NEOADJUVANT CHEMOTHERAPY WITH ETOPOSIDE, LEUCOVORIN, 5-FLUOROURACIL AND CISPLATIN FOR ADVANCED ESOPHAGEAL SQUAMOUS-CELL CARCINOMA

Eighteen patients with invasive periadventitial tissue (T4) or distant lymph node metastatic (M1,LYM) squamous cell carcinoma were entered i nto a pilot study of neoadjuvant chemotherapy with etoposide (50 mg/m( 2)/day, days 1-5), leucovorin (30 mg/body/day, days 2-5), 5-fluorourac il (5-FU; 400 mg/m(2)/day, days 2-5) and cisplatin (100 mg/m(2)/day, d ay 1) (ELFP). The overall response rate was 56%. The response rates in the T4 tumor and M1,LYM patients were 56 and 50%, respectively. Radic al esophagectomies were performed on six of 17 patients who had comple tely recovered from the chemotherapy, a resectability of 35%. Histolog ically, the primary tumor was moderately to slightly effective, and th e lymph nodes markedly to moderately effective. Histologic responses i n the lymph nodes were different from those in the primary tumors and in each node. There were four chemo-surgically related deaths. Median survival times in responding and non-responding patients were nine and three months, respectively. In conclusion, neoadjuvant chemotherapy w ith ELFP appears to be effective against esophageal squamous cell canc er with periadventitial tissue invasion or distant lymph node metastas is. Chemo-surgically related deaths were however, 22%, showing neoadju vant chemotherapy to necessitate extremely careful attention to the me dical and surgical management of patients.