TREATING ESOPHAGEAL CANCER WITH A COMBINATION OF CHEMOTHERAPY, RADIATION, AND EXCISION

BACKGROUND: Treatment of esophageal cancer has been primarily palliative. Recent studies have shown that preoperative combination chemo- and radiation therapy increases the effectiveness of surgical excision. PATIENTS AND METHODS: Beginning in 1990, 29 patients in the Spokane area were treated with preoperative chemo- and radiation therapy. They were 23 men and 6 women whose mean age was 66 years. Twenty-five had adenocarcinoma, of whom 3 had Barrett's esophagitis. Four had squamous cell carcinoma, The chemotherapy included fluorouracil, cisplatin, and vinblastine, Radiation was given concomitantly, BID for 21 days. Surgical excision Tvas performed about 3 weeks after the last radiation session, pending recovery from cytopenia. RESULTS: There was 1 operative death, for an operative mortality of 3.4%. Twenty-three patients (79%) were found to have no residual cancer at the time of resection, Of this group, 8 died of metastatic cancer at a mean of 15 months postoperatively (range 1 to 28), and 15 were alive at a mean of 28 months (range 12 to 46). Six patients (21%) had residual cancer in the resected specimen, either at the primary site or-more often-in adjacent lymph nodes, Five have died at 6, 8, 9, 24, and 28 months postoperatively; 1 remains alive at 14 months, The mean survival among these 6 patients is 15 months. CONCLUSIONS: Combined chemo- and radiation therapy prior to esophagectomy appeared to improve outcome in this small series of patients with esophageal cancer, Local control was excellent, but distant metastasis continues to be a significant problem.