Multimodality Treatment for Esophageal Cancer: The Role of Surgery and Neoadjuvant Therapy

Treatment of esophageal cancer has traditionally included surgery as the initial modality. Neoadjuvant chemoradiation therapy has been introduced with the goal of downstaging tumors before surgical resection; however, its role in esophageal cancer remains controversial. We report 116 patients who un...

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Veröffentlicht in:The American surgeon 2003-08, Vol.69 (8), p.693-702
Hauptverfasser: Makary, Martin A., Kiernan, Paul D., Sheridan, Michael J., Tonnesen, Glen, Hetrick, Vivian, Vaughan, Betty, Graling, Paula, Elster, Eric
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container_issue 8
container_start_page 693
container_title The American surgeon
container_volume 69
creator Makary, Martin A.
Kiernan, Paul D.
Sheridan, Michael J.
Tonnesen, Glen
Hetrick, Vivian
Vaughan, Betty
Graling, Paula
Elster, Eric
description Treatment of esophageal cancer has traditionally included surgery as the initial modality. Neoadjuvant chemoradiation therapy has been introduced with the goal of downstaging tumors before surgical resection; however, its role in esophageal cancer remains controversial. We report 116 patients who underwent esophagogastrectomy with reconstruction for carcinoma of the esophagus or esophagogastric junction over a 10-year period (January 1, 1990 to June 1, 2001). Forty patients underwent neoadjuvant radiation and chemotherapy followed by surgery. Hospital mortality in this group was 7.5 per cent, complete pathologic response (CPR) was 37.5 per cent, and overall 3– and 5-year survival rates were 47 and 38 per cent. Five-year survival in the 15 patients with CPR was 85 per cent. Five patients underwent neoadjuvant single-agent therapy (four chemotherapy and one radiation) followed by surgery, and none survived to 3 years. Seventy-one patients underwent surgery without neoadjuvant therapy. Hospital mortality in this group was 1.4 per cent, with 3- and 5-year survival of 21 and 17 per cent—a decreased long-term survival compared with the neoadjuvant therapy group despite the observation that patients who underwent neoadjuvant therapy had a larger tumor size on presentation (5.5 ± 0.4 cm vs 3.8 ± 0.2 cm; P = 0.002). Squamous cell carcinomas seemed to be more responsive to neoadjuvant radiation and chemotherapy followed by surgery than were adenocarcinomas, with a CPR of 44.4 versus 35.5 per cent; however, 5-year survival rates in these complete responders were not significantly different (100% and 78%, respectively; P = 0.97). We report that esophagogastrectomy in conjunction with neoadjuvant therapy results in increased survival compared with surgery without neoadjuvant therapy (P < 0.01), although there may be an increased perioperative mortality associated with neoadjuvant therapy. Further studies are needed to evaluate the role of preoperative chemoradiation and to better identify the pretreatment characteristics of patients with a complete pathological response.
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Hospital mortality in this group was 1.4 per cent, with 3- and 5-year survival of 21 and 17 per cent—a decreased long-term survival compared with the neoadjuvant therapy group despite the observation that patients who underwent neoadjuvant therapy had a larger tumor size on presentation (5.5 ± 0.4 cm vs 3.8 ± 0.2 cm; P = 0.002). Squamous cell carcinomas seemed to be more responsive to neoadjuvant radiation and chemotherapy followed by surgery than were adenocarcinomas, with a CPR of 44.4 versus 35.5 per cent; however, 5-year survival rates in these complete responders were not significantly different (100% and 78%, respectively; P = 0.97). We report that esophagogastrectomy in conjunction with neoadjuvant therapy results in increased survival compared with surgery without neoadjuvant therapy (P &lt; 0.01), although there may be an increased perioperative mortality associated with neoadjuvant therapy. Further studies are needed to evaluate the role of preoperative chemoradiation and to better identify the pretreatment characteristics of patients with a complete pathological response.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>12953828</pmid><doi>10.1177/000313480306900811</doi><tpages>10</tpages></addata></record>
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subjects Adenocarcinoma - drug therapy
Adenocarcinoma - radiotherapy
Adenocarcinoma - surgery
Adult
Aged
Cancer
Carcinoma, Squamous Cell - drug therapy
Carcinoma, Squamous Cell - radiotherapy
Carcinoma, Squamous Cell - surgery
Esophageal Neoplasms - drug therapy
Esophageal Neoplasms - radiotherapy
Esophageal Neoplasms - surgery
Esophagectomy
Esophagogastric Junction - surgery
Female
Gastrectomy
Hospital Mortality
Humans
Length of Stay
Male
Medical treatment
Middle Aged
Neoadjuvant Therapy
Neoplasm Staging
Surgery
Survival Rate
Therapy
Throat
title Multimodality Treatment for Esophageal Cancer: The Role of Surgery and Neoadjuvant Therapy
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