PRELIMINARY-RESULTS WITH NEOADJUVANT THERAPY AND RESECTION FOR ESOPHAGEAL-CARCINOMA

Between December 1988 and August 1992, 68 patients with adenocarcinoma (n = 39) and squamous carcinoma (n = 29) of the esophagus were entere d prospectively in a treatment protocol to receive two cycles of cispl atin, 5-fluorouracil, etoposide, leucovorin, and 3,000 cGy of radiatio n to the involved esophagus and adjacent mediastinum, followed by rese ction. There were four deaths during chemotherapy, and 7 patients had a decline in condition or were denied operation. Fifty-six patients ha ve come to operation, and 1 awaits resection. Twenty-two patients had transhiatal esophagectomy and 29 patients had esophagogastrostomy with a combined abdominal and right thoracic approach. Five patients did n ot undergo resection at operation. There was one hospital death (2%). A complete response to preoperative therapy was seen in 12 patients (2 1%): 5 of 20 with squamous cancer (25%) and 7 of 36 with adenocarcinom a (19%). Average follow-up is 19 months. Median survival in these pati ents after entrance in the protocol is 24 months. Actuarial survival a t 12, 18, and 24 months is 72% (confidence limits, 66% and 78%), 53% ( confidence limits, 46% and 60%), and 51% (confidence limits, 44% and 5 8%). Significantly better survival was associated with adenocarcinoma (p = 0.041). There is no survival advantage based on complete response to preoperative therapy. This neoadjuvant regimen is effective in pat ients with squamous carcinoma and adenocarcinoma. These preliminary re sults demonstrate an improved median and actuarial survival compared w ith historical controls in 137 patients operated on between 1966 and 1 985 at our institution.