Concurrent preoperative chemoradiotherapy for stage III or IV esophageal squamous carcinoma.

The poor progress of advanced esophageal carcinoma cannot be expected to be improved by surgical treatment alone. We retrospectively examined the results of surgery alone (SA: 39 cases) and of concurrent preoperative chemoradiation therapy (PCRT: 51 cases) for stage III or IV esophageal squamous carcinoma. In the PCRT group, the rate of pathological complete response was 31.4% for the primary lesion and 31.1% for metastatic lymph nodes, which viable cancer cells were not recognized in either region in 25.5% of all cases. In the PCRT group, grade 2 or more toxicity was found in 39 cases of leukopenia, 10 cases of anemia, 7 cases of thrombocytopenia, 11 cases of esophagitis, 4 cases of stomatitis, 2 cases of nausea, 2 cases of diarrhea, 2 cases of liver disfunction and 2 cases of infection. In 2 cases, PCRT was terminated for about 3 weeks because of thrombocytopenia. In the remaining 49 cases, PCRT was administered as scheduled. No statistically significant differences were noted between the PCRT group and the SA group in postoperative complications. There was postoperative recurrence in 16 cases (31.4%) in the PCRT group and 26 cases (66.7%) in the SA group (p=0.008). In stage III, the 5-year survival rate was 58.6% for the PCRT group and 17.2% for the SA group (p=0.022). In stage IV, the survival rate was 0% for the SA group and 16.7% for the PCRT group, showing better results in the latter, although there was no statistically significant difference. Multivariate analysis of prognostic variables revealed that therapeutic method (presence or absence of PCRT) contributed the greatest to the prognosis. These results indicate that PCRT is an effective adjuvant therapy for squamous cell carcinoma.