Combined chemotherapy and radiotherapy followed by surgery in the treatment of patients with squamous cell carcinoma of the esophagus - The Croix Rousse experiences

BACKGROUND, Surgery remains the treatment of choice for patients with esoph ageal squamous cell carcinoma (SCC), but survival rates have not improved o ver the past decades. The objective of this study was to evaluate the effec t of multimodal therapy on resectability, on the overall and on disease fre e survival (DFS) rates, and on the laryngeal resection rate. METHODS. Fifty-five patients (49 men and 6 women) with a mean age of 58 +/- 8 years underwent combined modality treatment for esophageal SCC. The tumo r location was in the upper one-third of the esophagus in 19 patients, the middle one-third in 22 patients, the lower one-third in 9 patients, and the upper and lower one-thirds in 5 patients. The intent of combined therapy w as curative in 87.3% of patients and palliative in 12.7% of patients. Neoad juvant treatment consisted of two courses of 5-fluorouracil and cisplatin o n Days 1-5 and Days 21-25. Radiotherapy was commenced on Day 21 and consist ed of 36 grays delivered in 12 fractions over 17 days. Surgery was performe d on Day 60. RESULTS. Full neoadjuvant treatment was possible in 67.3% of patients and w as uneventful in 56.4% of patients. The resection rate was 96.4% (complete macroscopic resection with histologic clear margins [RO], 83.6%; complete m acroscopic resection with microscopic disease at the resection margin [R1], 1.8%; and macroscopic residual disease [R2], 10.9%). The operative mortali ty rate was 0% whereas the hospital mortality was 7.3%. Twenty-three patien ts had a complete macroscopic response, 12 of whom (21.8%) had a complete h istopathologic response. The tumor stages according to the American Joint C ommittee on Cancer staging system were pT0N0 in 12 patients, Stage 0 in 8 p atients, Stage IIa in 6 patients, Stage IIb in 6 patients, Stage III in 8 p atients, and Stage IV in 13 patients. Laryngeal preservation was achieved i n 8 of 12 patients in whom total pharyngolaryngoesophagectomy initially was indicated because of tumor response and an RO resection. The overall survi val rates at 1 year, 3 years, and 5 years were 61%, 39%, and 33%, respectiv ely, and the DFS rates were 49%, 32%, and 29%, respectively. The respective survival rates for responders were 82%, 58%, and 53%, and the DFS rates we re 68%, 54%, and 48%. CONCLUSIONS, Neoadjuvant treatment is tolerated well by most patients. Comb ination therapy increases the resectability rate and facilitates laryngeal preservation Significant improvements in the actuarial survival rate and th e DFS rate were observed in the group of patients who achieved partial and complete responses. (C) 2000 American Cancer Society.