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Adjuvant therapies for cancer of the thoracic esophagus

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Abstract

During the past four decades, especially in recent years, various active adjuvant therapies combined with surgery have improved the outcome in cases of cancer of the esophagus. However, no optimum adjuvant therapy has been determined. From 1981 to 1992, 341 patients with regional and distant node metastasis who underwent curative surgery were treated with postoperative radiotherapy (RT), postoperative radiochemotherapy (RC), and postoperative aggressive chemotherapy (AGC) in a controlled study in our department of surgery. Five-year survival rates, including operative deaths and unrelated diseases of the former group, were 0% for RT, 19.9% for surgery alone, 39.8% for RC, and 48.2% for AGC. Such rates for the latter group were 6.8% for AGC, 13.3% for surgery alone, and 33.3% for RC. In addition, results of a group study on the effectiveness of three-field node dissection in 715 cases of thoracic esophageal carcinoma by 10 institutions were analyzed. This analysis showed that there were no differences in the 5-year survival rate of curative surgery in cases with positive nodes among the groups treated with surgery alone (SA), with postoperative radiotherapy (PR), and with postoperative chemotherapy (PC). As to the 91 cases with positive cervical nodes, the 3-year survival rates in cases treated with SA (n=22), PR(n=20), and PC (n=49) were 25.3%, 48.1%, and 53.6%, respectively; a significant improvement of survival in these patients. Summaries of studies of preoperative or postoperative radiotherapy, and both multimodal therapies are introduced.

Résumé

Pendant les quatre dernières décennies, et surtout plus récemment, les traitements adjuvants après la chirurgie ont grandement amélioré le pronostic des cancers de l'oesophage. Cependant, le traitement idéal reste à trouver. Entre 1981 et 1992, 341 patients ayant des métastases lymphatiques régionales et à distance, et ayant eu une résection à visée curative, ont eu en postopératoire, soit une radiothérapie (RT), soit une radìochimiothérapie (RC), soit encore une chimiothérapie agressive (CA) dans le cadre d'une étude contrôlée dans notre département de chirurgie. Les survies à 5 ans, y compris les décès opératoires et les décès sans rapport avec leur maladie ont été de 0% pour la RT, de 19.9% pour la chirurgie seule, de 39.8% pour la RC et de 48.2% pour la CA dans le premier groupe de malades. Ces mêmes taux de survie étaient de 6.8% pour la CA, 13.3% pour la chirurgie seule et de 33.3% pour la RC dans le deuxième groupe. Les résultats d'une étude comparant l'efficacité du curage à trois champs chez 715 cas de cancer oesophagien provenant de 10 institutions ont été anlysés. II n'y avait aucune différence dans la survie à 5 ans selon que les patients ont été traités par la chirurgie seule (C), avec une radiothérapie postopératoire (RP) ou par une chimiothérapie postopératoire (CP). Chez les 91 patients ayant des ganglions cervicaux envahis, cependant, la survie à 3 ans chez les patients traités par C (n=22), par RP (n=20) ou CP (n=49) étaient de 25.3%, 48.1% et de 53.6%, respectivement, ce qui semble démontrer l'amélioration importante chez ces patients. Les résultats des études comportant une radiothérapie pré-et/ou postopératoire et les thérapies multidisciplinaires sont résumés.

Resumen

Durante los último quaranta años, especialemente los mas recientes se ha registrado una mejoría en los resultados del manejo del cáncer del esófago con el uso de diversas clases de terapias adyuvantes combinadas con cirugía. Sin embargo, aún no se ha definido cual es la terapia adyuvante óptima.

Entre 1981 y 1992, 341 pacientes con metástasis ganglionares regionales y distantes sometidos a cirugía curativa fueron tratados con radioterapia postoperatoria (RT), radioquimioterapia postoperatoria (RQ) y quimioterapia postoperatoria agresiva (QPA) en un estudio controlado, en nuestro departamento quirúrgico.

Las tasas de sobrevida a cinco años, incluyendo muertes operatorias y enfermedades no relacionadas, en el primer grupo (ganglios regionales) fueron 0% para RT, 19.9% para cirugía sola, 39.8% para RQ y 48.2% para QPA.

Las tasas para el segundo grupo (ganglios distantes) fueron 6.8% para QPA, 13.3% para cirugía sola y 33.3% para RQ. Además, se analizaron los resultados en un grupo estudio sobre la eficacia de la disección de tres campos en 715 casos de carcinoma del esófago torácico realizada en diez instituciones japonesas.

Tal análisis demostró que no había diferencia en la sobrevida a cinco años en los casos de cirugía curativa en los pacientes con ganglios positivos tratados con cirugía sola, con radioterapia postoperatoria y con quimioterapia postoperatoria.

Sin embargo, en cuanto a los 91 casos con ganglios cervicales positivos, las tasas de sobrevida a 3 años en los pacientes de cirugía sola (n=22), radioterapia postoperatoria (n=20) y quimioterapia postoperatoria (n=49) fueron 25.3%, 48.1% y 53.6% respectivamente, lo cual indica una mejoría significatíva.

Se presentan en este artículo resúmenes de los estudios sobre radioterapia preoperatoria y/o postoperatoria y terapias multimodales.

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  1. Second Department of Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, 980, Sendai, Japan

    Tetsuro Nishihira M.D., Tatsuya Nakano M.D. & Shozo Mori M.D.

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Nishihira, T., Nakano, T. & Mori, S. Adjuvant therapies for cancer of the thoracic esophagus. World J. Surg. 18, 388–398 (1994). https://doi.org/10.1007/BF00316819

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