Background We conducted a multicenter, randomized trial to compare preoperative chemoradiotherapy followed by surgery with surgery alone in patients with stage I and II squamous-cell cancer of the esophagus. Methods The preoperative combined therapy consisted of two one-week courses; each involved radio therapy, in a dose of 18.5 Gy delivered in five fractions of 3.7 Gy each, and 80 mg of cisplatin per square meter of body-surface area, administered 0 to 2 days before the first day of radiotherapy. The surgical plan included one-stage en bloc esophagectomy and proximal gastrectomy by the abdominal and right thoracic routes, to be performed immediately after randomization in the group assigned to surgery alone and two to four weeks after the completion of preoperative chemoradiotherapy in the group assigned to combined therapy. Results A total of 297 patients entered the study; 11 were found to be ineligible, and 4 were lost to fol low-up. Of the remaining 282, 139 were assigned to surgery alone and 143 to combined therapy. After a median follow-up of 55.2 months, no significant difference in overall survival was observed; the median survival was 18.6 months for both groups. As compared with the group treated with surgery alone, the group treated preoperatively had longer disease-free survival (P=0.003), a longer interval free of local disease (P=0.01), a lower rate of cancer-related deaths (P=0.002), and a higher frequency of curative resection (P=0.017). However, there were more postoperative deaths (P=0.012) in the group treated preoperatively with chemoradiotherapy. Three prognostic factors were found to influence survival in a multivariate analysis: the disease stage, based on computed tomography; the location of the tumor; and whether the surgical resection was curative. Conclusions In patients with squamous-cell esophageal cancer, preoperative chemoradiotherapy did not improve overall survival, but it did prolong disease-free survival and survival free of local disease. (C)1997, Massachusetts Medical Society.
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Sun Yat Sen Univ, Thorac Oncol, Ctr Canc, Guangzhou, Guangdong, Peoples R China
Taizhou Hosp Zhejiang Prov, Radiotherapy, Taizhou, Peoples R China
Fudan Univ, Shanghai Canc Ctr, Radiotherapy, Shanghai, Peoples R ChinaSun Yat Sen Univ, Thorac Oncol, Ctr Canc, Guangzhou, Guangdong, Peoples R China
Yang, H.
Fu, J.
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Sun Yat Sen Univ, Thorac Oncol, Ctr Canc, Guangzhou, Guangdong, Peoples R ChinaSun Yat Sen Univ, Thorac Oncol, Ctr Canc, Guangzhou, Guangdong, Peoples R China
Fu, J.
Liu, M.
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Sun Yat Sen Univ, Radiat Oncol, Ctr Canc, Guangzhou, Guangdong, Peoples R ChinaSun Yat Sen Univ, Thorac Oncol, Ctr Canc, Guangzhou, Guangdong, Peoples R China
Liu, M.
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Chen, Y.
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Chen, Z.
Zhu, C.
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Taizhou Hosp Zhejiang Prov, Thorac Oncol, Taizhou, Peoples R ChinaSun Yat Sen Univ, Thorac Oncol, Ctr Canc, Guangzhou, Guangdong, Peoples R China
Zhu, C.
Yang, H.
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Sun Yat Sen Univ, Thorac Oncol, Ctr Canc, Guangzhou, Guangdong, Peoples R China
Taizhou Hosp Zhejiang Prov, Radiotherapy, Taizhou, Peoples R China
Fudan Univ, Shanghai Canc Ctr, Radiotherapy, Shanghai, Peoples R ChinaSun Yat Sen Univ, Thorac Oncol, Ctr Canc, Guangzhou, Guangdong, Peoples R China
Yang, H.
Fang, W.
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Shanghai Chest Hosp, Thorac Surg, Shanghai, Peoples R ChinaSun Yat Sen Univ, Thorac Oncol, Ctr Canc, Guangzhou, Guangdong, Peoples R China
Fang, W.
Wang, J.
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Shanghai Chest Hosp, Radiotherapy, Shanghai, Peoples R ChinaSun Yat Sen Univ, Thorac Oncol, Ctr Canc, Guangzhou, Guangdong, Peoples R China
Wang, J.
Yu, Z.
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Tianjin Med Univ, Thorac Oncol, Canc Inst & Hosp, Tianjin, Peoples R ChinaSun Yat Sen Univ, Thorac Oncol, Ctr Canc, Guangzhou, Guangdong, Peoples R China
Yu, Z.
Pang, Q.
