Surgical treatment combined with preoperative concentrated irradiation for esophageal cancer

Abstract

When a three‐stage operative procedure was performed in 200 cases of upper and midthoracic esophageal cancer, the operative mortality was 2.5% compared with 9.7% mortality of 236 patients treated by a one‐stage operation. Resectability also was extended with this method. Animal studies of transplanted tumors revealed that amputation of the primary lesion in addition to irradiation, when performed early, provides the most satisfactory result with the longest survival time. Lymph node metastasis associated with surgical manipulation was definitely prevented by preoperative radiotherapy. The effect of irradiation is greater in patients treated with preoperative concentrated irradiation than in those treated with fractional preoperative irradiation. In 191 patients with esophageal cancer 2000 to 2500 rads given over four to five days of concentrated irradiation was most practical and acceptable. This treatment caused no increase in operative mortality, operative difficulty or disturbance in hematopoetic and hepatic function. In those patients with cancer of the upper and midthoracic esophagus treated by irradiation plus surgery the 4‐year survival rate was 31.8% and the 5‐year survival rate was 37.5% in contrast to a 4‐year survival rate of 15.4% and a 5‐year survival rate of 19.1% in those patients treated by resection only. The authors conclude that preoperative irradiation, especially concentrated irradiation, should be added to the surgical treatment of upper and midthoracic esophageal cancer.

Mode of Lymphadenectomy and Surgical Outcome of Upper Thoracic Esophageal Squamous Cell Carcinoma

“…Before 1980, preoperative radiation therapy was usually undertaken for clinical T2-T4 tumors. 12 Postoperative adjuvant chemotherapy was administered to all eligible patients according to the protocols of the Japan Esophageal Oncology Group, which conducted three consecutive randomized controlled trials after 1980. [5][6][7] Preoperative adjuvant therapy was administered as follows: one patient received chemotherapy, 95 patients received radiation therapy, and 27 patients received chemoradiation therapy.…”

Radiation therapy alone or in combination with surgery in the treatment of carcinoma of the esophagus

“…The patients undergoing preoperative radiation and exploration in our series differ from those reported in Nakayama et al, 13 Marks et al, 14 and Katlic and Grillo" in that they were considered, by and large to have unresectable disease at presentation. The 14 of 15 patients undergoing exploration with esophagectomy had a survival of 33% at 18 months but 0% at 2 years, which may reflect the advanced nature of their disease.…”

Improved Surgical Results in Thoracic Esophageal Squamous Cell Carcinoma: A 40-year Analysis of 792 Patients

“…[8][9][10] Before 1980, preoperative radiation therapy was usually undertaken for clinical T2-T4 tumors. 11,12 Surgical Techniques…”