BACKGROUND AND OBJECTIVES: The prognosis for patients with intramural metastasis (IMM) of esophageal cancer is poor. We examined the role of preoperative chemotherapy in the management of patients with this disease. METHODS: Fifteen patients with IMM of esophageal carcinoma received preoperative chemotherapy cisplatin on day 1 and 5-fluorouracil on days 1 to 5. This regimen was repeated after a 3-week interval, except in patients with progressive disease or severe toxicity who received only one cycle of chemotherapy. Patients underwent surgery around 3 weeks after completion of chemotherapy. Clinical response was evaluated and survival was compared with that of patients who did not receive preoperative chemotherapy. RESULTS: Toxicity was manageable except in one patient who experienced severe neurological adverse effect. The clinical response rate of the IMM was 66.7% (10/15) and the complete response rate was 6.7% (1/15); for the primary lesion, response rates were 86. 7% and 6.7%, respectively. All 15 patients underwent surgery. Seven of the 15 patients (46.7%) experienced non-fatal operative complications. The 5-year survival rate after surgery was 20%. CONCLUSIONS: Preoperative chemotherapy with cisplatin and 5-fluorouracil is feasible in patients with IMM of esophageal carcinoma. This regimen, however, does not improve survival and more effective treatment strategies are required. Copyright 2000 Wiley-Liss, Inc.
BACKGROUND AND OBJECTIVES: The prognosis for patients with intramural metastasis (IMM) of esophageal cancer is poor. We examined the role of preoperative chemotherapy in the management of patients with this disease. METHODS: Fifteen patients with IMM of esophageal carcinoma received preoperative chemotherapy cisplatin on day 1 and 5-fluorouracil on days 1 to 5. This regimen was repeated after a 3-week interval, except in patients with progressive disease or severe toxicity who received only one cycle of chemotherapy. Patients underwent surgery around 3 weeks after completion of chemotherapy. Clinical response was evaluated and survival was compared with that of patients who did not receive preoperative chemotherapy. RESULTS:Toxicity was manageable except in one patient who experienced severe neurological adverse effect. The clinical response rate of the IMM was 66.7% (10/15) and the complete response rate was 6.7% (1/15); for the primary lesion, response rates were 86. 7% and 6.7%, respectively. All 15 patients underwent surgery. Seven of the 15 patients (46.7%) experienced non-fatal operative complications. The 5-year survival rate after surgery was 20%. CONCLUSIONS: Preoperative chemotherapy with cisplatin and 5-fluorouracil is feasible in patients with IMM of esophageal carcinoma. This regimen, however, does not improve survival and more effective treatment strategies are required. Copyright 2000 Wiley-Liss, Inc.