Induction chemotherapy, surgery, and concomitant chemoradiotherapy for carcinoma of the esophagus: A long-term analysis

Purpose. To define the activity and toxicity of preoperative chemotherapy and postoperative concomitant chemoradiotherapy in patients with carcinoma of the esophagus, and to determine the effect on survival in patients treated with this approach. Patients and methods. Patients were treated with two 21-day cycles of induction chemotherapy with cisplatin 100 mg/m(2) on day 1, 5-fluorouracil (5-FU) 800 mg/m(2)/day continuous infusion on days 1-5, and leucovorin 100 mg/m(2) every four hours on days 1-5. Surgical resection was performed if feasible (and could also be performed prior to chemotherapy). Patients then received radiotherapy (50 to 60 Gy) every other week x five to six weeks, concomitantly with 5-FU 800 mg/m(2) continuous infusion daily and hydroxyurea 1 g twice daily x five days. Results. Forty-six patients were treated. With a minimum follow-up of 58 months, the median survival for the entire group was 16 months; the median survivals for patients with squamous carcinoma and adenocarcinoma were 29 months and 12 months, respectively Toxicities of induction chemotherapy were severe neutropenia and mucositis; there was one toxic death. Toxicities of concomitant chemoradiotherapy were neutropenia, mucositis and esophagitis. There were five cases of radiation pneumonitis, one fatal. Conclusion: Induction chemotherapy and postoperative concomitant chemoradiotherapy can be added to surgical resection for carcinoma of the esophagus. Combined modality therapy, as reported here, produces long-term survival benefit, particularly in patients with squamous carcinoma. However, similar outcome results have been reported with less toxic and shorter treatment regimens as tested in randomized studies.