Overall survival with cisplatin and 5-fluorouracil neoadjuvant treatment in patients with esophageal cancer: Single-center experience

Background: The survival benefit of neoadjuvant chemotherapy in patients undergoing surgery for esophageal cancer is unclear. Patients and Methods: We retrospectively identified 37 patients with resectable esophageal squamous cell carcinoma or adenocarcinoma, who prior to surgery received 2 cycles of chemotherapy, consisting of cisplatin 80 mg/m² as 3-h intravenous infusion on day 1 followed by 5-fluorouracil 1,000 mg/m² as 96-h continuous infusion on days 1-4, separated by a 3-week interval. Surgery was performed 3-5 weeks after the start of the second cycle of chemotherapy. Results: The overall response rate was 30% (all partial responses). All patients underwent surgery, 32 with esophagectomy (29 transhiatal, 3 transthoracic). Median overall survival (OS) in all patients was 23 months, and was longer in responding than in non-responding patients (32 vs. 19 months). 5 patients with locally unresected tumor and 18 patients with microscopic surgical margin involvement (R1) underwent postoperative chemoradiotherapy or radiotherapy. Median OS in patients after radical tumor resection (R0) was comparable with that in patients who underwent R1 resection (25 vs. 23 months). Conclusions: This retrospective analysis suggests that neoadjuvant chemotherapy prolongs survival in patients with esophageal cancer who responded to chemotherapy compared with non-responding patients.