Neoadjuvant chemotherapy before surgery has been proposed to improve the ou
tcome in patients with early lon er esophageal cancer. To evaluate its effe
ctiveness, we performed a systematic retrospective analysis of consecutive
patients treated at the Ottawa Regional Cancer Center with prospective incl
usion criteria. Between 1988 and 1992 patients were treated with surgery al
one. From 1992 until 1997, patients were uniformly treated with neoadjuvant
chemotherapy consisting of cisplatin and 5-fluorouracil. Surgical resectio
n was then performed. Nineteen patients received neoadjuvant chemotherapy a
nd 15 received surgery alone. Although the two arms of the study were balan
ced for age and ses, there were more patients in the neoadjuvant arm with s
quamous histology, weight loss and regional nodes at diagnosis. In the neoa
djuvant arm, two patients did not hale surgery because of progression or to
xicity. However, complete resection rates were similar. There was no differ
ence in overall survival or disease-free survival between the two arms(p >
0.4), Multivariate analysis revealed that only the nodal status at diagnosi
s was predictive of outcome. Neoadjuvant chemotherapy with this regimen doe
s not result in improved survival ol-er surgery alone.