ENDOSCOPICALLY DEFINED TREATMENT STRATEGIES IN PATIENTS WITH LOCALLY ADVANCED ESOPHAGEAL CANCER

Sixty-five consecutive, locally advanced esophageal cancer patients we re treated by the West Side Medical Center Esophageal Service at the C ook County and University of Illinois hospitals. Each patient was pros pectively evaluated with multiple endoscopies including esophagogastro duodenoscopy, bronchoscopy, nasopharyngoscopy, and laryngoscopy. Twent y-four patients (37%) had endoscopic findings that significantly alter ed therapeutic regimens. Patients identified as having an obvious or i mpending esophageal fistula or poor performance status were treated in a palliative fashion. Forty (61.5%) patients were considered candidat es for treatment with multimodal therapy which included radiation, che motherapy, and surgery. There was a response rate of 82.5% and a 1-yea r disease-free survival of 88.9% which was statistically significant w hen compared to the other patient treatment groups. These data illustr ate the necessity of multiple endoscopic evaluation of locally advance d esophageal cancer patients for stratification into appropriate treat ment groups. Aggressive treatment afforded selected patients excellent relief of presenting symptomatology, as well as an improved, more acc eptable, disease-free survival.