Histopathological evaluation of response to pre-operative concurrent chemoradiotherapy for advanced squamous cell carcinoma of the thoracic esophagus

Abstract

The histological features of tumor degeneration of 20 advanced squamous cell carcinomas of the thoracic esophagus after pre-operative concurrent chemo-radiotherapy were evaluated. All patients were staged and diagnosed microscopically before treatment. The i.v. continuous chemotherapy (Cisplatin and 5- Fluorouracil) and concurrent Co-60 therapy (total dose: 3000 cGy) were followed by subtotal esophagectomy around the 42nd day from the start of the treatment. The response to treatment was evaluated qualitatively and semiquantitatively on the basis of findings of degeneration and regression of tumor mass together with signs of regeneration of esophageal wall. This response was classified as complete (CR), partial 1 (PR1), partial 2 (PR2) and stable disease (SD). Of twenty patients, four (20%) were CR without microscopical evidence of cancer cells, four (20%) were PR1 with small cancer nests or single cancerous cells, nine (45%) were PR2 with diffuse cancer infiltration with different degree of cancer degeneration and three (15%) were SD with no appreciable changes of tumor mass. Generally, the regression of tumor mass was seen in 17 out of 20 patients. In the majority of them, decrease of mainly the endoluminal part of tumor mass, as compared to the pre-operative stage, was observed.