[Multimodality treatment of esophageal carcinoma: evaluation of preoperative (neoadjuvant) chemotherapy]

Recently, esophageal carcinoma has shown a wide variation in spread, from carcinoma in situ to the far-advanced type. Therefore, the treatment must be performed on the basis of accurate clinical stagings, and not only the prognosis but also the quality of life of patients should be considered. Surgical resection has been regarded as standard treatment for patients with advanced carcinoma, but in some cases, preoperative treatments should be added to perform curative resections. Our objectives in preoperative (neoadjuvant) chemotherapy with cisplatin and other chemotherapeutic agents are three-fold: 1) To reduce the extent of direct invasion of neighboring structures (e.g., aorta, trachea or bronchus). 2) To reduce the degree of lymph node metastasis. 3) To preserve the larynx in cases of cervical esophageal carcinoma. For the past 4 years, we treated 13 cases of advanced esophageal carcinoma with this chemotherapy method preoperatively. Two of 13 patients showed a partial clinical response, including one with no viable carcinoma cells pathologically, and 4 had a minor clinical response. However, the impact on overall survival must be further investigated. We conclude that this multimodality treatment is effective for local tumor control, but should be applied for selected patients with careful management of its side effects.