Resectable esophageal carcinoma: Local control with neoadjuvant chemotherapy and radiation therapy

PURPOSE: To evaluate the usefulness of neoadjuvant chemotherapy and radiati on therapy before esophagectomy for invasive cancer of the esophagus or gas troesophageal junction (CEI). MATERIALS AND METHODS: The authors conducted a retrospective analysis of 15 4 patients who underwent esophagectomy for invasive cancer between Septembe r 1, 1991, and December 31, 1995. The end points evaluated were overall, di sease-free, local-regional relapse-free, and systemic relapse-free survival . RESULTS: Seventy of the 154 patients received neoadjuvant combined-modality therapy (CMT) consisting of concurrent cisplatin and fluorouracil administ ration and accelerated, hyperfractionated radiation therapy. The remaining 84 patients underwent immediate esophagectomy. With a median follow-up of 3 4.7 months, the 3-year overall, disease-free, and distant metastatic relaps e-free survival rates were 38.0%, 41.9%, and 56.0%, respectively. Although neoadjuvant therapy did not appear to prevent distant metastases, there was a dramatic effect on local control. After CMT, the 5-year local control ra te was 90% compared to 64% after surgery (P <.001). Tumors in the GEJ recur red more frequently (P =.01); however, multivariate analysis showed CMT was the only independent predictor of local control. Postoperative mortality w as 15.7% after CMT versus 5.9% without CMT (P =.05). CONCLUSION: Local control of esophageal cancer is excellent following neoad juvant chemotherapy and radiation therapy. However, the effects of CMT on o verall and disease-free survival are less clear due to significant differen ces between the treatment groups.