[Neoadjuvant chemotherapy and concurrent radiochemotherapy for advanced esophageal carcinoma potentially invading...

Advanced esophageal carcinoma invades adjacent structures, and its resection without residual tumor is difficult. Preoperative chemotherapy and combined modality therapy are being tried to improve survival in patients with T4 esophageal carcinoma. For these cases, chemotherapy with 5-fluorouracil and cisplatin (FP) is known to be not so effective. For 17 patients with T4 esophageal carcinoma in 2 institutes, treated primarily with chemotherapy with 5-fluorouracil, cisplatin and adriamycin (FAP), the response rate was 76%. Operation was performed in all of them after 2-3 courses of FAP, and curative resection without resection of adjacent structure was carried out in 14 cases (82%). Treatment with FP concurrent with more than 50Gy of radiation (CRT) was effective for patients with T4 esophageal carcinoma, its response rate was 72.80% in Japanese literature, and resectability rate was 37-48% after treatment. All of our 3 cases had partial response, but resection was not performed because patients refused surgery. Phase II trial of neoadjuvant chemotherapy followed by concurrent chemotherapy plus high-dose radiation therapy was carried out for 45 patients with clinical stage T1-4N0-1M0 in an attempt to improve the result of concurrent chemoradiation in America (RTOG), and the overall median survival was 20 months. But this treatment will not be used, because treatment-related death was seen in 10%. We think that FAP and CRT are the most effective neoadjuvant therapy in patients with T4 esophageal carcinoma. If curative resection is possible after treatment, operation should be done to improve prognosis.