Induction chemo-radiotherapy for squamous cell carcinoma of the thoracic esophagus: Long-term results of a phase II study

Background: This study was done to evaluate the results of the combined use of chemo- and radiotherapy before surgery in a group of patients with squa mous cell esophageal carcinoma after a median follow-up period of more than 5 years, Methods: Between June 1987 and January 1995, 111 patients with squamous cel l carcinoma of the thoracic esophagus were submitted to a preoperative cour se of radiotherapy (3000 cGy) and chemotherapy (cisplatin and 5-FU) before surgery in the First Division of General Surgery at the University of Veron a. Results: The neoadjuvant treatment was completed in 90.9% of the cases (101 /111). After an average of 29 days, 87 patients underwent surgery (operabil ity rate: 78.3%) and, of these, 80 underwent esophagectomy (resectability r ate: 91.9%). Histopathologic studies showed no residual disease in the spec imen (T0) in 17 cases (21.2%), only microscopic clusters of neoplastic cell s within the esophageal wall (Minimal Residual Disease, MRD) in 14 cases (1 7.5%) and in 5 cases the tumor did not extend beyond the submucosal layer ( T1). The median overall survival time of the 111 patients who were eligible for the study protocol was 14 months, and the 2- and 5-year survival rates were 32.0% and 17.5%, respectively. Kaplan-Meier determination of survival showed a statistically significant difference between the good responders (T0, T1, and MRD) to the neoadjuvant treatment and the remaining cases. The 2- and 5-year survival rates were 50.3% and 34.9%, respectively, in the go od responder group compared with 26.7% and 10.7%, respectively, in the othe r cases, with a median survival time of 24 months vs. 13 months, respective ly. Conclusions: The neoadjuvant treatment showed promising results, especially in the group of patients that had a good response. The identification of t hese patients may be the key to selecting which patients should be submitte d to preoperative radio- and chemotherapy.