Concurrent chemotherapy (5-fluorouracil and cisplatin) and radiation therapy followed by surgery for T4 squamous cell carcinoma of the esophagus

✍ Scribed by Yano, Masahiko; Tsujinaka, Toshimasa; Shiozaki, Hitoshi; Inoue, Masatoshi; Doki, Yuichiro; Yamamoto, Makoto; Tanaka, Eiichi; Inoue, Toshihiko; Monden, Morito

• Publisher: John Wiley and Sons
• Year: 1999
• Tongue: English
• Weight: 105 KB
• Volume: 70
• Category: Article
• ISSN: 0022-4790
• DOI: 10.1002/(sici)1096-9098(199901)70:1<25::aid-jso5>3.0.co;2-m

✦ Synopsis

Background and Objectives: Since the prognosis of patients with T4 squamous cell carcinoma (SCC) of the esophagus is extremely poor, an effective multimodal treatment needs to be established. Methods: Forty-five patients with SCC of the esophagus at the T4 classification of the disease but no hematogenous metastasis were treated with concurrent chemoradiation therapy followed by surgical resection. Twenty-eight patients were treated with a regimen (protocol A) of 5-fluorouracil 750 mg/m 2 on days 1-5 and 22-26, and cisplatin 70 mg/m 2 on days 1 and 22. The remaining 17 patients were treated with a modified regimen (protocol B) of 5-fluorouracil 400 mg/m 2 and cisplatin 10 mg/m 2 on days 1-5, 8-12, 15-19, and 22-26. Radiation was delivered daily for 5 days/week for 4 weeks at the rate of 2 Gy/day to a total dose of 40 Gy in both protocols. Results: A major clinical response was observed in 29 [3 complete response (CR) and 26 partial response (PR)] patients (64.4%). Twenty-eight patients (62.2%) underwent esophagectomy with no postoperative death. The median survival time of the resected patients (959 days) was significantly longer than that of the non-resected patients (178 days). Protocol B showed significantly higher pathologic effectiveness than protocol A. The pathologic CR rate for the main tumors was 1 (6.3%) of 16 patients for protocol A and 7 (58.3%) of 12 patients for protocol B. The pathologic CR rate for metastasized lymph nodes was 4/11 (36.4%) for protocol A and 5/5 (100%) for protocol B. Good histological response of the main tumors correlated well with long survival. The treatments were well tolerated except for one treatment-related death. Conclusions: Concurrent chemoradiation therapy followed by surgery is an effective and safe multimodal therapy for patients with primary inoperable T4 SCC of the esophagus.