ADENOCARCINOMA OF THE ESOPHAGUS AND GASTROESOPHAGEAL JUNCTION - CLINICAL AND PATHOLOGICAL ASSESSMENT OF RESPONSE TO INDUCTION CHEMOTHERAPY

A preoperative induction chemotherapy regimen consisting of two monthl y courses of etoposide, doxorubicin, and cisplatin was given to 13 pat ients with nonmetastatic adenocarcinoma of the distal esophagus or gas troesophageal junction. Esophageal ultrasound examination was performe d both before chemotherapy and again before surgery. Induction chemoth erapy was poorly tolerated with 10 of the 13 patients experiencing at least one episode of severe neutropenia. Two of the 13 patients refuse d the second course of treatment. A symptomatic response to chemothera py, defined as a reduction in the presenting symptom, was noted in 10 of the 13 patients (77%). Endoscopic improvement occurred in 9 of the 13 patients (69%). Esophageal ultrasound evidence of a reduction in ei ther T or N stage was noted in only 2 of the 13 patients (15%), howeve r, and neither of these responses was confirmed pathologically. Clinic al evidence of disease progression was noted in 4 patients during chem otherapy. With a median follow-up of 31 months, the relapse-free and o verall survivals are 25% and 31%, respectively. Despite significant to xicity, our chemotherapy regimen would be considered successful if ass essed by symptomatic or esophagoscopic improvement. Esophageal ultraso und, careful pathologic staging, and our disappointing survival rates, however, suggest limited, if any, value for this approach.