Treatment of oesophageal cancer with preoperative chemoradiotherapy may increase operative mortality

Aims: This phase II multicentric study evaluates a modified preoperative chemoradiotherapy schedule. Methods: Patients <75 years with potentially resectable neoplasm were eligible. Treatment included an initial course of CDDP 100 mg/m2 (Day 1) and 5-FU CI 5000 mg/m2 (Days 1–5) followed by 45 Gy (Days 28–63) and 5-FU CI 5000 mg/m2 (Days 28–33), CDDP 75 mg/m2 (Day 56) and 5-FU CI 3750 mg/m2 (Days 56–61). Regional lymph nodes were irradiated. Results: Nineteen patients were studied. Oesophagectomy was performed in 17. Clear margins were achieved in 16 of these. Eight patients showed a pathologic complete response (pCR). One patient died of infection during the preoperative treatment and four died due to acute surgical complications. The study was closed prematurely because of excessive mortality. Median follow-up was 19 months. Local and regional relapse occurred in one and three patients, respectively. Median time and actuarial 3-year of overall survival and progression free rates were 18.6 months and 28%, and 12.7 months and 10.4%, respectively. Conclusions: This schedule showed a high pCR, resectability and local control rate. Treatment-related mortality limits its clinical applicability, but further investigations are warranted.