Advertisement

Preoperative (Neoadjuvant) Chemotherapy in Squamous Cell Cancer of the Esophagus

  • P. Schlag
  • R. Herrmann
  • U. Raeth
  • B. Lehner
  • V. Schwarz
  • C. Herfarth
Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 110)

Abstract

Even after radical tumor resection less than 15% of the patients with esophageal cancer are alive 5 years after surgery [2, 4, 5]. Moreover, local tumor removal is possible only in some of the patients. There have been many efforts to search for ways of improving the treatment results in esophageal cancer [10]. These include surgical techniques [11, 14] as well as combined treatment modalities [3, 8, 15]. Nevertheless, the results obtained have been rather negative. This is due to a still high percentage of primarily unresectable tumors, early metastases, and a high local relapse rate. Preoperative chemotherapy seems to be a promising new strategy [13, 16]. The objective of neoadjuvant chemotherapy is to bring about tumor regression and thereby improve resectability. The risk of tumor spread during surgery should also be decreased by devitalization of the tumor cells. Already existing micrometastases, which cause metastases later on, should be destroyed as well. Even if the theoretical aspects of this therapy seem very attractive, the question remains whether this kind of treatment is feasible at all in patients with cancer of the esophagus. On the one hand, these patients mostly suffer multimorbidity and so may not tolerate this approach. On the other hand, it has to be taken into consideration that short- or long-term side effects of preoperative chemotherapy may impair surgery. In the following report we therefore present our own experiences with a phase-II study evaluating preoperative chemotherapy in esophageal cancer. By comparing these results with those reported in the literature it should be possible to clarify the current impact of this treatment modality for the primary therapy of esophageal cancer.

Keywords

Esophageal Cancer Preoperative Chemotherapy Minor Response Combine Treatment Modality Geal Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Carey RW, Hilgenberg AD, Wilkins EW, Choi NC, Mathisen DJ, Grillo H (1986) Preoperative chemotherapy followed by surgery with possible postoperative radiotherapy in squamous cell carcinoma of the esophagus: evaluation of the chemotherapy component. J Clin Oncol 4: 697–701PubMedGoogle Scholar
  2. 2.
    DeMeester TR, Levin B (eds) (1985) Cancer of the esophagus. Grune and Stratton, New YorkGoogle Scholar
  3. 3.
    Gignoux M, Roussel A, Paillot B, Gillet M, Schlag P, Dalesio A, Buyse M, Duez N (1987) The value of preoperative radiotherapy in esophageal cancer. World J Surg 11: 426–432PubMedCrossRefGoogle Scholar
  4. 4.
    Giuli R (ed) (1984) Cancer of the esophagus. Maloine, ParisGoogle Scholar
  5. 5.
    Huang GJ, K’ai WY (eds) (1984) Carcinoma of the esophagus and gastric cardia. Springer, Berlin Heidelberg New York TokyoGoogle Scholar
  6. 6.
    Kaplan EL, Meier P (1958) Nonparametric estimation for incomplete observations. J Am Stat Assoc 53: 457–481CrossRefGoogle Scholar
  7. 7.
    Kelsen DP (1984) Chemotherapy of esophageal cancer. Semin Oncol 11: 159–168PubMedGoogle Scholar
  8. 8.
    Kelsen P, Bains M, Hilaris B, Martini N (1984) Combined modality therapy of esophageal cancer. Semin Oncol 11: 169–177PubMedGoogle Scholar
  9. 9.
    Leichman L, Steiger Z, Seydel HG, Vaitkevicius VK (1984) Combined preoperative chemotherapy and radiation therapy for cancer of the esophagus: The Wayne State University, Southwest Oncology Group and Radiation Therapy Oncology Group Experience. Semin Oncol 11: 178–185PubMedGoogle Scholar
  10. 10.
    Linder F, Belsey R, Ong GB, Richard CA, Siewert JR, Skinner DB, Dietz R, Hissen W (1982) Panel discussion on treatment of oesophageal carcinoma. Langenbecks Arch Chir 357:237–257PubMedCrossRefGoogle Scholar
  11. 11.
    Orringer MB, Sloan H (1978) Esophagectomy without thoracotomy. J Thorac Cardio-vasc Surg 76: 643Google Scholar
  12. 12.
    Peto R (1978) Clinical trial methodology. Biomedicine 28: 24–36PubMedGoogle Scholar
  13. 13.
    Ragaz J, Band PR, Goldie JH (eds) (1986) Preoperative (neoadjuvant) chemotherapy. Recent results in cancer research, vol 103. Springer-Verlag, Berlin Heidelberg New York TokyoGoogle Scholar
  14. 14.
    Skinner DB (1984) Surgical treatment for esophageal carcinoma. Semin Oncol 11: 136–143PubMedGoogle Scholar
  15. 15.
    Steiger Z, Franklin R, Wilson RF, Leichman L, Seydel H, Loh JJK, Vaishampayan G, Knechtges T, Asfaw I, Dindogru A, Rosenberg JC, Buroker T, Torres A, Hoschner D, Miller P, Pietruk T, Vaitkevicius V (1981) Eradication and palliation of squamous cell carcinoma of the esophagus with chemotherapy, radiotherapy, and surgical therapy. Thorac Cardiovasc Surg 82: 713–719Google Scholar
  16. 16.
    Wagener DJT, Blijham GH, Smeets JBE, Wils JA (eds) (1985) Primary chemotherapy in cancer medicine. Liss, New YorkGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  • P. Schlag
    • 1
  • R. Herrmann
    • 1
  • U. Raeth
    • 1
  • B. Lehner
    • 1
  • V. Schwarz
    • 1
  • C. Herfarth
    • 1
  1. 1.Chirurgische KlinikKlinikum der Universität HeidelbergHeidelbergGermany

Personalised recommendations