Therapeutic alternatives in patients with esophageal cancer.

The records of 52 patients treated either with surgery alone (Group A), preoperative radiotherapy (Group B), or combined preoperative chemotherapy and radiotherapy (Group C) were reviewed to determine the optimal management of patients with squamous cell carcinoma of the esophagus. There was a significant difference in the number of patients with stage III disease between Groups A and C (100 percent and 48 percent, respectively). With the decrease in patients with stage III disease, both resectability rates in Groups A and C (21 percent and 62 percent) and 2 year cumulative survival (0 and 52 percent) increased. Eleven patients in Group C (53 percent) had apparent total resolution of the primary tumor after preoperative therapy. Microscopic tumor was present but was not detected by repeat endoscopy in 35 percent of these patients. The survival rate was higher in patients with apparent total tumor regression who underwent esophageal resection. These results suggest that patients with squamous cell carcinoma of the esophagus are best treated with preoperative chemotherapy and radiotherapy followed by esophagectomy regardless of their response to preoperative therapy.