Effectiveness of Preoperative Chemoradiotherapy for Advanced Esophageal Carcinoma

抄録

Since 1998, we have performed preoperative chemoradiotherapy (PCRT) for patients with advanced esophageal carcinoma. Approximately 4 weeks prior to surgery, low dose 5-fluorouracil and cisplatin (FP ;total dose : 7, 000mg/m², CDDP 100mg/m², respectively) and radiation (40Gy) were given to 55 patients with thoracic esophageal squamous carcinoma. The radiological effect to PCRT was 81.8% for primary lesions and 50.0% for lymph nodes, with cases of down staging recognized at 49.1%. Side effects included leukopenia (78.2%), anemia (21.8%), thrombocytopenia (12.7%), esophagitis (18.2%), stomatitis (7.3%), nausea and vomiting (5.5%), and so on. Postoperative complications included anastomotic leakage (16.4%), pneumonia (7.3%), liver dysfunction (3.6%), renal dysfunction (3.6%), wound infection (3.6%) and leukopenia (3.6%), and so on. The pathological effect was grade 2 or more in 81.8% of primary lesions and 71.7% of lymph nodes, and in 27.3% of these cases, no viable cancer cells were recognized in either primary lesions or lymph nodes. On the other hand, of 14 cases assessed as complete response (CR) by esophagoscopy, viable cancer cells remained in 7 cases (50%). The 3-year survival rates were 80.0% at stage II, 58.1% at stage III and 50.0% at stage IV. Moreover, based on an assessment of pathological effect, the 3-year survival rate was 24.2% at grade, 1, 74.4% at grade 2 and 86.7% at grade 3, so that cases of grade 2 and 3 had a significantly favorable prognosis compared to grade 1 (p<0.001). In conclusion, PCRT yielded high effectiveness for advanced esophageal cancer as a preoperative therapy. Nevertheless, clinical and pathological effects do not always match, and careful attention must be made in CR assessments.