The researchers investigated the use of neoadjuvant chemo-radiation protocols for esophageal carcinoma, and reported their findings in the October issue of American Surgeon.
They evaluated the outcome of patients undergoing surgery for esophageal carcinoma at the University of Miami/Jackson Memorial Hospital between 1991 and 1996.
A total of 72 patients underwent esophageal resection; 51 males and 21 females, with a median age of 63 years.
Histology was equally distributed between adenocarcinoma (36 patients; 50%) and squamous cell carcinoma (36 patients; 50%).
Pathological stage distribution consisted of 6 Stage 0 (8%), 10 Stage I (14%), 23 Stage II (32%), 31 Stage III (43%), and 2 Stage IV (3%) lesions.
Patients were divided into 3 groups, according to the type of preoperative treatment; Group 1 (n = 44) had surgery alone; Group 2 (n = 18) had neoadjuvant 5-fluorouracil based chemotherapy, and Group 3 (n = 9) had neoadjuvant 5-fluorouracil based chemotherapy in conjunction with external beam radiation (XRT). One patient received preoperative XRT alone.
All survivors were followed for a minimum of 1 year and statistical analyses were performed.
In the 28 patients receiving any form of neoadjuvant therapy, only 1 patient had a pathological complete response.
|5-year survival rates:|
Surgery alone: 28%
Neoadjuvant therapy: 21%
Neoadjuvant therapy with XRT: 0%
| American Surgeon |
The overall 5-year and median survival rates were 18% and 20.5 months, respectively.
Individual treatment group survival rates at 5 years were 28% for Group 1; 21% for Group 2; and 0% for Group 3. These showed no survival difference between Groups 1 and 2. Group 3 fared significantly worse than the other two, probably as a result of the high operative mortality in this group.
Dr M. J. Boyle, of the University of Miami Hospitals and Clinics, said on behalf of fellow authors, "These results indicate that surgical resection continues to be an important treatment modality for esophageal carcinoma.
"Neoadjuvant chemotherapy, in our experience, failed to improve these survival rates and pre-operative chemoradiation was associated with a high perioperative mortality rate."
"Chemotherapy regimens with higher complete responses may further improve these survival rates," it was concluded.