Pathological complete response (pCR) has been defined as a favorable indicator in esophageal cancer patients undergoing preoperative chemoradiation treatment. About 20-30% of pCR has been reported in prospective randomized trials. Increased rate of pCR may translate into long term survival benefit for esophageal cancer patients.
Methods: Twenty-two patients with locally advanced squamous cell esophageal cancer (T3, N0-1, M0) underwent preoperative chemoradiation during 2006-2007. Concurrent chemoradiation with 2 cycles of cisplatin and 5-FU and 50Gy irradiation using IMRT were given to all patients. Esophagectomy was performed in all patients with resectable cancer within 6-8 weeks after complete neoadjuvant treatment.
Results: One out of 22 patients (4.5%) died during preoperative chemoradiation treatment from sepsis. Three out of 22 patients (13.6%) developed distant metastasis during preoperative therapy. Three patients refused surgery because of much clinical improvement which were able to have solid food. They underwent upper GI endoscopy and PET scan with no residual tumor demonstration in all 3 patients. Fifteen patients underwent esophagectomy with no operative mortality. Resectability rate was 83%. R0 resection was achieved in all 15 patients. Ten out of 15 patients (67%) had pathological complete response. Two patients had T0 N1, 1 patient had T1N0 and 2 patients had T1N1 lesion. All patients were still alive at the median follow up of 10 months.
Conclusions: Two-third of locally advanced squamous cell esophageal cancer who had preoperative chemoradiation with high dose IMRT had pathological complete response. No operative mortality has been found with this treatment. This may translate into long term survival benefit over surgery alone for locally advanced esophageal cancer. Prospective randomized trial is ongoing in our institute.