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The Clinical Efficacy of Neoadjuvant Chemotherapy in Squamous Esophageal Cancer: A Prospective Nonrandomized Study of Pulse and Continuous-Infusion Regimens With Cisplatin and 5-Fluorouracil

From the Departments of Surgery (ACWC, JYWL, DWHL, YHL, EKWN, CCHL, SCSC), Diagnostic Radiology (JFG), and Clinical Oncology (SFL), Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.

Correspondence: Address correspondence and reprint requests to: Professor S. C. Sydney Chung, Department of Surgery, Prince of Wales Hospital, Shatin, NT, Hong Kong; Fax: 852-2637-7974; E-mail: sydneychung{at}cuhk.edu.hk

Background: We evaluated cisplatin and 5-fluorouracil as preoperative adjuvant chemotherapy for patients with locally advanced squamous esophageal cancer and compared two different infusion regimens. The outcomes were also compared with those of our historical control patients treated by surgery alone.

Methods: From 1991 to 1997, 83 consecutive esophageal cancer patients underwent surgical exploration after completion of two cycles of cisplatin and 5-fluorouracil chemotherapy regimens, either in pulse or in continuous infusion cycles. Outcomes were compared with those of 76 historical control patients. Both groups were comparable in demographic characteristics and tumor stages. The resection rates, operative morbidity, mortality, and survival rates were compared.

Results: Partial response was achieved in 50% of patients who received chemotherapy. There was no chemotherapy-related mortality. The resection, morbidity, and mortality rates and median survival between the surgery-alone group and the chemotherapy group were 71.1% vs. 82%, 51% vs. 55%, and 4% vs. 10.8%, 12.0 vs. 13.5 months, respectively (P > .05). There was also no statistically significant difference between the two regimens.

Conclusions: Preoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil infusion, in pulse or continuous regimens, followed by surgery for squamous esophageal cancer patients had no added benefit in the overall survival.

Key Words: Neoadjuvant chemotherapy • Squamous esophageal cancer • Cisplatin • 5-Fluorouracil

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