| Theme |
Current Topics on The Treatment for Esophageal Cancer |
| Title |
Esophagectomy, Is It Necessary after Chemoradiotherapy for a T4 Esophageal Cancer?: A Prospective Trial Comparing Chemoradiotherapy plus Surgery versus Chemoradiotherapy Alone |
| Author |
Hiromasa Fujita |
Department of Surgery, Kurume University School of Medicine |
| Author |
Susumu Sueyoshi |
Department of Surgery, Kurume University School of Medicine |
| Author |
Toshiaki Tanaka |
Department of Surgery, Kurume University School of Medicine |
| Author |
Hiroko Sasahara |
Department of Surgery, Kurume University School of Medicine |
| Author |
Satoru Matono |
Department of Surgery, Kurume University School of Medicine |
| Author |
Kazuo Shirouzu |
Department of Surgery, Kurume University School of Medicine |
| [ Summary ] |
To evaluate the results of chemoradiotherapy with versus without surgery in a locally-advanced (T4) esophageal cancer, a prospective comparative trial was performed, based on informed consent. After the first course of chemoradiotherapy-radiotherapy with a total dosage of 36 Gy and chemotherapy using cisplatin (CDDP) and 5-fluorouracil (5FU), patients chose to receive surgery or the second course of chemoradiotherapy-radiotherapy with total dosages of 24 Gy and chemotherapy using CDDP and 5FU. Fiftythree patients with a T4 esophageal cancer involving the tracheobronchus or the aorta were enrolled in this trial. In responders to the first course of chemoradiotherapy, there was no significant difference between the long term survival rates for the eighteen patients who underwent esophageal surgery (esophagectomy in seventeen and bypass in another) and the thirteen patients who did not (27% vs 33% in the five-year survival rates). In non-responders, the outcome of the eleven patients who underwent surgery (eight esophagectomies and three bypasses) was significantly better than the eleven patients who did not (57% vs 12% with a two-year survival rate). In multimodal treatment for T4 esophageal cancer, esophagectomy is not necessary for responders to chemoradiotherapy, while it may be necessary for non-responders. |