Original article
General thoracic
Adjuvant Chemotherapy with 5-Fluorouracil and Cisplatin in Lymph Node-Positive Thoracic Esophageal Squamous Cell Carcinoma

https://doi.org/10.1016/j.athoracsur.2005.03.058Get rights and content

Background

In this study we explored the effectiveness of adjuvant chemotherapy in node-positive, resected thoracic esophageal squamous cell carcinoma patients.

Methods

A prospective study of postoperative chemotherapy in N1 esophageal cancer patients who received curative resection was conducted and compared with the historical control group in regard to recurrence rate, patterns of failure, disease-free survival rate, and overall survival rate. The postoperative chemotherapy consisted of cisplatin (60 mg/m2 intravenously) and 5-fluorouracil (1,000 mg/m2 per day) in a continuous infusion for 4 days. Three cycles were administered at 3-week intervals.

Results

Forty patients were accrued from January 1998 to January 2003 at Samsung Medical Center for adjuvant chemotherapy. The historical control group consisted of 52 patients who received curative resection but not adjuvant chemotherapy during the same period of time. The 3-year disease-free survival rate was 47.6% in the adjuvant group and 35.6% in the control group (p = 0.049). The estimated 5-year overall survival rates were 50.7% in the adjuvant group and 43.7% in the control group (p = 0.228). The significant predictive factors for tumor recurrence were the number of positive lymph nodes (p = 0.008) and the adjuvant chemotherapy (p = 0.030).

Conclusions

This study suggests that the postoperative chemotherapy may prolong disease-free survival in lymph node-positive, curatively resected esophageal cancer patients. The postoperative treatment modality for esophageal cancer patients should be determined according to the lymph node status and a randomized phase III clinical trial is warranted using adjuvant chemotherapy if the esophageal cancer is lymph node-positive.

Section snippets

Patient Selection

From January 1998 to January 2003, 40 patients who underwent curative esophagectomy were prospectively enrolled in this study. Eligible criteria included (1) histologically proven squamous cell carcinoma of the thoracic esophagus; (2) curative R0 resection (no microscopic residual tumor); (3) transthoracic esophagectomy with radical lymphadenectomy such as cervico-thoracoabdominal three-field lymphadenectomy or thoracoabdominal total two-field lymphadenectomy; (4) a pathologic classification of

Patient Characteristics

During the period from January 1998 to January 2003, 40 consecutive patients were entered into the study. The clinical characteristics of the enrolled patients are provided in Table 1. The historical control group consisted of 52 patients. All patients in both arms had squamous cell carcinoma of esophagus and pathologically confirmed regional lymph node metastases (pN1). Both groups had similar pathologic characteristics in tumor status, location, histology, and differentiation. However, the

Comment

A high frequency of metastatic disease as the cause of death in resected esophageal cancer patients has resulted in intense exploration for the application of systemic therapy in the treatment of esophageal cancer. Recently, chemotherapy with or without other local modality of surgery or radiation has been introduced as neoadjuvant, definitive, or adjuvant settings; however, the confirmatory clinical trials showing survival advantages in any of these settings to date are lacking [10, 11, 12, 13

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