Impact of Clinical Staging for Neoadjuvant Therapy of Esophageal Cancer

Abstract

Survival of patients with esophageal carcinoma (EC) can be improved by preoperative neoadjuvant chemoradiation followed by esophageal resection. We introduced this treatment modality in 1994. Treatment results of 25 patients presenting with stage Ila/b or III EC (UICC 1987) were analyzed. After assessment of operability and clinical staging, all patients received radiation therapy (36 Gy, 1.8 Gy/day, days 1-5, weeks 1-4) and chemotherapy (cisplatin 20 mg/m2, days 1-5, weeks 1 and 4, and 5-fluorouracil 500 mg/m2, days 1-5, weeks 1-4). Patients were operated upon 8-10 weeks after treatment initiation and clinical restaging. In 3 patients thoracotomy demonstrated inoperability due to local tumor progression into the tracheobronchial tree. Major postoperative morbidity was observed in 72%, 2 patients died after resection while in hospital (8%). The comparison of pretreatment clinical staging with restaging after neoadjuvant therapy revealed tumor down-staging (UICC) in 12 patients, no change in 11 patients and up-staging in 2. Comparison of restaging after neoadjuvant therapy and pathohistological staging after resection demonstrated down-staging in 2 patients, no change in 8 patients and up-staging in 15 patients. Complete pathohistological remission was observed in 3 patients. Pathohistological findings revealed a different tumor stage (UICC) in 21 patients (11 × up-staging, 10 × down-staging) when compared with pretreatment clinical staging. Mean 2-year survival was 87.5% in patients with remission and 16.5 % in patients without remission or progress of disease. The data demonstrate the feasibility of neoadjuvant preoperative chemoradiation in EC. On the basis of staging results some patients benefit from neoadjuvant therapy while others show progress of disease. The impact of neoadjuvant therapy needs to be carefully evaluated to exclude pitfalls due to clinical misstaging.