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Improved survival with neoadjuvant therapy and resection for adenocarcinoma of the esophagus.
- Source :
-
Annals of surgery [Ann Surg] 1993 Oct; Vol. 218 (4), pp. 571-6; discussion 576-8. - Publication Year :
- 1993
-
Abstract
- Objective: This study sought to determine the impact of preoperative chemotherapy and radiation therapy (neoadjuvant therapy) followed by resection in patients with adenocarcinoma of the esophagus.<br />Summary Background Data: Long-term survival in patients with carcinoma of the esophagus has been poor. An increase in the incidence of adenocarcinoma of the esophagus has been reported recently.<br />Methods: Fifty-eight patients with biopsy-proven adenocarcinoma of the esophagus treated at this institution from January 1951 through February 1993 were studied. Since 1989, 24 patients were entered prospectively into a multimodality treatment protocol consisting of preoperative cisplatin, 5-fluorouracil (5-FU), and leucovorin with or without etoposide, and concomitant mediastinal radiation (30 Gy). Patients were re-evaluated and offered resection.<br />Results: There were no deaths related to neoadjuvant therapy and toxicity was minimal. Before multimodality therapy was used, the operative mortality rate was 19% (3 of 16 patients). With multimodality therapy, there have been no operative deaths (0 of 23 patients). The median survival time in patients treated before multimodality therapy was 8 months and has yet to be reached for those treated with the neoadjuvant regimen (> 26 months, p < 0.0001). The actuarial survival rate at 24 months was 15% before multimodality therapy and 76% with multimodality therapy. No difference in survival was noted in neoadjuvant protocols with or without etoposide (p = 0.827).<br />Conclusions: Multimodality therapy with preoperative chemotherapy and radiation therapy followed by resection appears to offer a survival advantage to patients with adenocarcinoma of the esophagus.
- Subjects :
- Actuarial Analysis
Adenocarcinoma drug therapy
Adenocarcinoma radiotherapy
Adult
Aged
Aged, 80 and over
Chemotherapy, Adjuvant
Combined Modality Therapy
Esophageal Neoplasms drug therapy
Esophageal Neoplasms radiotherapy
Female
Humans
Male
Middle Aged
Prospective Studies
Survival Rate
Adenocarcinoma mortality
Adenocarcinoma therapy
Esophageal Neoplasms mortality
Esophageal Neoplasms therapy
Preoperative Care
Subjects
Details
- Language :
- English
- ISSN :
- 0003-4932
- Volume :
- 218
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Annals of surgery
- Publication Type :
- Academic Journal
- Accession number :
- 8215648
- Full Text :
- https://doi.org/10.1097/00000658-199310000-00017