INDUCTION THERAPY FOR FOCALLY ADVANCED ES OPHAGEAL CANCER - PROGNOSTIC-SIGNIFICANCE OF THE HISTOPATHOLOGICAL RESPONSE

Objective: The purpose of this study was to determine the prognostic s ignificance of the histopathological response to preoperative radio-ch emotherapy in patients with locally advanced oesophageal cancer. Metho ds: Among the 57 patients included in this open prospective study, the disease-free survival of 48 patients (8 females, 40 males; mean age: 56.6 years +/- 8.4) who underwent an oesophagectomy after induction th erapy for oesophageal squamous cell (n = 38) or adenocarcinoma (n = 10 ) was correlated with the histopathological findings. Chemoradiation i ncluded 2 cycles associating continuous 5 FU from D1 to 5 and from D22 to 26, cisplatyl on D1 and D22, 15 Gy/5d from D1 to 5 and from D22 to 26. Histopathological response was assessed on the operative specimen s by routine examination of serial thin sections each 5 mm along the f ull oesophageal length, the resection margins and the lymph node disse ction. Results: A wide interindividual variability was seen regarding tissue changes related to induction therapy, with a grading in tumor r egression and the possibility of dissociated effects on the various tr eatment targets: tumor, adenopathy and vessel invasion. The 5-year pro bability of disease-free survival was 22% for the 48 resected patients . The presence of a complete histopathological response (n = 12) did n ot preclude metastatic spread in half the: cases. Furthermore, it did not result in improved survival when compared to that of nonresponder patients. Survival of patients who had a complete or major oesophageal response (n = 29, 35% at 5 years) was significantly lower than that o f patients who were operated on during the same period for a superfici al oesophageal cancer at presentation (n = 29, 57% at 5 years; P = 0.0 3). After multivariate analysis according to the Cox model, downstagin g of the primary tumor was not identified as an independent predictor of disease-free survival. Conclusions: Pathologic assessment of tumor regression on the operative specimen provides little prognostic inform ation.