Abstract
Preoperative chemotherapy for localized esophageal cancer is an area of increasing interest because neither surgery nor radiation has had a major impact on disease-free or overall survival. This is probably because, as several autopsy series have demonstrated, esophageal cancer is a systemic disease. Preoperative chemotherapy thus, in theory, allows a simultaneous attack on both the primary and metastatic disease. A number of single-arm, Phase II, multimodality trials have been completed. Toxicities of chemotherapy, while substantial, have been tolerable. With careful attention to detail, operative morbidity and mortality have not been increased. Although the theory is attractive, large-scale randomized trials are now needed to evaluate the impact of this technique on disease-free and overall survival before recommending it for general use.
Résumé
La chimiothérapie préopératoire pour traiter le cancer de l'oesophage limité est d'un intérêt croissant du fait que ni la chirurgie ni l'irradiation ont eu une action efficace sur la guérison ou la survie globale. Cela est dû probablement au fait que plusieurs séries d'autopsies ont démontré que le cancer de l'oesophage est une maladie systémique. La chimiothérapie préopératoire, au moins théoriquement, permet une action simultanée à la fois sur la maladie elle-même et sur les métastases. De nombreux essais ont été conduits. La toxicité de la chimiothérapie, quoique indéniable, fut acceptable. Grâce à une attention soigneuse portée aux modalités d'application la morbidité opératoire et la mortalité n'ont pas augmenté. Bien qu'en théorie la pratique de la chimiothérapie soit tentante, des essais randomisés sur une large échelle sont nécessaires pour apprécier avec précision l'effet de cette technique sur la guérison éventuelle et sur la survie globale avant de recommander son emploi systématique.
Resumen
La quimioterapia preoperatoria en el manejo de cáncer esofágico constituye un área de creciente interés puesto que ni la ciragía ni la irradición han tenido un impacto mayor sobre el estado libre de enfermedad o la supervivencia global. Probablemente esto es debido a que, tal como lo han documentado varias series de autopsias, el cáncer esofágico es una enfermedad sistémica. Por lo tanto, en teoría, la quimioterapia preoperatoria, hace posible un ataque simultáneo sobre la enfermedad primaria y la enfermedad metastática. Un número de ensayos clínicos, con o sin radioterapia concurrente, de tipo Fase II no aleatorizados han sido realizados. La toxicidad de la quimioterapia, aunque substancial ha sido tolerable. Con meticulosa atención al detalle, la cirugía no ha mostrado aumento en la morbilidad o mortalidad operatorias. Sin embargo, a pesar de que la teoría es atractiva, es necesario realizar ensayos clínicos aleatorizados de tipo Fase III en gran escala para evaluar el impacto de ésta técnica sobre las tasas de estado libre de enfermedad y supervivencia global antes de recomendarla para uso general.
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Kelsen, D.P. Preoperative chemotherapy in esophageal carcinoma. World J. Surg. 11, 433–438 (1987). https://doi.org/10.1007/BF01655806
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DOI: https://doi.org/10.1007/BF01655806