PROLONGED SURVIVAL FOLLOWS RESECTION OF ESOPHAGEAL SCC DOWNSTAGED BY PRIOR CHEMORADIOTHERAPY

Background: The poor survival rate of surgically treated patients with oesophageal cancer has not improved substantially over the last 25 ye ars, but combined modality therapy has shown early promising results. Methods: A prospective study was undertaken to determine the effect of pre-operative synchronous chemoradiotherapy followed by oesophagectom y in 53 patients with squamous cell carcinoma (SCC) of the oesophagus. The patient group was unselected, other than by fitness for surgery. Results: In 25% of patients, complete pathological regression of the t umour was achieved. All but one of the patients in this subgroup had T 2 rumours on pre-operative clinical staging and two had evidence of ly mph node involvement, but postoperative pathological examination revea led that pre-operative chemoradiotherapy had downstaged their disease to T0N0. There was no hospital mortality in this subgroup and the actu arial 7 year survival was 69%. Conclusions: For squamous oesophageal r umours deep to the submucosa this is an extremely good survival. For t he present, this form of therapy for SCC of the oesophagus appears cap able of achieving results comparable to, or better than, those reporte d for 3-field lymphadenectomy.