Chemo/radiation with and without surgery in the thoracic esophagus: the Wayne State experience

Wayne State University was the site of one of the initial experiences with combination chemotherapy, radiation, and surgery for carcinoma of the thoracic esophagus. This review analyzes all the patients seen with thoracic esophageal carcinoma from 1980 to 1984 inclusive, plus an additional 22 patient pilot study. The great majority of patients seen were treated with combination radiation and chemotherapy, which may have a greater applicability than dose esophagectomy. Eighty-nine patients completed planned preoperative treatment consisting of (5-FU cisplatin and radiation therapy). Of these patients, 39 patients refused or were not offered surgery, and 4 patients are still alive and well several years from treatment initiation. Fifty patients underwent esophagectomy. Twelve of this patients were free of tumor at esophagectomy, and 4 of these are still alive and well several years from treatment. One patient with residual tumor in the esophagectomy specimen alone is still alive. Because of disappointing results and surgical mortality risk, 22 patients were entered on the pilot study, increasing the tumor dose of 5,000 cGy, and increasing chemotherapy to 4 courses. Six patients are still alive in this small series. Since the results of radiation and chemotherapy combination approximates that of best prior trials of radiation therapy alone, a randomized study has been initiated comparing these treatment plans to determine if the combination of radiation and chemotherapy is superior to radiation alone.