Neoadjuvant chemotherapy before surgery for resectable carcinoma of the lower esophagus

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.