PREOPERATIVE SEQUENTIAL CHEMOTHERAPY AND RADIOCHEMOTHERAPY IN LOCALLYADVANCED CARCINOMAS OF THE LOWER ESOPHAGUS AND GASTROESOPHAGEAL JUNCTION

The purpose of this trial was to examine the feasibility of intensive, sequential chemo-and radiochemotherapy followed by surgery in patient s with locally advanced carcinomas of the lower oesophagus and the gas tro-oesophageal junction (GO junction). The chemotherapy consisted of two courses of 6 weekly administrations of 5-fluorouracil (5-FU) (2.0 g/m(2), 24h infusion) and folinic acid (FA) (500 mg/m(2), 2 h infusion ) combined with twice weekly cisplatin (50 mg/m(2), 1 h infusion). Irr adiation of 30 Gy was given concurrently with one course of cisplatin and etoposide. 25 patients with locally advanced (T3-T4 NX MO) squamou s cell or adenocarcinoma of the lower oesophagus and GO junction were included and evaluated. Toxicity was usually mild to moderate (WHO gra de 1 and 2) with mucositis as the most important side-effect of the pr e-operative treatment. Of the patients, 94 and 88% completed the chemo -and radiochemotherapy according to the protocol, respectively. A majo r response (=partial remission with subjective improvement) to chemoth erapy was achieved in 6/10 patients with squamous cell carcinoma and 1 0/15 with adenocarcinoma. 19 patients had subsequent surgery and compl ete resection was achieved in 16 (3 patients had intra-abdominal metas tases observed at laparotomy). The operative mortality rate was 16% (3 /19). 10 of the 16 patients with tumour resection had a pathological c omplete response. 15 patients (43%) remain alive at a median follow-up of 20 months and the median survival exceeds 16+ months. Our data sug gest that this intensive pre-operative chemoradiotherapy programme is feasible and remarkably effective in patients with locally advanced ca rcinomas of the lower oesophagus or GO junction. (C) 1998 Elsevier Sci ence Ltd. All rights reserved.