Jr. Stewart et al., IMPROVED SURVIVAL WITH NEOADJUVANT THERAPY AND RESECTION FOR ADENOCARCINOMA OF THE ESOPHAGUS, Annals of surgery, 218(4), 1993, pp. 571-578
Objective This study sought to determine the impact of preoperative ch
emotherapy and radiation therapy (neoadjuvant therapy) followed by res
ection in patients with adenocarcinoma of the esophagus. Summary Backg
round Data Long-term survival in patients with carcinoma of the esopha
gus has. been poor. An increase in the incidence of adenocarcinoma of
the esophagus has been reported recently. Methods Fifty-eight patients
with biopsy-proven adenocarcinoma of the esophagus treated at this in
stitution from January 1951 through February 1993 were studied. Since
1989, 24 patients were entered prospectively into a multimodality trea
tment protocol consisting of preoperative cisplatin, 5-fluorouracil (5
-FU), and leucovorin with or without etoposide, and concomitant medias
tinal radiation (30 Gy). Patients were re-evaluated and offered resect
ion. Results There were no deaths related to neoadjuvant therapy and t
oxicity was minimal. Before multimodality therapy was used, the operat
ive mortality rate was 19% (3 of 16 patients). With multimodality ther
apy, there have been no operative deaths (0 of 23 patients). The media
n survival time in patients treated before multimodality therapy was 8
months and has yet to be reached for those treated with the neoadjuva
nt regimen (> 26 months, p < 0.0001). The actuarial survival rate at 2
4 months was 15% before multimodality therapy and 76% with multimodali
ty therapy. No difference in survival was noted in neoadjuvant protoco
ls with or without etoposide (p = 0.827). Conclusions Multimodality th
erapy with preoperative chemotherapy and radiation therapy followed by
resection appears to offer a survival advantage to patients with aden
ocarcinoma of the esophagus.