Role of preoperative chemoradiation in the management of upper third thoracic esophageal squamous cell carcinoma

BACKGROUND: The treatment of upper thoracic esophageal cancer remains chall enging, and combined treatment is necessary to improve the outcome. We cond ucted preoperative chemoradiation therapy (CRT) for potential T4 tumors loc ated in the upper third esophagus and carried out a retrospective study to elucidate the role of preoperative CRT. METHODS: Surgical resection was performed on 64 patients with upper thoraci c esophageal cancer. Thirty-seven of these patients underwent primary resec tion, while 27 underwent preoperative CRT and surgery. The regimen of chemo therapy consisted of daily tegaful or 5-fluorouracil plus cisplatin. Concur rent radiation therapy of 4,000 cGy was conducted over 4 weeks. RESULTS: There were no differences in either tumor depth and nodal involvem ent or the surgical morbidity and mortality between the two groups. Seven o f 27 patients downstaged to a complete pathologic response, and 13 patients showed a partial response. The 5-year survival rates were 42% in the preop erative CRT group and 27% in the surgery group, and these were not signific antly different. In all patients, the depth of tumor influenced the prognos is significantly, while operative curability, nodal involvement, or the num ber of metastatic nodes showed a tendency to influence the prognosis. CONCLUSIONS: Preoperative CRT contributed to downstaging of the tumors and did not increase the operative mortality. Preoperative CRT was useful in th e management of upper thoracic esophageal cancer, especially in advanced ca ses. (C) 1999 by Excerpta Medica, Inc.