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Tianjin Med Univ, Canc Inst & Hosp, Radiotherapy, Tianjin, Peoples R ChinaSun Yat Sen Univ, Thorac Oncol, Ctr Canc, Guangzhou, Guangdong, Peoples R China
Pang, Q.
Mao, W.
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Zhejiang Canc Hosp, Thorac Oncol, Hangzhou, Zhejiang, Peoples R ChinaSun Yat Sen Univ, Thorac Oncol, Ctr Canc, Guangzhou, Guangdong, Peoples R China
Mao, W.
Zheng, X.
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Zhejiang Canc Hosp, Radiotherapy, Hangzhou, Zhejiang, Peoples R ChinaSun Yat Sen Univ, Thorac Oncol, Ctr Canc, Guangzhou, Guangdong, Peoples R China
Zheng, X.
Xiang, J.
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Fudan Univ, Shanghai Canc Ctr, Thorac Oncol, Shanghai, Peoples R ChinaSun Yat Sen Univ, Thorac Oncol, Ctr Canc, Guangzhou, Guangdong, Peoples R China
Xiang, J.
Yang, H.
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Sun Yat Sen Univ, Thorac Oncol, Ctr Canc, Guangzhou, Guangdong, Peoples R China
Taizhou Hosp Zhejiang Prov, Radiotherapy, Taizhou, Peoples R China
Fudan Univ, Shanghai Canc Ctr, Radiotherapy, Shanghai, Peoples R ChinaSun Yat Sen Univ, Thorac Oncol, Ctr Canc, Guangzhou, Guangdong, Peoples R China
Yang, H.
Han, Y.
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Sichuan Canc Hosp, Thorac Oncol, Chengdu, Peoples R ChinaSun Yat Sen Univ, Thorac Oncol, Ctr Canc, Guangzhou, Guangdong, Peoples R China
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Department of Surgery, Academic Medical Center, AmsterdamDepartment of Surgery, Academic Medical Center, Amsterdam
Van Heijl M.
Van Lanschot J.J.B.
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Department of Surgery, Academic Medical Center, Amsterdam
Department of Surgery, Erasmus Medical Center, RotterdamDepartment of Surgery, Academic Medical Center, Amsterdam
Van Lanschot J.J.B.
Koppert L.B.
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Department of Surgery, Erasmus Medical Center, RotterdamDepartment of Surgery, Academic Medical Center, Amsterdam
Koppert L.B.
Van Berge Henegouwen M.I.
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Department of Surgery, Academic Medical Center, AmsterdamDepartment of Surgery, Academic Medical Center, Amsterdam
Van Berge Henegouwen M.I.
Muller K.
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Department of Radiotherapy-Oncology, Erasmus Medical Center, RotterdamDepartment of Surgery, Academic Medical Center, Amsterdam
Muller K.
Steyerberg E.W.
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Department of Clinical Epidemiology, Erasmus Medical Center, RotterdamDepartment of Surgery, Academic Medical Center, Amsterdam
Steyerberg E.W.
Van Dekken H.
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Department of Pathology, Erasmus Medical Center, RotterdamDepartment of Surgery, Academic Medical Center, Amsterdam
Van Dekken H.
Wijnhoven B.P.L.
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Department of Surgery, Erasmus Medical Center, RotterdamDepartment of Surgery, Academic Medical Center, Amsterdam
Wijnhoven B.P.L.
Tilanus H.W.
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Department of Surgery, Erasmus Medical Center, RotterdamDepartment of Surgery, Academic Medical Center, Amsterdam
Tilanus H.W.
Richel D.J.
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Department of Medical Oncology, Academic Medical Center, AmsterdamDepartment of Surgery, Academic Medical Center, Amsterdam
Richel D.J.
Busch O.R.C.
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Department of Surgery, Academic Medical Center, AmsterdamDepartment of Surgery, Academic Medical Center, Amsterdam
Busch O.R.C.
Bartelsman J.F.
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Department of Gastroenterology, Academic Medical Center, AmsterdamDepartment of Surgery, Academic Medical Center, Amsterdam
Bartelsman J.F.
Koning C.C.E.
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Department of Radiotherapy, Academic Medical Center, AmsterdamDepartment of Surgery, Academic Medical Center, Amsterdam
Koning C.C.E.
Offerhaus G.J.
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Department of Pathology, Academic Medical Center, AmsterdamDepartment of Surgery, Academic Medical Center, Amsterdam
Offerhaus G.J.
Van Der Gaast A.
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Department of Medical Oncology, Erasmus Medical Center, RotterdamDepartment of Surgery, Academic Medical Center, Amsterdam