Brief Reports
Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2005; 11(34): 5367-5372
Published online Sep 14, 2005. doi: 10.3748/wjg.v11.i34.5367
Esophagectomy for locally advanced esophageal cancer, followed by chemoradiotherapy and adjuvant chemotherapy
Hung-Chang Liu, Shih-Kai Hung, Charn-Jer Huang, Chung-Chu Chen, Ming-Jen Chen, Chun-Chao Chang, Cheng-Jeng Tai, Chi-Yuan Tzen, Li-Hua Lu, Yu-Jen Chen
Hung-Chang Liu, Shih-Kai Hung, Charn-Jer Huang, Chung-Chu Chen, Ming-Jen Chen, Chi-Yuan Tzen, Li-Hua Lu, Yu-Jen Chen, Departments of Thoracic Surgery, Radiation Oncology, Gastroenterology, and Pathology, Mackay Memorial Hospital, Taipei, Taiwan, China
Hung-Chang Liu, Chun-Chao Chang, Cheng-Jeng Tai, Taipei Medical University Hospital, Taipei, Taiwan, China Hung-Chang Liu, Mackay Junior College of Nursing, Taipei, Taiwan
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Yu-Jen Chen, Department of Radiation Oncology, Mackay Memorial Hospital, 92 Chung San North Road, Section 2, Taipei 104, Taiwan, China. chenmdphd@yahoo.com
Telephone: +886-2-28094661 Fax: +886-2-28096180
Received: December 29, 2004
Revised: February 23, 2005
Accepted: February 28, 2005
Published online: September 14, 2005
Abstract

AIM: To compare the efficacy and toxicity of a three-step combination therapy with post-operative radiation alone for locally advanced esophageal cancer.

METHODS: Patients with T3-4 and N0-1 esophageal carcinoma from a number of institutions were non-randomly, prospectively enrolled in the study. All patients underwent single-stage curative en bloc esophagectomy. The patients were then assigned into one of two treatment groups based on treatment consisting of either post-operative concurrent chemoradiotherapy (CCRT) with weekly cisplatin 30 mg/m2 followed by systemic adjuvant chemotherapy (four monthly cycles of cisplatin 20 mg/m2 and 5-fluorouracil 1 000 mg/m2 for five consecutive days), or, post-operative radiation alone. The radiotherapy dose was 55-60 Gy for all patients. Primary end-point of this study was to assess the per-protocol patients’ improvement of overall survival benefit. Secondary end-point was designed to evaluate both the per-protocol and intent-to-treat patients’ outcome of survival.

RESULTS: A total of 60 patients (n = 30 per group) were enrolled in this study. The two groups were generally comparable for demographic characteristics and hematological and non-hematological toxicities. The CCRT with weekly cisplatin was well tolerated, with significantly better overall survival (30.9 mo vs 20.7 mo; 95% CI, 27.5-36.4 vs 15.2-26.1) and 3-year survival (70.0% vs 33.7%; P = 0.003). Low histological grade of tumor (P < 0.001) was associated with favorable survival in these locally advanced patients.

CONCLUSION: For locally advanced esophageal cancer, the combination of esophagectomy, post-operative CCRT with weekly cisplatin and systemic adjuvant chemotherapy is well tolerated and effective. A large-scale, prospective randomized trial of this regimen is in progress.

Keywords: Curative esophagectomy; Concurrent chemoradiotherapy; Cisplatin