Adjuvant therapies for cancer of the thoracic esophagus

During the past four decades, especially in recent years, various active adjuvant therapies combined with surgery have improved the outcome in cases of cancer of the esophagus. However, no optimum adjuvant therapy has been determined. From 1981 to 1992, 341 patients with regional and distant node metastasis who underwent curative surgery were treated with postoperative radiotherapy (RT), postoperative radiochemotherapy (RC), and postoperative aggressive chemotherapy (AGC) in a controlled study in our department of surgery. Five-year survival rates, including operative deaths and unrelated diseases of the former group, were 0% for RT, 19.9% for surgery alone, 39.8% for RC, and 48.2% for AGC. Such rates for the latter group were 6.8% for AGC, 13.3% for surgery alone, and 33.3% for RC. In addition, results of a group study on the effectiveness of three-field node dissection in 715 cases of thoracic esophageal carcinoma by 10 institutions were analyzed. This analysis showed that there were no differences in the 5-year survival rate of curative surgery in cases with positive nodes among the groups treated with surgery alone (SA), with postoperative radiotherapy (PR), and with postoperative chemotherapy (PC). As to the 91 cases with positive cervical nodes, the 3-year survival rates in cases treated with SA (n = 22), PR (n = 20), and PC (n = 49) were 25.3%, 48.1%, and 53.6%, respectively; a significant improvement of survival in these patients. Summaries of studies of preoperative or postoperative radiotherapy, and both multimodal therapies are introduced.