PREOPERATIVE CONCOMITANT RADIOCHEMOTHERAPY IN SQUAMOUS-CELL CARCINOMAOF THE ESOPHAGUS - RESULTS OF A STUDY OF 56 PATIENTS

Purpose: Today the prognosis for patients with esophageal carcinoma st ill remains quite poor. In the last few years interesting results have been obtained by associating radio- and chemotherapy with or without surgery with this type of cancer. In this work we report the results o f concomitant radio- and chemotherapy in a split-course schedule prece eding surgery for the treatment of squamous cell carcinomas of the eso phagus. Methods and Materials: Fifty-six patients with squamous cell c arcinomas of the esophagus were treated between April 1989 and Septemb er 1993 in the Centre Hospitalier Universitaire in Brest, France with two courses of preoperative concomitant radiochemotherapy, separated b y a 2-week interval, and followed by surgery (each course 18.5 Gy in f ive fractions, days 1-5 with continuous infusion 5-fluorouracil (5-FU) 800 mg/m(2) days 1-5 and cisplatinum 70 mg/m(2) day 2). Patients who had responded well to preoperative treatment (response > 50%) received four more courses of chemotherapy alone, The two patients who were no t operated and those with palliative surgery received a third course o f radiochemotherapy (radiotherapy 12 Gy in five fractions, days 1-5). Results: Fifty-four patients were operated on, Twenty-one showed histo logical complete response at surgery (37.5% of the whole group). Actua rial survival for the 56 patients was 55% at 3 years and 30% at 4 year s, with a median survival of 37.4 months (40.4 months for complete res ponders to preoperative treatment). Toxicity of preoperative concomita nt radio-chemotherapy was low (5-FU had to be stopped in one patient b ecause of cardiac rythm disturbances and in another patient because of aplasia Grade 4 associated with infection after the first course). Po stoperative mortality was 11% (six patients). Conclusion: This combina tion of preoperative radiochemotherapy followed by surgery seems to im prove both response rates and survival in patients with esophageal can cer when compared with previous patients treated with surgery alone in our hospital or with results found in literature and it warrants furt her studies.