[Surgical adjuvant therapy of carcinoma of the thoracic esophagus]

Between 1981 and 1991, we conducted 3 trials of surgical adjuvant therapy for esophageal carcinoma. The first randomized trial was pre- and post-operative radiotherapy, 30 Gray for preoperative therapy and 50 Gray for postoperative therapy. The 2nd trial was performed with postoperative radiotherapy and postoperative chemotherapy, 30 Gray for radiotherapy and cisplatin (CDDP, 50 mg/m2) plus vindesine (VDS, 3 mg/m2) for chemotherapy. The 3rd trial was postoperative chemotherapy (CDDP+VDS) and surgery alone. In the survival rate of the first trial, no significant difference was noted between the 2 groups (n = 20 and n = 16), while in the 2nd trial, the 5-year survival rate in the chemotherapy group (n = 12) was significantly longer (p = 0.017) than that of the radiotherapy group (n = 12). At the present time, the 3rd trial shows no significant difference in survival between patients with (n = 15) and without (n = 15) postoperative chemotherapy. Therefore, we are now performing a new randomized trial with surgery alone and postoperative chemotherapy using a more effective regimen (CDDP 80 mg/m2 + 5-FU 800 mg/m2). In the near future, the most effective therapy will be selected for individual patients with esophageal carcinoma, thanks to developments in clinical oncology, new anticancer drugs, drug delivery systems and molecular biology.