Six of the Best, Upper GI 16

Introduction: The benefits of neoadjuvant therapy in the treatment of patients with resectable oesophageal carcinoma are controversial. Patients with locally advanced carcinomas were entered into a phase II trial of preoperative chemotherapy and radiotherapy followed by oesophagectomy. Methods: Fifty-five patients aged <70 years with T3 ± N1 oesophageal tumours were recruited between February 1998 and July 2001. Patients received 12 weeks of chemotherapy with four cycles of cisplatin 60 mg m−2 plus infusional 5FU (300 mg m−2, days 1–42; 225 mg m−2, days 43–75). Radiotherapy 45Gy was administered on days 43–75. Two stage en-bloc oesophagectomy with two field lymphadenectomy was undertaken 6 weeks after neoadjuvant therapy. Results: Forty-one patients (74 per cent) completed the treatment. Two patients (3.6 per cent) died during neoadjuvant therapy (SVC obstruction, perforated diverticular disease), while four withdrew due to toxicity. In eight patients (14.5 per cent), the tumour progressed on therapy. Overall mortality was 5/55 (9.1 per cent) with a postoperative mortality of 3/41 (7.3 per cent). Significant postoperative morbidity was observed in 19/41 (46.3 per cent). The tumour was downstaged in 34/41 (83 per cent) with a pathological complete response in 26.8 per cent. Median lymph node yield was 18, there was no proximal or distal margin involvement and a positive circumferential margin in 25 per cent. Median survival on an intention to treat basis was 26 months, and it was 38 months in the patients who underwent surgical resection. Conclusions: Preoperative neoadjuvant therapy followed by en-bloc oesophagectomy can be undertaken with acceptable levels of morbidity and mortality. The survival data appears promising and this study should act as a platform for the initiation of a phase III multicentre trial.