A Swedish Study of Chemoradiation in Squamous Cell Carcinoma of the Esophagus

Efficacy of Neoadjuvant Chemoradiotherapy in Resectable Esophageal Squamous Cell Carcinoma

“…Nevertheless, the results from phase II and phase III trials at this time are intriguing and lend impetus to further investigation of this potential multimodality approach. In our study, the combination of 5-FU, cisplatin and hyperfractionated radiotherapy led to a pCR of 43%, which is similar to that of a Swedish multicenter study (46%) (9) and fairly high compared with the results previously obtained with a similar combination using 5-FU and cisplatin (7 Â/33%) (5, 7, 19 Á/21). Even after we reduced the dose of 5-FU and radiotherapy, the pCR rate remained constant.…”

“…There were four postoperative deaths (10%). Although this figure is rather high for a modern series (9,14), it was comparable to that observed with the surgery alone matched historic control and that of reports elsewhere (2, 8, 10 Á/13, 31). These findings confirm that preoperative regimens have not led to an increase in postoperative mortality and morbidity (12,18,31).…”

“…In addition, even though there have been conflicting results (1,21,26), squamous cell carcinoma is likely to be more sensitive to CRT than adenocarcinoma (18), which perhaps also supports the high pCR rate in our study. In line with previous studies, a pCR to CRT was strongly predictive of long-term survival (5,6,9,14,15,20). In our study, we used strict criteria to assess clinical response.…”

Chemoradiotheraphy of Esophageal Cancer

“…In our own study published in 1991, 20% received a histologically complete response, and in this group all patients were long-term survivors. In all studies so far reported, improved survival is observed for patients who are pathologically complete responders (40)(41)(42)(43)(44)(45)(46)(47). A recently reported abstract of a Medical Research Council trial of chemotherapy before surgery versus surgery alone shows a statistically signi cant improvement in survival (48).…”

“…The swallowing function is often well restituted for responding patients and for those with remaining tumors surgical salvage is still possible. Several studies with preoperative chemoradiation have shown that a pathologically complete remission is predictive of those who will be long-term survivors (40)(41)(42)(43)(44)(45)(46)(47). This also stresses the need for a surgical resection.…”