[Multitherapy of advanced esophageal carcinoma with special reference to pre- and post-operative administration of cis-platinum].

We discussed the results of multitherapy after pre- and post-operative administration of cis-platinum (CDDP) in resected cases of advanced esophageal carcinoma. The patients were, pre-operatively, dosed in the following ways; 1) CDDP (50 mg, 1/week) X 2-3, 2) CDDP (50 mg, 1-week) +BLM (15 mg, 1/week) X 2-3 or +MTX (30mg, 1/week) X 2-3. The patients under went surgery 1 to 2 weeks later. Post-operative administration of CDDP + MTX, or CDDP + BLM was performed 3-4 times about 3 weeks after surgery. Intra-operative and/or post-operative irradiation was also performed. CDDP was administered pre-operatively in 11 cases who ranged in age 45 to 71. Regarding stage, 2 were stIII and 9 were stIV; and curabilities where cIII in 2 cases, c I in 5 and c 0 in 4. With regard to surgery, the right thoracic and abdominal approach was adopted in 7 cases and the left thoracic and abdominal approach adopted in 3. Blunt dissection was performed in 1 case. We have never experienced post-operative complication of histological effects noticed in resected specimens, Ef1 was evaluated in 3/11 and Ef2 was noticed in 2/11. Patients who achieved an Ef2-1 effect due to the administration of CDDP as part of the multitherapy made satisfactory progress. On the other hand, patients who did not react to CDDP and who had marked vascular invasion died after a short period.

Resection of the carina and oesophagus for malignant tumours of the oesophagus or tracheobronchial tree.

Resection of the oesophagus together with the bifurcation of the trachea has been performed in three patients with oesophageal carcinoma or mucoepidermoid carcinoma of bronchial origin. Two patients had an uneventful recovery and survived five and 10 months but one patient died in the immediate postoperative period from aspiration pneumonia and respiratory failure. There has been no report of combined resection of the oesophagus and carina since Thompson's paper in 1973, but it appears to be indicated occasionally in patients with tracheobronchial or oesophageal malignancy, particularly when it is associated with an oesophagobronchial fistula.

[Phase II study on peplomycin for esophageal cancer].

For the purpose of verifying the effectiveness of peplomycin, one of the derivatives of bleomycin, against carcinoma of the esophagus and the safety of it, the analysis of the data for total 113 cases collected from 25 institutions in Japan was made. The results are as follows. It was effective in 19 out of 74 evaluable cases of carcinoma of the esophagus (25.7%). In case of treatment with peplomycin alone, it was effective in 6 out of 39 cases (15.4%). In case of the combination treatment with peplomycin and some other therapy, it was effective in 13 out of 35 cases (37.1%). As for the side effects, the incidence of fever was the highest in both the cases of peplomycin alone and the combination treatment such as 39.6% and 37.0%, respectively. Anorexia, nausea, vomiting, respiratory symptoms and tiredness were found in relatively many cases. In the clinical laboratory tests, the vital capacity after the treatment tended to be lower than that before the treatment, but there was little change in the hematological tests, pulmonary function test and renal function test.

[Combination chemotherapy with cisplatin and bleomycin in esophageal cancer].

Combination chemotherapy of cis-diammine dichloro platinum (II) (CDDP) and bleomycin was given to 10 patients with advanced squamous cell carcinoma of the esophagus. Nine patients had had major ablative surgical procedures, 8 had received prior radiotherapy, and 4 had been previously treated with chemotherapy. Responses were as follows (duration in months): 3 complete (1, 1.5, 7), 1 partial (1.5), and 3 minor. Vomiting related to CDDP was observed in 6 patients, and nephrotoxicity in 2 patients.