Treatment of Esophageal Carcinoma by Pre-operative Chemo-radiotherapy Modality Cancer Research Center, Mashhad University of Medical Sciences

Combined modality treatments have been proposed for improving survival in patients with esophageal carcinoma. In this study, we evaluated the results of neoadjuvant radiotherapy and chemotherapy followed by surgery in patients with esophageal Squamous Cell Carcinoma (SCC). Between September 2001 and September 2006, 75 patients with Operable esophageal SCC underwent neoadjuvant radiotherapy (30 Gray/10 fractions in 34 or 40 Gray/20 fractions in 41 cases) followed by trans-hiatal esophagectomy at Omid Hospital, Mashhad, Iran. A total of 42 patients received at least 3 courses of chemotherapy containing cisplatin and 5FU. Complete response to neoadjuvant treatment was found in 5 cases (6.7%). With a median follow up time of 13 months, 21 cases (28%) experienced recurrence including 9 locoregional recurrences, 9 distant metastasis and 3 concomitant local and distant failure. Period of 3-year survivals for all patients was 62.2%. There was no significant difference in survival between patients treated with either radiotherapy protocols (p=0.37). Patients who received at least 3 courses of chemotherapy had relatively better survival compared with those receiving less than three courses or no chemotherapy (p=0.09). In comparison with patients having grade III tumors, patients with grade I & II tumors had significantly better survival rate (p=0.05). Major treatment complications included leukopenia in 13 (17%), anemia in 6 (8%), Thrombocytopenia in 2 (3%), postsurgical fistula in 2 (3%) and anastomosis stricture in 8 (11%) patients. In this study, neoadjuvant chemoradiotherapy and surgery achieved satisfactory survival and acceptable incidence of complications for patients with esophageal SCC and we recommend further investigation in this regard.