European Journal of Cardio-Thoracic Surgery, Vol 7, 606-611, Copyright © 1993 by European Association for Cardio-thoracic Surgery
Esophageal carcinoma with doubtful extirpability. Value of preoperative chemotherapy plus radiotherapy
I Sielezneff, P Thomas, M Giovannini, R Guidicelli, JF Seitz and P Fuentes
Service de Chirurgie Thoracique et des Maladies de l'Oesophage, Hopital Sainte-Marguerite, Marseille, France.
To improve resectability for bulky esophageal tumors and/or tumors evolving
close to the pharyngo-esophageal junction (PEJ), a combined preoperative
chemotherapy plus radiotherapy (CT+RT) was given in 25 patients. There were
23 men and 2 women (mean age: 55 years); 21 had squamous cell carcinoma and
4 had adenocarcinoma. According to TNM classification based on computed
tomography, the tumor was graded T3 in 20 cases, T4 in 2, T2 in 2 and T1 in
1. The preoperative treatment included two sessions of continuous infusion
of 5-fluorouracil (800 mg/m2 per day) and cisplatin (20 mg/m2 per day), and
combined radiotherapy (3 Gy/day). The overall tolerance was acceptable. The
tumoral mass decreased in 23 patients (92%). All the patients underwent a
wide esophagectomy; among the six patients with a tumor close to the PEJ,
two required an associated pharyngolaryngectomy. The operative mortality
rate was 8%. Major non-fatal complications occurred in 52%. On histology,
there was no evidence of residual disease in seven patients (28%). The
median survival was 18 months and the overall survival rate was 22.1% at 2
years. For the patients who had a complete histological response, the
2-year survival rate was 35%. Our data suggest that combined CT+RT may
improve resectability of esophageal carcinoma. Improved survival rates seem
to be appreciable in patients with a complete histologic response.
