[Skip to Content]
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
August 1996

The Role of Neoadjuvant Therapy in Surgically Resectable Esophageal Cancer

Author Affiliations

From the Department of Surgery, Divisions of General Surgery (Drs Swisher, Doty, Zinner, and McFadden), Cardiothoracic Surgery (Dr Holmes), and Surgical Oncology (Dr Hunt), University of California Medical Center, Los Angeles. Drs Swisher and Hunt are currently at the University of Texas M. D. Anderson Cancer Center, Houston; Dr Zinner is currently at Brigham and Women's Hospital, Boston, Mass; and Dr Doty is currently at Good Samaritan Hospital, San Jose, Calif.

Arch Surg. 1996;131(8):819-825. doi:10.1001/archsurg.1996.01430200029005

Objective:  To determine the effect of neoadjuvant therapy (NT) (preoperative chemotherapy, radiation therapy, or both) in surgically resectable esophageal cancer.

Design:  A retrospective review over a 20-year period.

Setting:  A tertiary academic medical center.

Participants:  All patients undergoing surgical resection for esophageal cancer (N=316) over this time period.

Main Outcome Measures:  Perioperative morbidity and mortality, local and distant recurrences, and overall survival.

Results:  Patients undergoing NT (n= 106) had prognostic factors similar to those treated with surgery alone (n=210). No increase was noted in surgical morbidity with NT (anastomotic leaks, reoperation rates, complications, or extended hospital stays). Overall survival was not improved by NT (median survival, 14 months) except in the subset of patients (11/83) who responded completely (100% histological necrosis) to preoperative chemotherapy (median survival, 79.2 months; P<.02). Complete response to radiation therapy alone was not associated with improved survival. Partial necrosis of the primary tumor was seen in 13 (15%) of 83 patients but conferred no survival advantage. Complete response to preoperative chemotherapy was associated with squamous cell pathological features and excellent performance status as measured by preanesthesia evaluation.

Conclusions:  The addition of NT did not increase perioperative morbidity or mortality. Only the subset of patients who had a complete response to preoperative chemotherapy showed a survival advantage. Excellent performance status and squamous cell pathological features were associated with an increased chance of complete pathological response following preoperative chemotherapy.Arch Surg. 1996;131:819-825

DeMeester TR, Barlow AP.  Surgery and current management for cancer of the esophagus and cardia . Curr Probl Surg . 1988;25:477-531.Article
Muller JM, Erasmi H, Stelzner M, Zieren U, Pichlmaier H.  Surgical therapy of oesophageal carcinoma . Br J Surg . 1990;77:845-857.Article
Fahn H-J, Wang L-S, Huang B-S, Huang M-H, Chien K-Y.  Tumor recurrence In long-term survivors after treatment of carcinoma of the esophagus . Ann Thorac Surg . 1994;57:677-681.Article
Forastiere AA, Orringer MB, Perez-Tarnayo C, Urba SG, Zahurak M.  Preoperative chemoradiation followed by transhiatal esophagectomy for carcinoma of the esophagus: final report . J Clin Oncology . 1993;11:1118-1123.
Naunheim KS, Petruska PJ, Roy TS, et al.  Preoperative chemotherapy and radiotherapy for esophageal carcinoma . J Thorac Cardiovasc Surg . 1992;103: 887-895.
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;96:242-248.
Wolfe WG, Vaughn AL, Seigler HF, Hathorn JW, Leopold KA, Duhaylongsod FG.  Survival of patients with carcinoma of the esophagus treated with combined-modality therapy . J Thorac Cardiovasc Surg . 1993;105:749-756.
Mandard A-M, Dalibard F, Mandard J-C, et al.  Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma: clinicopathologic correlations . Cancer . 1994;73:2680-2686.Article
Herskovic A, Martz K, Al-Sarraf M, et al.  Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus . N Engl J Med . 1992;326:1593-1598.Article
Schlag PM.  Randomized trial of preoperative chemotherapy for squamous cell cancer of the esophagus . Arch Surg . 1992;127:1446-1450.Article
Wu GS, El-Deiry W.  Apoptotic death of tumor cells correlates with chemosensitivity of p53 or bcl-2 . Clin Cancer Res . 1996;2:623-633.