Neoadjuvant chemotherapy for esophageal squamous cell carcinoma

Purpose: Although surgical treatment for esophageal carcinoma has improved over the years, the prognosis of advanced tumors is still poor. To improve the survival rate, we compared the survival rates of patients undergoing neoadjuvant chemotherapy (NAC) using cisplatin and 5-fluorouracil, and those who received surgery alone. Methods: Patients with operable squamous cell carcinoma of the esophagus (Stage II-III, UICC 6th), treated between 2008 and 2011 were eligible for the study. T4 patients were excluded from this study. The control group consisted of patients treated with primary surgery alone between 2001 and 2006. Two cycles of chemotherapy using cisplatin 80 mg/m² on day 1 and 22, and 5-fluorouracil 800 mg/m² on days 1-5, and days 22-26 were given and thoracoscopic esophagectomy with regional lymph nodes dissection was performed. In most cases, a stomach tube was used as an esophageal substitute. Cervical lymph nodes dissection was added in cases of upper esophageal tumors. Results: Sixty-nine patients were treated with NAC. Patients' characteristics were average age: 65 years; male/female ratio: 61:8; UICC Stage IIA/IIB/III: 12/13/44. Chemotherapy was completed in 81% of patients. The operation was safely performed and occurrence of anastomotic leakage and other complications were not higher compared with the control group. Pathologically, 2 patients (2.9%) were evaluated as having complete response. Overall 3-year survival rates of the NAC and control groups were 62% and 56%, respectively, although the difference was not significant. Conclusion: Surgery was safely performed after neoadjuvant chemotherapy and no increase of peri- or postoperative complications were observed. No difference was observed in the survival rates of the NAC and control groups in Stage III, although the survival rate of the NAC group improved in Stage II.,.