title: The usefulness of neoadjuvant chemoradiation therapy for locally advanced esophageal cancer with multiple lymph-node metastases.
abstract: BACKGROUND
  The prognosis of patients with esophageal squamous-cell cancer (ESCC) and multiple lymph-node metastases is quite poor. We examined whether neoadjuvant chemoradiation therapy (CRT) has a beneficial effect in such patients.
  
  
  METHODS
  A total of 50 consecutive patients with T3-4 tumors and without organ metastases were prospectively enrolled. Of those patients, 20, who had four or more nodal metastases, underwent neoadjuvant CRT (CRT group), and the remaining 30 patients, who had three or fewer nodal metastases, underwent surgery alone (surgery group). CRT consisted of 5-fluorouracil plus cisplatin and 40 Gy of radiation. The groups' clinical outcomes were compared.
  
  
  RESULTS
  Surgery was performed in 48 patients: all enrolled patients except for 2 who had organ metastasis after CRT. In the CRT group, the number of patients with pathological complete response was observed in 8 patients (44 %), mean nodal metastases number was changed from 8.2 to 2.6 and 9 patients had pN0. The 3-year survival rate was 76 % in the CRT group (4 patients relapsed) and 68 % in the surgery group (8 patients relapsed), which is not a statistically significant difference (P = 0.61).
  
  
  CONCLUSIONS
  Neoadjuvant CRT is beneficial for locally advanced ESCC with four or more lymph-node metastases.
authors.affiliation: Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical Sciences, Kagoshima University, Kagoshima, Japan, hokumura@m.kufm.kagoshima-u.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okumura
authors.forename: Yasuto
authors.initials: Y
authors.lastname: Uchikado
authors.forename: Itaru
authors.initials: I
authors.lastname: Omoto
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kita
authors.forename: Ken
authors.initials: K
authors.lastname: Sasaki
authors.forename: Takaaki
authors.initials: T
authors.lastname: Arigami
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Uenosono
authors.forename: Daisuke
authors.initials: D
authors.lastname: Matsushita
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Hiraki
authors.forename: Tetsuhiro
authors.initials: T
authors.lastname: Owaki
authors.forename: Sumiya
authors.initials: S
authors.lastname: Ishigami
authors.forename: Shoji
authors.initials: S
authors.lastname: Natsugoe
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate
chemical_list: D002945:Cisplatin; D005472:Fluorouracil