Skip to main content
Log in

The clinical efficacy of neoadjuvant chemotherapy in squamous esophageal cancer: A prospective nonrandomized study of pulse and continuous-infusion regimens with cisplatin and 5-fluorouracil

  • Original Articles
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We evaluated cisplatin and 5-fluorouracil as preoperative adjuvant chemotherapy for patients with locally advanced squamous esophageal cancer and compared two different infusion regimens. The outcomes were also compared with those of our historical control patients treated by surgery alone.

Methods

From 1991 to 1997, 83 consecutive esophageal cancer patients underwent surgical exploration after completion of two cycles of cisplatin and 5-fluorouracil chemotherapy regimens, either in pulse or in continuous infusion cycles. Outcomes were compared with those of 76 historical control patients. Both groups were comparable in demographic characteristics and tumor stages. The resection rates, operative morbidity, mortality, and survival rates were compared.

Results

Partial response was achieved in 50% of patients who received chemotherapy. There was no chemotherapy-related mortality. The resection, morbidity, and mortality rates and median survival between the surgery-alone group and the chemotherapy group were 71.1% vs. 82%, 51% vs. 55%, and 4% vs. 10.8%, 12.0 vs. 13.5 months, respectively (P>.05). There was also no statistically significant difference between the two regimens.

Conclusions

Preoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil infusion, in pulse or continuous regimens, followed by surgery for squamous esophageal cancer patients had no added benefit in the overall survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Skinner DB. En bloc resection for neoplasms of the esophagus and cardia.J. Thorac Cardiovasc Surg 1983;85:59–71.

    PubMed  CAS  Google Scholar 

  2. Akiyama H, Tsurumaru M, udagawa H, Kajiyama Y. Radical lymph node dissection for cancer of the thoracic esophagus.Ann Surg 1994;220:364–72.

    Article  PubMed  CAS  Google Scholar 

  3. Holscher AH, Bollschweiler E, Schneider PM, Siewert JR. Prognosis of early esophageal cancer. Comparison between adeno- and squamous cell carcinoma.Cancer 1995;76:178–86.

    Article  PubMed  CAS  Google Scholar 

  4. Earlam R, Cunha-Melo JR. Esophageal squamous cell carcinoma: I. A critical review of surgery.Br J Surg 1980;67:381–90.

    Article  PubMed  CAS  Google Scholar 

  5. Muller JM, Erasmi H, Stelzner M, Zieren U, Pichlmaier H. Surgical therapy of esophageal carcinoma.Br J Surg 1990;77:845–57.

    Article  PubMed  CAS  Google Scholar 

  6. Gurther GC, Robertson CS, Chung SC, Li AK. Two-team synchronous oesophagectomy.Br J Surg 1994;81:1620–2.

    Article  Google Scholar 

  7. Carey RW, Hilgenberg AD, Choi NC, et al. A pilot study of neoadjuvant chemotherapy with 5-fluorouracil and cisplatin with surgical resection and postoperative radiation therapy and/or chemotherapy in adenocarcinoma of the esophagus.Cancer 1991;68: 489–92.

    Article  PubMed  CAS  Google Scholar 

  8. Kies MS, Rosen ST, Tsang TK, et al. Cisplatin and 5-fluorouracil in the primary management of squamous esophageal cancer.Cancer 1987;60:2156–60.

    Article  PubMed  CAS  Google Scholar 

  9. De Besi P, Sileni VC, Salvagno L, et al. Phase II study of cisplatin, 5-FU, and allopurinol in advanced esophageal cancer.Cancer Treat Rep 1986;70:909–10.

    PubMed  Google Scholar 

  10. Schlag PM. Randomized trial of preoperative chemotherapy for squamous cell cancer of the esophagus. The Chirurgische Arbeitsgemeinschaft fuer Onkologie der Deutschen Gesellschaft fuer Chirurgie Study Group.Arch Surg 1992;127:1446–50.

    PubMed  CAS  Google Scholar 

  11. Roth JA, Pass HI, Flanagan MM, Graeber GM, Rosenberg JC, Steinberg S. Randomized clinical trial of preoperative and postoperative adjuvant chemotherapy with cisplatin, vindesine, and bleomycin for carcinoma of the esophagus.J Thorac Cardiovasc Surg 1988;96:242–8.

    PubMed  CAS  Google Scholar 

  12. Kelsen DP, Minsky B, Smith M, et al. Preoperative therapy for esophageal cancer: a randomized comparison of chemotherapy versus radiation therapy.J Clin Oncol 1990;8:1352–61.

