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The Journal of Thoracic and Cardiovascular Surgery, Vol 96, 242-248, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JA Roth, HI Pass, MM Flanagan, GM Graeber, JC Rosenberg and S Steinberg
Thirty-nine patients with potentially resectable cancer of the middle or
lower esophagus who had not previously been treated were randomly assigned
to receive either immediate operation (n = 20) or operation plus
preoperative and postoperative therapy with cisplatin, vindesine, and
bleomycin (n = 19). Patients were stratified by tumor size and location and
by sex, with no significant differences appearing between the two treatment
groups. Median follow-up for both groups was 30 months. The preoperative
response rate to chemotherapy was 47%. The postoperative complication rate
for patients in the operation-only group was 47%; it was 29% for patients
receiving chemotherapy. The overall resectability rates were similar for
the two groups. Patients responding to chemotherapy preoperatively had
significantly prolonged survival (median greater than 20 months) when
compared with either nonresponders (median 6.2 months) or patients
receiving only operation (median 8.6 months). A highly significant
correlation was noted between a weight loss of less than 10% and response
to chemotherapy, which suggested that responses occurred in patients with
less advanced disease. We conclude that preoperative and postoperative
cisplatin, vindesine, and bleomycin chemotherapy has acceptable toxicity
and does not increase the incidence of postoperative complications. The
natural history of epidermoid carcinoma of the esophagus is altered and
overall survival is prolonged for patients responding to preoperative
chemotherapy. Potential responding patients can be identified by the degree
of preoperative weight loss.
ARTICLES
Randomized clinical trial of preoperative and postoperative adjuvant chemotherapy with cisplatin, vindesine, and bleomycin for carcinoma of the esophagus
M.D. Anderson Hospital, University of Texas and Tumor Institute, Houston 77030.
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