Role of the neoadjuvant therapy in the treatment of advanced carcinoma of the esophagus

The aim of this study was to compare microscopically radical resection (R0) rate after surgery alone, preoperative chemotherapy, and preoperative chemo-/radiotherapy.

Between 1992-1997, 101 patients were operated for squamous cell carcinoma of the esophagus. Thirty four patients were treated by surgery alone, in 42 patients surgery followed preoperative chemotherapy with cisplatin (20 mg/m²/dobe; days: 1-5 i 17-21 days) and 5-FU (300 mg/m²/dobe; for 21 days). In 25 patients concurrently with chemotherapy, radiotherapy was applied in fractions (for 15 days) up to total dose of 3000 cGy. Postoperative mortality and morbidity was 15% and 50%, respectively. In the chemotherapy group, complete response (CR) rate was 4,8%, partial response (PR) was 80,9%, and stabile disease (SD) was observed in 14,3% of patients. In the chemo-/radiotherapy group the CR, PR, and SD rate were 8%, 80%, and 12%, respectively. The R0 resection rates after surgery alone, preoperative chemotherapy and chemo-/radiotherapy were 3%, 26%, and 40%, respectively.

Conclusion: in patients with advanced squamous cell carcinoma of the esophagus, preoperative chemo- and/or radiotherapy improves microscopically radical resection rate, as compared to surgery alone.