Abstract
The results of surgical treatment for advanced esophageal cancer remain extremely poor. Irradiation and chemotherapy are not superior to surgery. Perioperative morbidity and the influence on long-term survival of a combination of surgery and preoperative chemotherapy were investigated in patients with advanced esophageal cancer. Forty-nine patients with advanced esophageal squamous cell carcinoma were subjected to preoperative chemotherapy of cisplatin-5-fluorouracil. Fifty-seven patients were chosen as a historical control group who had not undergone chemotherapy before surgery but had the same histological stages as the chemotherapy group. The response to chemotherapy was assessed by histological studies of surgical specimens. The survival rates noted no significant difference between preoperative chemotherapy plus surgery and a resection alone. However, subclassification according to the grading of chemotherapeutic effectiveness showed that, compared with control, preoperative chemotherapy was beneficial to high responders (P=0.01), ineffective in low responders (P=0.61), and detrimental to nonresponders (P=0.03). Postoperative morbidity was significantly higher in the chemotherapy group than in the control group (P=0.02). These findings suggest that preoperative chemotherapy is necessary only for high responders and we therefore need to reliably identify non-, low, and high responders before chemotherapy to improve the survival and quality of life of patients with advanced esophageal cancer.
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Daly JM, karnell LH, Menck HR (1996) National cancer data base report on esophageal carcinoma. Cancer 78:1820–1828
Pree C, Aapro MS, Spiliopoulus A, Popowski Y, Mermillod B, Mirimanoff RO, Alberto P (1995) Combined chemotherapy and radiotherapy, followed or not by surgery, in squamous cell carcinoma of the esophagus. Ann Oncol 6:551–557
Le Prise E, Etienne PL, Meunier B, Maddern G, Ben Hassel M, Gedouim D, Boutin D, Campion JP, Launois B (1994) A randomized study of chemotherapy, radiation therapy, and surgery versus surgery for localized squamous cell carcinoma of the esophagus. Cancer 73:1779–1784
Japanese Society for Esophageal Disease (1992) Guidelines for clinical and pathologic studies on carcinoma of the esophagus, 8th edn. Kanchara, Tokyo, pp 59–93
Miller AB, Hoogstraten B, Staquet M, Wikler A (1981) Reporting results of cancer treatment. Cancer 42:207–214
Schlag P, Herrmann V, Raeth V, Lehner B, Schwarz V, Herfarth C (1988) Preoperative chemotherapy in esophageal cancer. A phase 2 study. Acta Oncol 27:811–814
Kies MS, Rosen ST, Tsang TK, Shetty R, Schneider PA, Wallemark CB, Shields TW (1987) Cisplatin and 5-fluorouracil in the primary management of squamous esophageal cancer. Cancer 60:2156–2160
Feliu J, Conzalez B, Garcia G, Espinosa E, Vicent JM, Gomez Navarro J, Berrocal A, Ordonez A, Vilches Y, de Castro J, Diaz J (1996) Phase II study of cisplatin, 5-fluorouracil, and leucovorin in inoperable squamous cell carcinoma of the esophagus. Am J Clin Oncol 19:577–580
Swisher SG, Holmes EC, Hunt KK, Doty JE, Zinner MJ, McFadden DW (1996) The role of neoadjuvant therapy in surgically resectable esophageal cancer. Arch Surg 131:819–825
Ajani JA, Ryan B, Rich TA, McMurtrey M, Roth JA, DeCaro L, Levin-B, Mountain C (1992) Prolonged chemotherapy for localised squamous carcinoma of the oesophagus. Eur J Cancer 28:880–884
Roth JA, Pass HI, Flanagan MM, Graeber GM, Rosenberg JC, Steinberg S (1988) Randomized clinical trial of preoperative and postoperative adjuvant chemotherapy with cisplatin, vindesine, and bleomycin for carcinoma of the esophagus. J Thorac Cardiovasc Surg 96:242–248
Hilgenberg AD, Carey RW, Wilkins EW Jr, Choi-NC, Mathisen DJ, Grillo HC (1988) Preoperative chemotherapy, surgical resection, and selective postoperative therapy for squamous cell carcinoma of the esophagus. Ann Thorac Surg 45:357–363
Bleiberg H, Conroy T, Paillot B, Lacave AJ, Blijham G, Jacob JH, Bedenne L, Namer M, De Besi P, Gay F, Collette L, Sahmoud T (1997) Randomised phase II study of cisplatin and 5-fluorouracil (5-FU) versus cisplatin alone in advanced squamous cell oesophageal cancer. Eur J Cancer 33:1216–1220
Ilson D (1997) Toxicity of chemotherapy for esophageal carcinoma. Chest Surg Clin North Am 7:551–564
Mathew G, Jamieson GG (1997) Neoadjuvant therapy for oesophageal cancer. Br J Surg 84:1185–1187
Mandard AM, Dalibard F, Mandard JC, Marnay J, Henry Amar M, Petiot JF, Roussel A, Jacob JH, Segol P, Samama G (1994) Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Cancer 73:2680–2686
Law S, Fok M, Chow S, Chu KM, Wong J (1997) Preoperative chemotherapy versus surgical therapy alone for squamous cell carcinoma of the esophagus: a prospective randomized trial. J Thorac Cardiovasc Surg 114:210–217
Shibusawa H, Koshizuka S, Waki Y, Tuchiya I, Kobayashi N, Takazawa I, Nagashima T, Ueno I, Hosoya Y, Kanazawa K (1996) The existing stage of preoperative chemotherapy for advanced esophageal cancer in our hospital (in Japanese). Nippon Gekakeirengou Gakkai Zassi (J Jpn College Surg) 21:527
Okuma T, Yoshioka M, Isechi S, Kondo K, Tabira Y, Torigoe Y, Miyauchi Y (1994) Preoperative chemotherapy for esophageal cancer based on chemosensitivity testing. J Thorac Cardiovasc Surg 108:823–829
Segalin A, Ruol A, Panozzo M, Bonavina L, Bianchi LC, Peracchia A (1993) Flow cytometric DNA analysis does not predict the radiochemoresponsiveness of esophageal cancer. J Surg Oncol 54:87–90
Lam KY, Law S, Ma LT, Ong SK, Wong J (1997) Pre-operative chemotherapy for squamous cell carcinoma of the oesophagus: do histological assessment and P53 over espression predict chemoresponsiveness. Eur J Cancer 33:1221–1225
Hickey K, Grehan D, Reid IM, O'Briain S, Walsh TN, Hennessy TP (1994) Expression of epidermal growth factor receptor and proliferating cell nuclear antigen predicts response of esophageal squamous cell carcinoma to chemoradiotherapy. Cancer 74:1693–1698
Puglisi F, Di-Loreto C, Panizzo R, Avellini C, Fongione S, Cacitti V, Beltrami CA (1996) Expression of p53 and bcl-2 and response to preoperative chemotherapy and radiotherapy for locally advanced squamous cell carcinoma of the oesophagus. J Clin Pathol 49:456–459
Imamura M, Shimada Y, Kanda Y, Fukumoto M, Yanagibashi K, Miyahara T, Tobe T (1992) Usefulness of preoperative low dose cisplatin treatment for advanced esophageal cancer. Surg Today 22:409–415
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Hosoya, Y., Shibusawa, H., Nagai, H. et al. Preoperative chemotherapy for advanced esophageal cancer and relation with histological effect. Surg Today 29, 689–694 (1999). https://doi.org/10.1007/BF02482310
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DOI: https://doi.org/10.1007/BF02482310