Objectives: This study evaluated the concurrent treatment of chemoradiation followed by esophagectomy in the management of locoregional esophageal carcinoma. The main end points were to determine the resectability of the tumor and the pathologic tumor response. An accessory aim was to evaluate the survival rate.
Patients and methods: Thirty-nine patients were treated as follows: 5-fluoruracil, 1,000 mg/m2, by 24-h IV infusion for 4 days, and cisplatin, 100 mg/m2, on day 1. Concurrent radiotherapy was delivered at a total dose of 40 Gy in daily fractions of 2 Gy five times per week. The performance of an esophagectomy was planned 4 weeks after induction treatment and restaging.
Results: All patients completed the preoperative treatment. A potentially radical resection was performed in 29 patients, and a complete or partial histologically proven response was observed in 9 patients (23%) and 20 patients (51%), respectively. The 3-year overall survival rate was 40%. The 3-year rates of overall survival and disease-free survival were 88% and 76%, respectively, in patients with complete response (p < 0.0012), and 16% and 17%, respectively, in patients with partial response (p < 0.0013). Age, histology, and response represented the best prognostic model related to survival.
Conclusions: The results of this combined approach appear to be better than those reported with surgery alone. Despite the small number of patients in the series and the inclusion of patients with different histotypes, we concluded that patients with the squamous histotype show a better outcome than those with adenocarcinoma.