Improved survival with neoadjuvant therapy and resection for adenocarcinoma of the esophagus

James R. Stewart, Steven J. Hoff, David H. Johnson, Michael J. Murray, Dean R. Butler, Charles C. Elkins, Kenneth W. Sharp, Walter H. Merrill, John L. Sawyers

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Objective: This study sought to determine the impact of preoperative chemotherapy and radiation therapy (neoadjuvant therapy) followed by resection in patients with adenocarcinoma of the esophagus. Summary Background Data: Long-term survival in patients with carcinoma of the esophagus has been poor. An increase in the incidence of adenocarcinoma of the esophagus has been reported recently. Methods: Fifty-eight patients with biopsy-proven adenocarcinoma of the esophagus treated at this institution from January 1951 through February 1993 were studied. Since 1989, 24 patients were entered prospectively into a multimodality treatment protocol consisting of preoperative cisplatin, 5-fluorouracil (5-FU), and leucovorin with or without etoposide, and concomitant mediastinal radiation (30 Gy). Patients were re-evaluated and offered resection. Results: There were no deaths related to neoadjuvant therapy and toxicity was minimal. Before multimodality therapy was used, the operative mortality rate was 19% (3 of 16 patients). With multimodality therapy, there have been no operative deaths (0 of 23 patients). The median survival time in patients treated before multimodality therapy was 8 months and has yet to be reached for those treated with the neoadjuvant regimen (> 26 months, p < 0.0001). The actuarial survival rate at 24 months was 15% before multimodality therapy and 76% with multimodality therapy. No difference in survival was noted in neoadjuvant protocols with or without etoposide (p = 0.827). Conclusions: Multimodality therapy with preoperative chemotherapy and radiation therapy followed by resection appears to offer a survival advantage to patients with adenocarcinoma of the esophagus.

Original languageEnglish (US)
Pages (from-to)571-576
Number of pages6
JournalAnnals of Surgery
Volume218
Issue number4
StatePublished - Oct 1993

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Neoadjuvant Therapy
Survival
Etoposide
Radiotherapy
Therapeutics
Adenocarcinoma Of Esophagus
Radiation Dosage
Drug Therapy
Leucovorin
Clinical Protocols
Fluorouracil
Cisplatin
Esophagus
Survival Rate
Carcinoma
Biopsy
Mortality
Incidence

ASJC Scopus subject areas

  • Surgery

Cite this

Stewart, J. R., Hoff, S. J., Johnson, D. H., Murray, M. J., Butler, D. R., Elkins, C. C., ... Sawyers, J. L. (1993). Improved survival with neoadjuvant therapy and resection for adenocarcinoma of the esophagus. Annals of Surgery, 218(4), 571-576.

Improved survival with neoadjuvant therapy and resection for adenocarcinoma of the esophagus. / Stewart, James R.; Hoff, Steven J.; Johnson, David H.; Murray, Michael J.; Butler, Dean R.; Elkins, Charles C.; Sharp, Kenneth W.; Merrill, Walter H.; Sawyers, John L.

In: Annals of Surgery, Vol. 218, No. 4, 10.1993, p. 571-576.

Research output: Contribution to journalArticle

Stewart, JR, Hoff, SJ, Johnson, DH, Murray, MJ, Butler, DR, Elkins, CC, Sharp, KW, Merrill, WH & Sawyers, JL 1993, 'Improved survival with neoadjuvant therapy and resection for adenocarcinoma of the esophagus', Annals of Surgery, vol. 218, no. 4, pp. 571-576.
Stewart JR, Hoff SJ, Johnson DH, Murray MJ, Butler DR, Elkins CC et al. Improved survival with neoadjuvant therapy and resection for adenocarcinoma of the esophagus. Annals of Surgery. 1993 Oct;218(4):571-576.
Stewart, James R. ; Hoff, Steven J. ; Johnson, David H. ; Murray, Michael J. ; Butler, Dean R. ; Elkins, Charles C. ; Sharp, Kenneth W. ; Merrill, Walter H. ; Sawyers, John L. / Improved survival with neoadjuvant therapy and resection for adenocarcinoma of the esophagus. In: Annals of Surgery. 1993 ; Vol. 218, No. 4. pp. 571-576.
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