Neoadjuvant chemoradiation therapy in patients with surgically treated esophageal cancer

Over the past 10 years, 232 patients were treated at the East Carolina Scho ol of Medicine for cancer of the esophagus. Of these, 73 received neoadjuva nt chemoradiation therapy and subsequent surgical resection, The results in this group suggest improved cancer control, with IS patients (25%) remaini ng free of recurrence 3 years after treatment, compared with 11 out of 159 patients (7%) in the group that was not treated with neoadjuvant therapy (p < 0.0001). The 5-year recurrence-free survival with neoadjuvant chemoradio therapy and surgery was 16% (12/73) compared with 3% (5/159) with other typ es of therapy. Two protocols of neoadjuvant chemoradiotherapy with subseque nt surgery were compared: I: Split-course, once-a-day radiotherapy and conc omitant cisplatinum/5-fluorouracil followed by esophagectomy. II: Accelerat ed, twice-a-day radiotherapy with concomitant triple chemotherapy using cis platinum/5-fluorouracil/vinblastine followed by transhiatal extrathoracic e sophagectomy. The survival rate was similar in the two groups of patients b ut the complication rate was higher in group II. Neoadjuvant chemoradiation therapy and the techniques of transhiatal esophagectomy may have contribut ed to the improved results in the treatment of esophageal carcinoma. Accele rated radiotherapy with triple chemotherapy was more toxic and did not give better survival rates than split-course, once-a-day, conventional, fractio nated-protracted radiotherapy combined with two drugs.