PREOPERATIVE CHEMOTHERAPY FOLLOWED BY ESOPHAGECTOMY COMPARED WITH SURGERY ALONE IN THE TREATMENT OF SQUAMOUS-CELL CARCINOMA OF THE ESOPHAGUS

The aim of this study is to assess the effect of concomitant preoperat ive radio-chemotherapy in the treatment of epidermoid esophageal cance r. We studied a total of 45 patients, divided into two groups. Group I consisted of 20 patients diagnosed with epidermoid esophageal cancer who had been treated initially with esophagectomy. Group II consisted of 25 patients treated with preoperative radiotherapy and two cycles o f chemotherapy (cisplatin and 5-fluorouracil), one at the beginning an d the other at the end of the radiation treatment, on whom an esophage ctomy was subsequently performed. The clinical characteristics were si milar in both groups. In group II, there were 12 cases (48%) with abse nce of tumor in the esophageal wall, three of which had node involveme nt. The operative mortality was similar in both groups (10% and 8% res pectively). The only significant difference found in the postoperative complications was the incidence of anastomotic leak; but this was rel ated to the different esophagectomy techniques used rather than the ty pe of therapy. A decrease in the number of patients with tumor recurre nce was observed in Group II, especially where the local component was concerned. The best actuarial survival rate at five years was in pati ents with no presence of tumor after neoadjuvant treatment (44.4%). Ho wever, the radio-chemotherapy seems not to have had any benefit in cas es with node involvement.