Multimodality approach to treatment of carcinoma of the esophagus

We conducted a combined treatment pilot project in 17 patients with squamous cell carcinoma of the thoracic esophagus. Thirteen of the patients initially had stage I or II disease, and four had stage III disease. Each patient received three cycles of chemotherapy consisting of a high dose of cisplatin (100 mg/sq m), followed by continuous infusion of fluorouracil (1,000 mg/sq m/day for five days). Thirteen patients had a favorable response to the chemotherapy, and ten of the 11 responding patients with stage I or II disease were offered surgical resection. Total thoracic esophagectomies and cervical gastroesophagostomies were done in the six patients who accepted the surgical recommendation. Pathologically, five patients had stage I disease, and one had stage III disease (even in this patient the local tumor was confined within the wall of the esophagus). All six patients were alive, without evidence of disease, four to 34 months after diagnosis. Two patients with stage II disease had tumor progression, as did two of the four patients with stage III disease. Three of the nonresponding patients died of their disease two to seven months after diagnosis. The eight remaining patients, three of whom received irradiation after chemotherapy, were alive, but with evidence of persistent disease, one to seven months after entrance into the study.