Neo-adjuvant chemoradiotherapy followed by surgery in treatment of advanced esophageal carcinoma

Abstract

To investigate the effects of neo-adjuvant chemoradiotherapy followed by surgery in treatment of advanced esophageal carcinoma. Forty-two consecutive patients with locally advanced esophageal carcinoma underwent chemotherapy and radiotherapy concurrently. The chemotherapy consisted of intravenous infusion of vinorelbine (25 mg/m(2) per day) on days 1, 8, 22, and 29 or 5-fluorouracil (2.4 g/m(2)) on days 1 - 3 and days 22 - 24, and cisplatin (75 mg/m(2)) on days 1 and 22. Radiotherapy was delivered 5 days a week for 4 weeks with the total dose of 40 Gy divided into a daily fraction of 2.0 Gy. After the completion of chemoradiotherapy, clinical restaging was performed. Esophagectomy and lymphadenectomy were performed 4 - 6 weeks after the chemoradiotherapy. Forty-one of the 42 patients finished the preoperative chemoradiotherapy. The clinical response rate of chemoradiotherapy was 83.3%. Forty cases received esophagectomy, with a radical operation rate of 97.5% and a pathological complete response rate of 23.8%. The overall 1, 3, and 5-year survival rates were 66.9%, 54.5%, and 44.9% respectively with a median survival time of 43.4 months. The 1, 3, and 5-year disease-free survival rates were 61.1%, 48.7%, and 39.5% respectively with a median disease-free survival time of 32.7 months. The toxic responses of the chemoradiotherapy, such as myelotoxicity, pulmonary toxicity, and esophagitis were at grade 1 or 2. No death occurred during chemoradiotherapy. The incidence rates of postoperative pulmonary infection and severe arrhythmia were 22.5% and 20.0% respectively. The postoperative mortality rate was 5.0%. The neoadjuvant chemoradiotherapy followed by surgery achieves a high clinical response rate and pathologic complete tumor regression rate, significantly downstages the esophageal cancer, and improves the survival. Although the toxicity of chemoradiotherapy is mild, the side-effects cannot be ignored still.