Treatment of Esophageal Carcinoma by Pre-operative Chemo-radiotherapy Modality "Cancer Research Center, Mashhad University of Medical Sciences"

Document Type : Research Paper


1 Assistant Professor of Radiotherapy and Oncology, Omid Hospital, Mashhad University of Medical Sciences

2 Rad. Oncologist, Omid Hospital, Mashhad University of Medical Sciences

3 Resident of Rad. Oncology, Mashhad University of MedicalSciences

4 General Practitioner, Mashhad University of Medical Sciences, Mashhad, Iran


Combined modality treatments have been proposed for improving survival in patients with esophageal carcinoma. In this study, we evaluated the results of neoadjuvant radiotherapy and chemotherapy followed by surgery in patients with esophageal Squamous Cell Carcinoma (SCC).
Materials and Methods
Between September 2001 and September 2006, 75 patients with Operable esophageal SCC underwent neoadjuvant radiotherapy (30 Gray/10 fractions in 34 or 40 Gray/20 fractions in 41 cases) followed by trans-hiatal esophagectomy at Omid Hospital, Mashhad, Iran. A total of 42 patients received at least 3 courses of chemotherapy containing cisplatin and 5FU.
Complete response to neoadjuvant treatment was found in 5 cases (6.7%). With a median follow up time of 13 months, 21 cases (28%) experienced recurrence including 9 locoregional recurrences, 9 distant metastasis and 3 concomitant local and distant failure. Period of 3-year survivals for all patients was 62.2%. There was no significant difference in survival between patients treated with either radiotherapy protocols (p=0.37). Patients who received at least 3 courses of chemotherapy had relatively better survival compared with those receiving less than three courses or no chemotherapy (p=0.09). In comparison with patients having grade III tumors, patients with grade I & II tumors had significantly better survival rate (p=0.05).
Major treatment complications included leukopenia in 13 (17%), anemia in 6 (8%), Thrombocytopenia in 2 (3%), postsurgical fistula in 2 (3%) and anastomosis stricture in 8 (11%) patients.
In this study, neoadjuvant chemoradiotherapy and surgery achieved satisfactory survival and acceptable incidence of complications for patients with esophageal SCC and we recommend further investigation in this regard.


1- Kelsen D. Preoperative chemoradiotherapy for esophageal cancer. J Clin Oncol 2001; 19:283-285.
2- Earlam R, Cunha-Melo JR. Oesophageal squamous cell carcinoma: I. A critical review of surgery. Br J Surg 1980;
3- Whyte RI, Orringer MB. Surgery for carcinoma of the esophagus: The case for transhiatal esophagectomy. Semin
Radiat Oncol 1994; 4:146-156.
4- Sun DR. Ten-year follow-up of esophageal cancer treated by radical radiation therapy: Analysis of 869 patients. Int J
Radiat Oncol Biol Phys 1989; 16:329-334.
5- Okawa T, Kita M, Tanaka M, Ikeda M. Results of radiotherapy for inoperable locally advanced esophageal cancer.
Int J Radiat Oncol Biol Phys 1989; 17:49-54.
6- Baruch B, Ilson DH, Minsky BD .Treatment of Localized Esophageal Cancer. Semin Oncol 2004; 31:554-565.
7- Urba SG, Orringer MB, Turrisi A, Iannettoni M, Forastiere A, Strawderman M, et al. Randomized trial of
preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol
2001 ; 19:305-313.
8- Bosset JF, Gignoux M, Triboulet JP, Tiret E, Mantion G, Elias D, et al. Chemoradiotherapy followed by surgery
compared with surgery alone in squamous cell cancer of the esophagus. N Engl J Med 1997; 337:161-167.
9- Walsh TN, Noonan N, Hollywood D Kelly A, Keeling N, Hennessy TP. A comparison of multimodal therapy and
surgery for esophageal adenocarcinoma. N Engl J Med 1996; 335:462-467.
10- Urschel JD, Vasan H. A meta-analysis of randomized controlled trials that compared neoadjuvant chemoradiation
and surgery to surgery alone for resectable esophageal cancer. Am J Surg 2003; 185:538-543.
11- Posner MC, Forastiere Arlene A, Minsky BD. Cancer of the esophagus. In: Devita VT, Hellman S, Rosenberg SA.
Principles and Practice of Oncology. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.p. 861-901.
12- Adams RA, Morgan MD, Mukherjee SA, Brewster AA, Maughan TA, Morrey DA, et al. A prospective comparison
of multidisciplinary treatment of oesophageal cancer with curative intent in a UK cancer network. Eur J Surg Oncol
2007; 33:307-313.
13- Lee JL, Park SI, Kim S-B, Jung H-Y, Lee GH, Kim J-H, et al. A single institutional phase III trial of preoperative
chemotherapy with hyperfractionation radiotherapy plus surgery versus surgery alone for resectable esophageal
squamous cell carcinoma. Ann Oncol 2004 ; 15: 947-954.
14- Mukherjee S, Abraham J, Brewster A, Hardwick R, Havardz T, Lewisx W, et al. Pilot Study of Preoperative
Combined Modality Treatment for Locally Advanced Operable Oesophageal Carcinoma:Toxicities and Long-term
Outcome. Clin Oncol 2006; 18:338-344
15- Urba SG, Orringer MB, Iannettoni M, Hayman JA, Satoru H. Concurrent cisplatin, paclitaxel, and radiotherapy
as preoperative treatment for patients with locoregional esophageal carcinoma. Cancer 2003; 98:2177-2183.
16- Ruhstaller T, Widmer L, Schuller JC, Roth A, Hess V, Mingrone W, et al. Multicenter phase II trial of
preoperative induction chemotherapy followed by chemoradiation with docetaxel and cisplatin for locally advanced
esophageal carcinoma (SAKK 75/02). Ann Oncol 2009; Epub ahead of print.
17- Law S, Chi r M, Kwong DLW, Wong KH, Kwok KF, Wong J. The Effects of neoadjuvant chemo radiation on
pTNM staging and its prognostic significancein esophageal cancer. J Gastrointest Surg 2006; 10:1301–1311.
18- Schneider PM, Baldus SE, Metzger R, Kocher M, Bongartz R, Bollschweiler E, et al. Histomorphologic tumor
regression and lymph node metastases determine prognosis following neoadjuvant radiochemotherapy for esophageal
cancer: Implications for response classification. Ann surg 2005; 242:684-692.
19- Gebski V, Burmeister B, Smithers BM, Foo K, Zalcberg J, Simes J. Survival benefits from neoadjuvant
chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol 2007; 8:226–234.