Combined results from three phase II trials of neoadjuvant chemotherapy inoperable adenocarcinoma of the oesophagus

Adenocarcinoma of the oesophagus is a systemic disease at presentation in t he majority of patients. This article analyses the impact of preoperative c hemotherapy on a cohort of 68 patients. From 1990 to 1996, 68 patients with potentially operable adenocarcinoma of the oesophagus were entered into th ree sequential Phase II trials of neoadjuvant chemotherapy with cisplatin/m itomycin C/ifosfamide, cisplatin/5-fluorouracil (5-FU) and mitomycin C/cisp latin/5-FU. Twenty-four (35%) patients had a radiological (4 complete; 20 partial) resp onse to chemotherapy, and 52 (76%) went on to have the primary tumour resec ted. There was only one pathological complete responder. The overall median survival was 13 months (95% confidence interval (CI) 9-16). Survival for t he 28 N-0 patients was 34 months (95% CI 14-60). The pattern of failure for resected patients was predominantly systemic (16/17). These results indicate that neoadjuvant chemotherapy followed by surgery fo r adenocarcinoma of the oesophagus achieves excellent local control. The do minance, however, of distant recurrence after surgery underlines the fact t hat, in the majority of patients, the only hope of improving results in the future is to develop better systemic therapies.