[Preoperative chemotherapy of esophageal cancer]

A series of 25 patients with advanced esophageal cancer treated from Mar. 1981 to Sep. 1982 by preoperative chemotherapy plus surgery is reported. All the patients came from the hospitals of the cooperative research group and were randomized into chemotherapy and control groups. They were proved by X-ray, cytology and histopathology prior to treatment. By histology, 22 cases were squamous cell carcinoma, 1 adenocarcinoma and 2 squamous adenocarcinoma. The COF chemotherapy consisted of Vincristine 1 mg, cyclophosphamide 600 mg and 5-fluorouracil 500 mg IV on days 1 and 8 with or without the addition of Pingyangmycin, a drug equivalent to Bleomycin A5, at the dose of 10 mg IM on days 1, 3, 6 and 8. The interval between the ending of chemotherapy and the surgical resection was 5-6 days. The results showed that preoperative chemotherapy caused no myelosuppression, but merely mild gastrointestinal symptoms. All patients were operated and resected without difficulty. The subjective improvement in various degrees and the shrinkage of tumor in the X-ray films were present in 5/25 cases who received preoperative chemotherapy. The histopathological changes in the chemotherapy and control groups (16 specimens) were different. In the chemotherapy group, excessive keratinization in the squamous component of the esophageal cancerous tissue appeared in the resected specimens. The incidence of degeneration and necrosis in the squamous epithelium adjacent to carcinoma was higher in the chemotherapy group (P less than 0.01). The results suggested that such combined modality is worth further study.