INDUCTION CHEMORADIOTHERAPY FOLLOWED BY ESOPHAGECTOMY IN PATIENTS WITH CARCINOMA OF THE ESOPHAGUS

Background. Induction chemoradiotherapy followed by esophagectomy may provide results superior to those of single-modality treatment in pati ents with esophageal cancer. The purpose of this study was to review o ur experience with this approach for esophageal cancer. Methods. From 1988 to 1996, 166 consecutive patients with esophageal cancer were eva luated; 66 entered a protocol of chemotherapy (5-fluorouracil, cisplat in) concurrent with radiation (45 Gy) followed by esophagectomy. Fifty -four patients completed the protocol. Results. Toxicity associated wi th induction chemoradiotherapy was minimal. The actuarial survival at 12, 24, and 36 months was 59%, 42%, and 32%, respectively. The patholo gic complete response (pCR) rate was 41%, with 12-, 24-, and 36-month survivals of 77%, 50%, and 45%, whereas non-pCR patients had survivals of 46%, 35%, and 23%. The difference in survival between pCR and non- pCR patients was not significant (p = 0.13), but the difference in rec urrence-free survival was significant (p = 0.007). Conclusions. This w ell-tolerated protocol resulted in a high pCR. Trimodality treatment f or esophageal cancer may provide long-term survival in some patients r egardless of their pCR status. (C) 1997 by The Society of Thoracic Sur geons.