Objectives: This cogitation evaluated the concurrent treatment of chemoradiation followed by the agency of esophagectomy in the management of locoregional esophageal carcinoma.

Objectives: This cogitation evaluated the concurrent treatment of chemoradiation followed by the agency of esophagectomy in the management of locoregional esophageal carcinoma. The main extreme point points were to determine the resectability of the tumor and the pathologic tumor replication An accessory aim was to evaluate the survival rate.

Patients and methods: Thirty-nine patients were treated as follows: 5-fluoruracil, 1000 mg/[msup2] at 24-h IV infusion for 4 days, and cisplatin, 100 mg/[msup2] forward day 1. Concurrent radiotherapy was delivered at a total dose of 40 Gy in daily fractions of 2 Gy five times by means of week. The performance of an esophagectomy was planned 4 weeks after induction treatment and restaging.

Results: All patients complet the preoperative treatment. A potentially radical resection was performed in 29 patients, and a ended or partial histologically proven rejoinder was observed in 9 patients (23%) and 20 patients (51%) respectively. The 3-year overall survival rate was 40% The 3-year rates of overall survival and disease-free survival were 88% and 76% respectively, in patients with unimpaired response (p < 0.0012), and 16% and 17% respectively, in patients with partial answer (p < 0.0013). Age, histology, and answer represented the best prognostic protoplast related to survival.

Conclusions: The originates of this combined approach appear to be better than those reported with surgery alone. Despite the small number of patients in the series and the inclusion of patients with different histotypes, we conclud that patients with the squamous histotype display a better outcome than those with adenocarcinoma.

tonic words: esophageal cancer; pathologic unbroken response; preoperative chemoradiation

Abbreviations: ANOVA = analysis of variance; CR = unbroken response; DFS = disease-free survival; EUS = endoscopic ultrasonography; O = overall survival; PR=partial response; P = performance status; WHO = World Health Organization

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While still relatively rare in Western countries, esophageal cancer is a actual aggressive tumor, and only 40 to 60% of patients at hand with clinically localized disease. These patients usually are treated predominantly with surgery However, resection is frequently not radical, and the overall 5-year survival rate remains poor, with solely 10% of patients alive after surgery (1) This poor prognosis bring reproachs the fact that few esophageal tumors are diagnosed at an early stage and that, calm in localized stages, early lymphatic and hematogenous dissemination come to one's minds owing to the underlying anatomy. (2) Therefore, esophageal cancer may not be cur from local approaches, such as surgery or radiotherapy. Combination chemoradiotherapy provides a clear survival advantage when compared to radiation therapy alone. (34) Chemoradiotherapy with after esophagectomy has been reported to be effective as well, although the value of surgery is still not unequivocal. The goal of this approach was predominantly aimed at eliminating micrometastases and facilitating clean tumor resection, which is the requisite for long-term survival. Chemotherapy agents of the like kind as 5-fluorouracil, cisplatin, mitomycin, and bleomycin have been shown to be highly effective in previously untreated patients, particularly when associated with concomitant radiotherapy. Preoperative chemoradiotherapy has been demonstrated to follow in a pathologic complete answer (CR) rate of approximately 20 to 30% (56) However, a wide range of pathologic CR survival, and mortality rates have been reported in the literature. Factors influencing these deductions include the modality of patient sampling, the design of the studies, and inadequate staging. (78) The use of positron emission tomography using 18-fluorodeoxy-glucose has been shown to improve the clinical staging of patients with locally advanced esophageal cancer. (910) Moreover, improvements in staging managements have been achieved with endoscopic ultrasonography (EUS), which is superior to one as well as the other CT scanning and MRI in assessing esophageal involvement. (1112) Although publicly not useful in patient management, EUS does enhance the precision in clinical staging and should be used to selected or stratify patients in clinical trials. Here we report the outcomes of a phase II meditation employing concurrent preoperative chemoradiotherapy in patients with the two adenocarcinoma and squamous cell carcinoma of the esophagus staged with EUS. The main goal of this trial was to investigate the influence of a primary treatment forward tumor resectability, pathologic tumor replication and prognosis.

MATERIALS AND METHODS

Patient Selection

Between February 1994 and June 1999 73 patients with previously untreated, biopsy-proven adenocarcinoma or squamous enclosed space carcinoma of the esophagus were admitted at our hospital. upon evaluation, 3 patients had tumors of the cervical esophagus, 9 patients were affected according to metastatic disease, 7 patients had early-stage disease (ie, T1-T2 N0) and 15 patients had poor performance status (PS) which made them eligible for best supportive care sole Therefore, the remaining 39 patients with locally advanced disease (ie, T3-T4 N0 or any TN+) Eastern Cooperative Oncology assign places to PS 0 to 2, adequate pulmonary function to tolerate an esophagectomy, and no pre-existing renal, hepatic, or hematologic dysfunction were eligible for associate preoperative chemoradiation. The pretreatment evaluation included physical examination, serum chemistry touchstones barium esophagogram, contrast CT scanning of the chest and abdomen, and esophageal EUS. Bronchoscopy was performed in patients with tumors at or above the carina. Based in succession the results of the EUS, patients were assigned to a preoperative clinical stage according to the 1992 TNM connected view of the American Joint Committee forward Cancer. All patients gave written informed consent

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