    PubMed  CAS  Google Scholar 

  13. Kelsen DP, Ginsberg R, Pajak TF, et al. Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer.N Engl J Med 1998;339:1979–84.

    Article  PubMed  CAS  Google Scholar 

  14. Griffith JF, Chan ACW, Ahuja AT, et al. Neck ultrasound in staging squamous esophageal carcinoma—a high yield technique.Clin Radiol 2000;55:696–701.

    Article  PubMed  CAS  Google Scholar 

  15. Findlay M, Cunningham D, Norman A, et al. A phase II study in advanced gastro-esophageal cancer using epirubicin and cisplatin in combination with continuous infusion 5-fluorouracil (ECF).Ann Oncol 1994;5:609–16.

    PubMed  CAS  Google Scholar 

  16. Highley MS, Parnis FX, Trotter GA, et al. Combination chemotherapy with epirubicin, cisplatin and 5-fluorouracil for the palliation of advanced gastric and esophageal adenocarcinoma.Br J Surg 1994;81:1763–5.

    Article  PubMed  CAS  Google Scholar 

  17. Liang EY, Chan A, Chung SC, Metreweli C. Short communication: esophageal tumor volume measurement using spiral CT.Br J Radiol 1996;69:344–7.

    Article  PubMed  CAS  Google Scholar 

  18. Griffith JF, Chan ACW, Chow LTC, et al. Assessing chemotherapy response of esophageal carcinoma with spiral CT.Br J Radiol 1999;72:678–84.

    PubMed  CAS  Google Scholar 

  19. Nygaard K, Hagen S, Hansen HS, et al. Pre-operative radiotherapy prolongs survival in operable esophageal carcinoma: a randomized, multicenter study of pre-operative radiotherapy and chemotherapy. The second Scandinavian trial in esophageal cancer.World J Surg 1992;16:1104–9.

    Article  PubMed  CAS  Google Scholar 

  20. MRC Upper GI Tract Cancer Group. Medical Research Council (MRC) randomized phase III trial of surgery with or without pre-operative chemotherapy in resectable cancer of the oesophagus (abstract).Br J Cancer 2000;83(Suppl 1):1.

    Google Scholar 

  21. Matsubara T, Ueda M, Nakajima T. Preoperative assessment of lymph nodes in the prediction of disease spread and outcome in cancer of the thoracic esophagus.Br J Surg 1995;82:356–9.

    Article  PubMed  CAS  Google Scholar 

  22. Roubein LD, Dubrow R, David C, et al. Endoscopic ultrasonography in the quantitative assessment of response to chemotherapy in patients with adenocarcinoma of the esophagus and esophagogastric junction.Endoscopy 1993;25:587–91.

    Article  PubMed  CAS  Google Scholar 

  23. Hordijk ML, Kok TC, Wilson JH, Mulder AH. Assessment of response of esophageal carcinoma to induction chemotherapy.Endocropy 1993;25:592–6.

    CAS  Google Scholar 

  24. Fok M, Sham JS, Choy D, Cheng SW, Wong J. Postoperative radiotherapy for carcinoma of the esophagus: a prospective, randomized controlled study.Surgery 1993;113:138–47.

    PubMed  CAS  Google Scholar 

  25. Goldminc M, Maddern G, Le Prise E, Meunier B, Campion JP, Launois B. Oesophagectomy by a transhiatal approach or thoracotomy: a prospective randomized trial.Br J Surg 1993;80:367–70.

    Article  PubMed  CAS  Google Scholar 

  26. Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment.Cancer 1981;47:207–14.

    Article  PubMed  CAS  Google Scholar 

  27. Forastiere AA, Heitmiller RF, Lee DJ, et al. Intensive chemoradiation followed by esophagectomy for squamous cell and adenocarcinoma of the esophagus.Cancer J Sci Am 1997;3:144–52.

    PubMed  CAS  Google Scholar 

  28. Le Prise E, Etienne PL, Meunier B, et al. A randomized study of chemotherapy, radiation therapy, and surgery versus surgery for localized squamous cell carcinoma of the esophagus.Cancer 1994; 73:1779–84.

    Article  PubMed  Google Scholar 

  29. Bosset JF, Gignoux M, Triboulet JP, et al.. Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus.N Engl J Med 1997;337:161–7.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S. C. S. Chung MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chan, A.C.W., Lee, D.W.H., Griffith, J.F. et al. The clinical efficacy of neoadjuvant chemotherapy in squamous esophageal cancer: A prospective nonrandomized study of pulse and continuous-infusion regimens with cisplatin and 5-fluorouracil. Annals of Surgical Oncology 9, 617–624 (2002). https://doi.org/10.1007/BF02574476

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02574476

Key Words

Navigation