A RANDOMIZED STUDY OF CHEMOTHERAPY, RADIATION-THERAPY, AND SURGERY VERSUS SURGERY FOR LOCALIZED SQUAMOUS-CELL CARCINOMA OF THE ESOPHAGUS

Background. Despite well-established surgical approaches, the prognosi s for patients with squamous cell carcinoma of the esophagus remains d ismal. To assess the benefit of adjuvant chemotherapy and radiation th erapy (CRT), a randomized trial with and without sequential preoperati ve CRT was undertaken; CRT combined 20 Gy and two courses of 5-FU and cisplatin. Methods. Patients were included on the basis of the followi ng criteria: squamous cell carcinoma of the esophagus, younger than 70 years of age, World Health Organization status below 2, estimated sur vival time greater than 3 months, and no previous treatment for the ca ncer. Patients were not included if they had experienced a loss in bod y weight greater than 15% or had tracheoesophageal fistula, metastases , or uncontrollable infection. Results. Eighty-six patients thus fulfi lled the criteria for inclusion (41 CRT, 45 non-CRT). The groups were well-matched for age, sex, tumor location, size, and grade. Operative mortality was 8.5% and 7%, respectively, for each group with a 27-day hospital stay for both groups. Long-term survival was not significantl y different, with 47% of both groups alive at 1 year. Conclusions. The authors concluded that this neoadjuvant treatment did not change oper ative mortality or survival time for patients with squamous cell carci noma of the esophagus.