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When a three-stage operative procedure was performed on 303 patients with upperand mid-thoracic esophageal cancer, the operative mortality was 3.9%; the mortality was 8.1% in 294 patients treated by a one-stage operation.8 Resectability also was extended with this method. Studies in animals of transplanted tumors revealed that amputation of the primary lesion in addition to irradiation, when it is performed early, provides the most satisfactory result with the longest survival time. Lymph node metastasis associated with surgical manipulation was definitely prevented by preoperative radiotherapy.
The effect of irradiation is greater in patients who are treated with preoperative, concentrated irradiation than in those who are treated with fractional, preoperative irradiation. A dose of 2,000 to 2,500 rads given over four to five days of concentrated irradiation was found to be most practical and acceptable in 191 patients with esophageal cancer. This treatment caused no increase in operative mortality, operative difficulty,
Nakayama K, Kinoshita Y. Surgical Treatment Combined With Preoperative Concentrated Irradiation. JAMA. 1974;227(2):178-181. doi:10.1001/jama.1974.03230150030008