Combined modality therapy for the thoracic esophageal squamous cell carcinoma

A total of 674 patients with thoracic esophageal squamous cell carcinoma (EC) were treated at Oncological Surgery Clinic Medical University of Gdansk between 1970 and 1994. Of these patients 164 received respective surgery and 382 palliative surgery. The rate of resection was 24.2% and the rate of operation was 80.9%. Combined modality therapy (preoperative chemotherapy) was applied in 47 cases. Radiation therapy volume include the primary tumor and the regional lymph nodes. The tumor dose was 3000 cGy, five-day-a-week 200 cGy fractions delivered by megavoltage radiation, in conventional: 15 fractions 2 parallel opposite fields or 3, 4 oblique fields. In the same time patients received chemotherapy with: 5-Fu, 1000 mg/m2, 24-h infusion, i.v., 1-21 day, and CDDP, 20 mg/m2, 24-h infusion, i.v., 1-5 and 17-21 day. 21 days after radio-chemotherapy subtotal esophagectomy by 3 approaches: right thoracotomy, laparotomy, left or right cervical incision was performed. Surgical procedure include one stage on block resection of the tumor and an clearance of the regional lymph node. Reconstruction of the alimentary tract was performed with the use of stomach by retrosternal tunnel. When neoadjuvant chemotherapy has been combined with radiotherapy and then followed by surgery, operability improved as a result of reducing tumor volume. The use of combined modality therapy seems worth investigating to try to improve survival. (author)