Neoadjuvant chemotherapy with cisplatinum/5-fluorouracil/low-dose leucovorin for advanced squamous cell carcinoma of the esophagus.

Forty-four patients with advanced esophageal squamous cell carcinoma were treated with biochemical modulated combination chemotherapy and surgery. Treatment consisted of cisplatinum (70 mg/m2/day 1, day 22), 5-fluorouracil (5-FU; 700 mg/m2/day, days 1-5, 22-26), and leucovorin (20 mg/m2/day, days 1-5, 22-26) with nutritional support, and surgery (days 42-70, mean day 56). Surgery consisted of subtotal esophagectomy with extended lymphadenectomy. Postoperative adjuvant chemotherapy or additional irradiation to the mediastinum was restricted to patient with residual tumors. Clinical response rate was 63.6% in primary tumor, 52.6% in intramural metastasis, 100% in intraepithelial spread, and 30.9% for metastatic lymph nodes. There was a slight disagreement between the result of evaluation of histological and clinical effect. The incidence of postoperative complications was 25%, and the mortality rate was 2.3%. Overall 1-, 2-, 3-, and 4-year survival rates of the patients were 57%, 37.9%, 28.5%, and 28.5%, respectively. The median survival time was 14.7 months. Responders survived longer than nonresponders. The histological responders survived longer than clinical responders. The 4-year survival rate of patients without residual tumor after treatment was 75% in the superficial cases, 51% in the locoregional cases, and 50% in the widespread cases.