[Multidisciplinary treatment of esophageal cancer]

Hyperthermia combined with irradiation and chemotherapy was prescribed for patients with resectable squamous cell carcinoma of the esophagus. The long-term results were compared between two groups of patients, one treated with chemotherapy, radiotherapy and hyperthermia (HCR), the other with chemotherapy and radiotherapy, but not hyperthermia (GR). The five-year survival rates of patients with resectable carcinoma, given preoperative HCR or CR, were 22.3 and 13.7 per cent, respectively. In particular, for the patients classified as Stages III and IV, a longer survival period was obtained with HCR (p < 0.05). Since 1990, we applied a protocol of prospective randomized study for neoadjuvant chemotherapy. We presented the results of comparison between two groups, one of which was treated by chemotherapy alone and the other by chemotherapy combined with hyperthermia, for both resectable and non-resectable cases. Data on 21 patients with a primary squamous cell carcinoma of the thoracic esophagus were included in the present study. Among these 21 cases, 10 received only chemotherapy (Group A), and 11 were treated by hyperthermo-chemotherapy (Group B). In each group, 6 and 9 patients each were surgically treated. According to our regimen, in Group A, 30 mg of oil bleomycin (BLM) orally six times, and 50mg div. of cisplatin (CDDP) triplicate, were administered during three weeks, respectively. Besides chemotherapy, RF intraluminal hyperthermia was performed six times just after administration of BLM in Group B. There was no significant difference of prognostic factors between groups, and all the patients tolerated well the treatment modalities. The overall efficacy (% CR+PR+MR) of Group A and B was 30.0% and 63.6%, respectively. Histopathological evaluation of the effectiveness was 16.7% and 33.3% in Groups A and B, respectively. Thus, as severe side effects in patients given hyperthermia were nil, this treatment deserves serious consideration when treating patients with a malignant lesion of the esophagus. Moreover, postoperative adjuvant therapies were also important, and choice of the treatment according to the status of carcinoma and the patient's condition is essential.