IMPROVED SURVIVAL WITH NEOADJUVANT THERAPY AND RESECTION FOR ADENOCARCINOMA OF THE ESOPHAGUS

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.