A series of 25 patients with advanced
esophageal cancer treated from Mar. 1981 to Sep. 1982 by preoperative
chemotherapy plus surgery is reported. All the patients came from the hospitals of the cooperative research group and were randomized into
chemotherapy and control groups. They were proved by X-ray, cytology and histopathology prior to treatment. By histology, 22 cases were
squamous cell carcinoma, 1
adenocarcinoma and 2 squamous
adenocarcinoma. The COF
chemotherapy consisted of
Vincristine 1 mg,
cyclophosphamide 600 mg and
5-fluorouracil 500 mg IV on days 1 and 8 with or without the addition of
Pingyangmycin, a
drug equivalent to
Bleomycin A5, at the dose of 10 mg IM on days 1, 3, 6 and 8. The interval between the ending of
chemotherapy and the surgical resection was 5-6 days. The results showed that preoperative
chemotherapy caused no myelosuppression, but merely mild gastrointestinal symptoms. All patients were operated and resected without difficulty. The subjective improvement in various degrees and the shrinkage of
tumor in the
X-ray films were present in 5/25 cases who received preoperative
chemotherapy. The histopathological changes in the
chemotherapy and control groups (16 specimens) were different. In the
chemotherapy group, excessive keratinization in the squamous component of the esophageal cancerous tissue appeared in the resected specimens. The incidence of degeneration and
necrosis in the squamous epithelium adjacent to
carcinoma was higher in the
chemotherapy group (P less than 0.01). The results suggested that such combined modality is worth further study.