Role of preoperative chemoradiation in the management of upper third thoracic esophageal squamous cell carcinoma

Background: The treatment of upper thoracic esophageal cancer remains challenging, and combined treatment is necessary to improve the outcome. We conducted preoperative chemoradiation therapy (CRT) for potential T4 tumors located in the upper third esophagus and carried out a retrospective study to elucidate the role of preoperative CRT. Methods: Surgical resection was performed on 64 patients with upper thoracic esophageal cancer. Thirty-seven of these patients underwent primary resection, while 27 underwent preoperative CRT and surgery. The regimen of chemotherapy consisted of daily tegaful or 5-fluorouracil plus cisplatin. Concurrent radiation therapy of 4,000 cGy was conducted over 4 weeks. Results: There were no differences in either tumor depth and nodal involvement or the surgical morbidity and mortality between the two groups. Seven of 27 patients downstaged to a complete pathologic response, and 13 patients showed a partial response. The 5-year survival rates were 42% in the preoperative CRT group and 27% in the surgery group, and these were not significantly different. In all patients, the depth of tumor influenced the prognosis significantly, while operative curability, nodal involvement, or the number of metastatic nodes showed a tendency to influence the prognosis. Conclusions: Preoperative CRT contributed to downstaging of the tumors and did not increase the operative mortality. Preoperative CRT was useful in the management of upper thoracic esophageal cancer, especially in advanced cases.