Abstract |
The (dis-)advantages of preoperative chemoradiation in patients with esophageal cancer (EC) are still controversial as data are lacking showing a clear cut benefit. Therefore, data of neoadjuvant therapy of our hospital have been analyzed. Since 1994 102 patients with an EC (33 % adenocarcinoma, 67 % squamous cell cancer, scc) were operated after receiving preoperative chemoradiation (36 Gy radiation, 1.8 Gy/day for 4 weeks, 500 mg/m (2) 5-FU for 4 weeks and 20 mg/m (2) Cisplatin, day 1-5, week 1 and 4). Operation was performed usually 8-10 weeks after treatment start. In 11.7 % of patients with an adenocarcinoma a complete pathological response (CR, pT0N0M0) was observed and a pT0 stage in 20.6 %. 38.2 % of these patients were staged as pN0. Postoperative morbidity was observed in 66 % ( anastomotic leakage in 20 %, recurrent nerve palsy in 23 %). In-hospital mortality was 5.9 %. 5-year survival was calculated as 30.5 %, in patients wit a CR 66 %.26.5 % of patients with a scc revealed a CR. However no effect at all was observed in 32 % of these patients. 56 % were staged as pN0. Postoperative morbidity was observed in 87 % ( anastomotic leakage in 16 %, recurrent nerve palsy in 32 %). In-hospital mortality was 11.8 %. 5-year survival was calculated as 19.2 %, in patients with a CR 45 %. The impact of pN stage was significant (p = 0.0052). These results underline the benefit of neoadjuvant therapy in patients with a CR. Further on, a pN0 stage is an important prognostic indicator. However, it remains open, whether neoadjuvant therapy leads to a downstaging of lymph node involvement, as histological confirmation in clinically positive lymph node is seldom performed prospectively.
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Authors | A Imdahl, U Schöffel, G Ruf, U T Hopf |
Journal | Zentralblatt fur Chirurgie
(Zentralbl Chir)
Vol. 129
Issue 5
Pg. 350-5
(Oct 2004)
ISSN: 0044-409X [Print] Germany |
Vernacular Title | Präoperative Radio-Chemotherapie beim Osophaguskarzinom: Erfahrungen eines Zentrums mit 102 Patienten. |
PMID | 15486784
(Publication Type: Comparative Study, Evaluation Study, Journal Article)
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Chemical References |
- Antimetabolites, Antineoplastic
- Antineoplastic Agents
- Cisplatin
- Fluorouracil
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Topics |
- Adenocarcinoma
(drug therapy, mortality, pathology, radiotherapy, surgery)
- Adult
- Aged
- Antimetabolites, Antineoplastic
(administration & dosage, therapeutic use)
- Antineoplastic Agents
(administration & dosage, therapeutic use)
- Antineoplastic Combined Chemotherapy Protocols
(therapeutic use)
- Carcinoma, Squamous Cell
(drug therapy, mortality, pathology, radiotherapy, surgery)
- Chi-Square Distribution
- Cisplatin
(administration & dosage, therapeutic use)
- Combined Modality Therapy
- Data Interpretation, Statistical
- Esophageal Neoplasms
(drug therapy, mortality, pathology, radiotherapy, surgery)
- Esophagus
(pathology)
- Female
- Fluorouracil
(administration & dosage, therapeutic use)
- Humans
- Lymphatic Metastasis
- Male
- Middle Aged
- Neoadjuvant Therapy
- Neoplasm Staging
- Preoperative Care
- Radiation Dosage
- Remission Induction
- Survival Analysis
- Time Factors
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