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Ann Thorac Surg 2005;80:1176-1183
© 2005 The Society of Thoracic Surgeons

Original article: General thoracic

Induction Chemoradiotherapy for Squamous Cell Carcinoma of the Thoracic Esophagus: Impact of Increased Dosage on Long-Term Results

Giovanni de Manzoni, MD a , * , Corrado Pedrazzani, MD a , Ernesto Laterza, MD a , Felice Pasini, MD b , Antonio Grandinetti, MD c , Marco Bernini, MD a , Andrea Ruzzenente, MD a , Germana Zerman, MD a , Anna Tomezzoli, MD d , Claudio Cordiano, MD a

a First Department of General Surgery, University of Verona
b Division of Medical Oncology, University of Verona
c Division of Radiation Oncology, Borgo Trento Hospital, Verona, Italy
d Division of Pathology, Borgo Trento Hospital, Verona, Italy

Accepted for publication February 14, 2005.

* Address reprint requests to Prof de Manzoni, 1a Chirurgia Clinicizzata, Ospedale di Borgo Trento, Piazzale Stefani, 1, 37126 Verona, Italy (Email: chirurgia.urgenza{at}univr.it; nadaffona{at}intrefree.it).

BACKGROUND: This study analyzed the impact on long-term results of an increase in the dosage of an induction chemoradiotherapy protocol for squamous cell carcinoma (SCC) of the thoracic esophagus.

METHODS: Two groups were considered among 177 patients who underwent preoperative chemoradiotherapy for SCC of the thoracic esophagus. Group A includes 111 patients (from 1987 to 1995) who were submitted to cisplatin and 5-fluorouracil (two cycles) and radiotherapy (3,000 cGy). Group B includes 66 patients (from 1995 to 2002) in which the doses were raised both in terms of chemotherapy (three cycles) and radiotherapy (5,000 cGy).

RESULTS: The induction treatment was completed in most of the patients (92.1%) with an acceptable treatment-related mortality (2.6%). Surgery was accomplished in 148 patients; 78.4% and 92.4% in groups A and B, respectively (p = 0.015). The postoperative in-hospital mortality was 8.8%. Tumor resection was possible in 91.8% with a better R0-resection rate for group B (83.9%; p = 0.004). Responders represented 34.9% of the patients with 20.1% of "complete" responses (29.5% in group B; p = 0.018). The overall 5-year survival rate was improved in group B (30.2%; p = 0.017), and when survival analysis was restricted to responders (70.1%; p = 0.027).

CONCLUSIONS: No differences in feasibility and complication rate were observed during the two study periods. A higher rate of R0-resections was achieved in group B. The increased dosage led to an increased rate of complete responses and to an improved overall 5-year survival.




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J. M. Piehler
Invited commentary
Ann. Thorac. Surg., October 1, 2005; 80(4): 1183 - 1184.
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