ESOPHAGEAL-CARCINOMA WITH DOUBTFUL EXTIRPABILITY - VALUE OF PREOPERATIVE CHEMOTHERAPY PLUS RADIOTHERAPY

To improve resectability for bulky esophageal tumors and/or tumors evo lving close to the pharyngo-esophageal junction (PEJ), a combined preo perative chemotherapy plus radiotherapy (CT + RT) was given in 25 pati ents. There were 23 men and 2 women (mean age: 55 years); 21 had squam ous cell carcinoma and 4 had adenocarcinoma. According to TNM classifi cation based on computed tomography, the tumor was graded T3 in 20 cas es, T4 in 2, T2 in 2 and T1 in 1. The preoperative treatment included two sessions of continuous infusion of 5-fluorouracil (800 mg/m2 per d ay) and cisplatin (20 Mg/m2 per day), and combined radiotherapy (3 Gy/ day). The overall tolerance was acceptable. The tumoral mass decreased in 23 patients (92%). All the patients underwent a wide esophagectomy ; among the six patients with a tumor close to the PEJ, two required a n associated pharyngolaryngectomy. The operative mortality rate was 8% . Major non-fatal complications occurred in 52%. On histology, there w as no evidence of residual disease in seven patients (28%). The median survival was 18 months and the overall survival rate was 22.1% at 2 y ears. For the patients who had a complete histological response, the 2 -year survival rate was 35%. Our data suggest that combined CT + RT ma y improve resectability of esophageal carcinoma. Improved survival rat es seem to be appreciable in patients with a complete histologic respo nse.