 (bilateral recurrent nerve palsy), and two grade three (pneumonitis and mucositis).
  
  
  CONCLUSIONS
  Although severe prognosis was identified for cervical esophageal cancer, good response to NAC indicates a good prognosis with organ preservation even for those with T4 tumor.
authors.affiliation: Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Kyoto 602-8566 Japan. hideya10@hotmail.com.
authors.forename: Gen
authors.initials: G
authors.lastname: Suzuki
authors.forename: Hideya
authors.initials: H
authors.lastname: Yamazaki
authors.forename: Etsuyo
authors.initials: E
authors.lastname: Ogo
authors.forename: Toshi
authors.initials: T
authors.lastname: Abe
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Eto
authors.forename: Koichiro
authors.initials: K
authors.lastname: Muraki
authors.forename: Chikayuki
authors.initials: C
authors.lastname: Hattori
authors.forename: Hirohito
authors.initials: H
authors.lastname: Umeno
authors.forename: Tadashi
authors.initials: T
authors.lastname: Nakashima
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Tanaka
authors.forename: Satoaki
authors.initials: S
authors.lastname: Nakamura
authors.forename: Ken
authors.initials: K
authors.lastname: Yoshida
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011379:Prognosis; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Cervical esophageal cancer; chemoradiotherapy; larynx preservation; neoadjuvant chemotherapy