[Multidisciplinary treatment of esophageal carcinoma]

From 1965 until Aug. 1987, a total of 1,249 cases of primary thoracic esophageal carcinoma were resected. Some 70%-80% of these cases treated before 1980 underwent preoperative irradiation. From 1976-1987, in addition to preoperative irradiation, postoperative irradiation of the neck and upper mediastinum was performed in 20% of resected cases. (1) Evaluation of combined radiotherapy: In C greater than 0 resected cases, the postoperative T-shape irradiated group was significantly better than the nonirradiated and preoperative irradiation--only groups, with a risk factor of p less than 0.05, However in comparison to historical controls, no significant improvement was obtained and in the preoperative irradiated group. (2) Multidisciplinary treatment based on preoperative staging: The effectiveness of CDDP treatment in cases of recurrence or non-resectable cancer of the esophagus was 44.4%. Based on these findings, we have administered adjuvant CDDP + VDS in resected cases from 1985 and have obtained encouraging 1-year survival. Since 1985, extended dissection in 3 regions (cervical, thoracic and abdominal) has been carried out. Compared to C greater than 0 resected since 1981, in which dissection of lymph-nodes in two major regions was performed, dissection of lymph-nodes in the three major regions has resulted in an improved 1-2 year survival, despite the increased numbers of stage IV cases. The findings thus indicate that the presence of lymph-node metastasis significantly affects prognosis. Therefore, in cases that are preoperatively evaluated as sm or more extensive invasion, it is necessary to combine extensive lymph-node dissection, postoperative irradiation or chemotherapy.