Prospective evaluation of preoperative chemotherapy in resectable squamouscell carcinoma of the thoracic esophagus

A prospective study was performed to clarify the surgical outcome of patien ts with esophageal carcinoma who would benefit from induction chemotherapy followed by surgery. Of 55 eligible patients, 42 (76.3%) agreed to randomiz ation with either chemotherapy followed by surgery (n=21) or surgery alone (n=21). The other 13 refused. The chemotherapy consisted of cisplatin, 5-fl uorouracil and leucovorin. All 55 patients underwent esophagectomy with two - or three-field resection, including two (3.6%) hospital mortalities. Of t he 21 patients receiving chemotherapy, the response rate was 33.3% after th e first course and 60% after the second course. A complete response was not obtained. Responders to the first course showed a prolonged survival, howe ver time to treatment failure did not differ between patients treated with chemotherapy followed by surgery or surgery alone. This chemotherapy offere d a worse surgical outcome for patients with pretreatment diagnosis of T3. Multivariate analysis identified a partial response to the first course of chemotherapy to be a favorable prognostic indicator. Preoperative chemother apy does not give a survival benefit over surgery alone for patients with a dvanced tumor (T3). Initial response to the first dose of chemotherapy is d eemed to be a prognostic factor for patients with less advanced tumor (T1/T 2).