Neoadjuvant treatment in surgical management of Esophageal Cancer

We conducted a prospective study on neoadjuvant treatment for squamous cell carcinoma of the esophagus, modifying the chemotherapy protocol by adding I-folinic acid and giving bifractionated radiotherapy with a cis-diaminedichloroplatinum (CDDP) injection before each fraction. Thirty-two patients, 30 men, 2 women, mean age 56.2-8. 9 years, with resectable squamous cell carcinoma ot the esophagus (TNM stage I = 4, IIA = 4, IIB = 13, III = 11) were included. Chemotherapy, CDDP (80 mg/m2 : D2), 5-fluorouracil (5-FU ; 600 mg/m2. D1-4), and 1-folinic acid (200 mg/m2, D1-4), was given in two sessions with a 3-week interval during which the patients received radiotherapy (45 Gy), two fractions per day (150 cGy/fraction). A 3-mg Injection of CDDP was given prior to each fraction. Patients underwent surgery 4 to 7 weeks after neoadjuvant therapy. No severe side effects were observed in 12 patients Grade 3 effects (WBC, platelests, mucosite's) occurred in 16 patients and grade 4 effects (platelets mucositils) in four including I death due to septicemia with an infected catheter. Surgery was performed in 29 patients; 26 had resectable tumors (81 %). Operative mortality was 10 %. The 26 surgical specimens showed complete response (n = 18), persistent microscopic residues (n = 4), or not significant modification (n = 4). Survival at 1, 3, and 5 years was 82, 47, and 47 % and disease-free survival was 77, 47, and 47 % respectively. This new therapeutic combination is aggressive and associated with a high postoperative mortality but has a remarkable histological effect since complete response was achieved in 56 % (95 % CI : 39-73 %) of the patients and 5-year survival reached 47 %, a very high rate in our experience.