Squamous cell carcinoma of the esophagus: Multimodal therapy in locally advanced disease. Long-term results

The aim of this prospective study, is to report our experience in the multimodal management of locally advanced esophageal squamous cell carcinoma (LAESC) (stage III cTNM). These findings were compared to the results of a standard group of patients with locally advanced esophageal carcinoma treated in our center with surgery alone. Sixty-one patients with LAESC were considered for preoperative chemoradiotherapy (5-fluorouracil+cisplatin) with concomitant 45 Gray radiotherapy in a 5 weeks course. Transthoracic esophagectomy was performed 4 to 5 weeks after the end of the neoadjuvant therapy in thirty-eight patients, and 37 of them were resected (resectability:97% in the multimodal group-84% in the standard surgical series) (p<0.07). The RO resection rate was 78% compared to 56% in the standard surgical group (p<0.03). Eleven patients had no residual tumor in the resected specimen (pCR:30%). The operative mortality rate was 19% compared with 8.8% in the standard series. The overall median survival of the resected patients was 21 months, with a 5-year survival rate of 11% (14% in the surgical group)(NS). The 3 and 5-year survival rates were 34% for the pathologic complete response (pCR) group and respectively 5 and 0% for the group with incomplete response (pIR)(p<0.05). The median survival was 28 months for the PCR patients and 19 months for the pIR group. This multimodal treatment cannot be: proposed as a standard procedure, unless less toxic regimens are developed, increasing the benefits with better local and distant failure control and decreasing operative mortality.