A COMPARISON OF MULTIMODAL THERAPY AND SURGERY FOR ESOPHAGEAL ADENOCARCINOMA

Background Uncontrolled studies suggest that a combination of chemothe rapy and radiotherapy improves the survival of patients with esophagea l adenocarcinoma. We conducted a prospective, randomized trial compari ng surgery alone with combined chemotherapy, radiotherapy, and surgery . Methods Patients assigned to multimodal therapy received two courses of chemotherapy in weeks 1 and 6 (fluorouracil, 15 mg per kilogram of body weight daily for five days, and cisplatin, 75 mg per square mete r of body-surface area on day 7) and a course of radiotherapy (40 Gy, administered in 15 fractions over a three-week period, beginning concu rrently with the first course of chemotherapy), followed by surgery. T he patients assigned to surgery had no preoperative therapy. Results O f the 58 patients assigned to multimodal therapy and the 55 assigned t o surgery, 10 and 1, respectively, were withdrawn for protocol violati ons. At the time of surgery, 23 of 55 patients (42 percent) treated wi th preoperative multimodal therapy who could be evaluated had positive nodes or metastases, as compared with 45 of the 55 patients (82 perce nt) who underwent surgery alone (P<0.001). Thirteen of the 52 patients (25 percent) who underwent surgery after multimodal therapy had compl ete responses, as determined pathologically. The median survival of pa tients assigned to multimodal therapy was 16 months, as compared with 11 months for those assigned to surgery alone (P=0.01). At one, two, a nd three years, 52, 37, and 32 percent, respectively, of patients assi gned to multimodal therapy were alive, as compared with 44, 26, and 6 percent of those assigned to surgery, with the survival advantage favo ring multimodal therapy reaching significance at three years (P=0.01). Conclusions Multimodal treatment is superior to surgery alone for pat ients with resectable adenocarcinoma of the esophagus. (C) 1996, Massa chusetts Medical Society.