[Esophagus carcinoma--systemic or local risk of recurrence--which perioperative measures are successful?]

In patients with locally advanced esophageal cancer, a complete tumor resection is usually not possible. We report an interim analysis of an ongoing phase II trial with multimodal therapy. From February 1995 to November 1997, 50 patients, median age 54.9 years, with uT3N0/N + M0 tumors of the suprabifurcal esophagus, staged by endoscopy, EUS, and CT scan had neoadjuvant, simultaneous radiochemotherapy (RTx/CTx): total dose 30 Gy und 300 mg 5-FU m2 day1 continuous infusion. Surgery was performed 35 days after RTx/CTx. 43/50 (86%) had resection after RTx/CTx. Postoperative morbidity was 40%, 30-day mortality after reconstruction was 4.7%. Histopathological assessment showed a complete response in 3, subtotal in 12, and partial or no response in 28 patients. An R0 resection could be achieved in 28/43 (65.2%) patients. The median overall survival was 13.6 months, after R0 resection 20.6 months vs 9.8 months in R1 resections (p = 0.001). Complete or subtotal response to RTx/CTx (p = 0.002), complete tumor resection after RTx/CTx (p = 0.001) and absence of vascular tumor invasion on histopathology (p = 0.0007) were significant prognostic factors. Neoadjuvant RTx/CTx, although associated with substantial morbidity, is a promising approach for patients with locally advanced esophageal cancer located at or above the tracheal bifurcation in responding patients, provided an R0 resection can be achieved.