FEASIBILITY OF 5 COURSES OF PREOPERATIVE CHEMOTHERAPY IN PATIENTS WITH RESECTABLE ADENOCARCINOMA OF THE ESOPHAGUS OR GASTROESOPHAGEAL JUNCTION

The purpose of this study was to examine the feasibility of administer ing all chemotherapy pre-operatively to patients with resectable adeno carcinoma of the oesophagus or gastrooesophageal junction. 32 patients with potentially resectable adenocarcinoma of the oesophagus or gastr ooesophageal junction were studied in a stepwise fashion in which comb ination chemotherapy with cisplatin, high-dose arabinoside and 5-fluor ouracil was administered. In the first part, 15 patients were to recei ve three chemotherapy courses pre-operatively and two chemotherapy cou rses postoperatively. In the second part, the next 15 patients were to receive all five chemotherapy courses pre-operatively, provided there was an objective response after three courses. Endoscopic ultrasonogr aphy was also performed, when feasible, prior to chemotherapy and surg ery, and in some patients sequentially between chemotherapy courses. A ll of the 14 assessable patients in the first group tolerated all thre e courses of pre-operative chemotherapy, and 86% of patients in this g roup completed all protocol chemotherapy. In the second group, 9 of 18 (50%) assessable patients tolerated all five courses of preoperative chemotherapy, and 100% of patients in this group received all protocol chemotherapy. The median number of chemotherapy courses for the entir e group (32 patients) was five (range one to five). Forty-one per cent (13/32) of patients had a major response to chemotherapy. Sixty-nine per cent (or 76% of 29 patients taken to surgery) had a curative resec tion. One patient had a pathological complete response. The median sur vival time of 32 patients was 17 months (range 2-36+ months). 14 patie nts (37%) remain alive at a median follow-up time of 26+ months. There was a correlation between endoscopic ultrasonographic tumour and noda l stage and pathological tumour and nodal stages in 16 patients. The t umour stage correlation was higher (75%) than the nodal stage correlat ion (62%). Our data suggest that it is feasible to administer five cou rses of cisplatin-based chemotherapy to patients with potentially rese ctable adenocarcinoma of the oesophagus or gastrooesophageal junction. More effective chemotherapy regimens that might result in higher path ological complete response rates and acceptable toxic effects are need ed.