Combined modality therapy for esophageal squamous cell carcinoma

Area of Science:

• Oncology
• Surgical Oncology
• Radiation Oncology

Background:

• Esophageal squamous cell carcinoma (ESCC) presents a significant treatment challenge.
• Combined modality treatments are explored to improve outcomes for localized ESCC.

Purpose of the Study:

• To evaluate the efficacy and safety of a combined modality treatment (chemotherapy, radiation, and surgery) for localized esophageal squamous cell carcinoma.
• To determine if neoadjuvant therapy can obviate the need for surgical resection in select patients.

Main Methods:

• 30 patients with localized ESCC received mitomycin C and 5-FU chemotherapy, radiation therapy (3000 rad), and surgery (esophagectomy).
• Postoperative chemotherapy and radiation (2000 rad) were given for positive surgical margins.
• Pretreatment celiotomy was considered to identify patients with disseminated disease.

Main Results:

• Of 18 resected patients without disseminated tumor, 6 were tumor-free, 3 had intramural, and 9 had transmural tumor.
• Median survival was 76 weeks; 5 of 6 living patients were disease-free at 95-190 weeks.
• Local recurrence was 13% in resected patients and 29% in unresected patients. Postoperative pneumonitis occurred in 13%.

Conclusions:

• Pretreatment celiotomy may be warranted to identify patients with a poor prognosis.
• A combined modality approach with two chemotherapy courses and 5000 rad radiation may potentially eliminate the need for surgical resection in localized ESCC.
• The observed toxicity was minimal, and local recurrence rates were low.