CONCURRENT RADIATION-THERAPY AND CHEMOTHERAPY FOLLOWED BY ESOPHAGECTOMY FOR LOCALIZED ESOPHAGEAL-CARCINOMA

Purpose: A prospective study was performed to determine the outcome of patients with esophageal cancer who received preoperative radiation t herapy and chemotherapy followed by esophagectomy, and to determine th e role of preresection esophagogastroduodenoscopy (EGD) in predicting the patients in whom surgery could possibly be omitted, and the impact of surgery on survival. Materials and Methods: Thirty-five patients w ith localized carcinoma ofthe esophagus received concurrent external-b eam radiotherapy and chemotherapy followed by esophagectomy. Patients received 45 Gy in 25 fractions. Chemotherapy consisted of continuous i nfusion fluorouracil (5-FU; 1,000 mg/m(2)/d) on days 1 through 4 and 2 9 through 32 and cisplatin (100 mg/m(2)) on day 1, patients underwent an Ivor-Lewis esophagectomy 18 to 33 days after completion of radiothe rapy. Results: Eighty percent of the patients had squamous cell carcin oma and 20% had adenocarcinoma. In addition, 51% had a pathologic comp lete response (CR). Twenty-two of the 35 underwent a preresection EGD before resection, Seventeen of the 22 (77%) had negative pathology fro m the preresection EGD, but seven of the 17 (41%) had residual tumor a t surgery. The median survival and disease-free survival rates for all patients were 25.8 months and 32.8 months, respectively. Eighteen pat ients (51%) held no tumor at resection, The median survival for these patients was 36.8 months; the median disease-free survival time has no t been reached, The median survival and disease-free survival rate for the patients with residual tumor in the surgical specimen were 12.9 m onths and 10.8 months, respectively. Conclusion: Preresection EGD is n ot reliable for de termining the presence of residual disease or the p atients in whom surgery could be omitted. Twenty-five percent of the p atients with residual tumor in the resected surgical specimen were lon g-term survivors; this suggests a benefit from esophagectomy after con current radiotherapy and chemotherapy. (C) 1996 by American Society of Clinical Oncology.