COMBINED PREOPERATIVE CHEMOTHERAPY AND RADIOTHERAPY IN PATIENTS WITH LOCALLY ADVANCED ESOPHAGEAL CANCER - INTERIM ANALYSIS OF A PHASE-II TRIAL

Purpose: The prognosis of patients with locally advanced esophageal ca ncer (LAEC) remains poor when treated with local modalities. An intens ive preoperative program with chemoradiotherapy was used to evaluate t he curative resection rate, pathologic response, and survival of patie nts with LAEC. Patients and Methods: Ninety patients with LAEC were tr eated preoperatively with chemotherapy (three courses of fluorouracil, leucovorin, etoposide, and cisplatin [FLEP]) followed by concurrent c hemoradiotherapy (one course of cisplatin plus etoposide in combinatio n with 40 Gy of radiation). Transthoracic esophagectomy was performed 4 weeks after the end of radiation, Results: Seventy-two patients were included in this evaluation. Forty-four (61%) underwent a complete tu mor resection, and 16 (22%) had no tumor in the resected specimen (pat hologic complete response [PCR]), The operative mortality rate was 15% . At a median follow-vp time of 22 months (range, 12 to 41), the media n survival duration of all 72 patients was 17 months (range, 1 to 41 ). The calculated survival rates at 3 years were 33%, 42%, and 68% for all patients, patients after complete resection, and patients with PC R, respectively. Conclusion: This combined treatment modality is activ e in LAEC, with a PCR in 33% of the patients undergoing surgery. The r esults appear improved compared with those reported with surgery alone , by approximately doubling the 3-year survival rate. The high efficac y of preoperative chemoradiation warrants evaluation of the role of su rgery in LAEC.