ABSTRACT
Carcinoma of the cervical esophagus is invariably fatal because of its advanced stage at presentation. In our surgical division, 167 patients with primary squamous-cell carcinoma of the cervical esophagus were treated over the period between 1973 and June 1992. The tumor was localized in the cervical esophagus in only 37 cases, whereas it also involved the hypopharynx in 112 patients or extended to the cervico-thoracic segment in the remaining 18 subjects. Ninety-three patients underwent surgery (operability rate: 55.6%), and in 68 of these the tumor was resected (resectability rate: 73.1%). Over the 20-year study period, surgical techniques have evolved as a result of the experience gained with previous surgical therapies. Six of the 68 resected patients died (8.8%). Ten patients undergoing surgical resection subsequently presented with local recurrence: 3 after cervical esophagectomy (25%) and 7 after total esophagectomy (12.5%). Moreover, six patients treated by radical resection without laryngectomy had recurrent tumor (46.1%). The cumulative 5-year survival rate was 16.6%. The experience accumulated over the years suggests that the procedure of choice is laryngopharyngo-(total)-esophagectomy without thoracotomy, with gastric pull-up for reconstruction of the digestive tract. The other surgical procedures, in our experience as well in that of other authors, are associated with a higher incidence of relapse and a decreased survival rate. In an attempt to improve on the disappointing long-term results, we introduced a preoperative course of chemotherapy and radiotherapy in the management of the last 6 patients in our series.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Carcinoma, Squamous Cell/surgery , Esophageal Neoplasms/surgery , Esophagectomy , Hypopharyngeal Neoplasms/surgery , Laryngectomy , Neoplasms, Second Primary/surgery , Pharyngectomy , Adult , Aged , Carcinoma, Squamous Cell/drug therapy , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/radiotherapy , Chemotherapy, Adjuvant , Combined Modality Therapy , Esophageal Neoplasms/drug therapy , Esophageal Neoplasms/mortality , Esophageal Neoplasms/radiotherapy , Female , Follow-Up Studies , Humans , Hypopharyngeal Neoplasms/drug therapy , Hypopharyngeal Neoplasms/mortality , Hypopharyngeal Neoplasms/radiotherapy , Incidence , Male , Middle Aged , Neck , Neoplasm Recurrence, Local/epidemiology , Neoplasms, Second Primary/drug therapy , Neoplasms, Second Primary/mortality , Neoplasms, Second Primary/radiotherapy , Postoperative Complications/epidemiology , Preoperative Care , Prognosis , Radiotherapy, Adjuvant , Retrospective Studies , Survival Rate , Time FactorsABSTRACT
From June 1987 to March 1992, 70 patients with squamous cell carcinoma of the esophagus were entered into a treatment protocol that included a preoperative course of radiotherapy (3,000 cGy) and chemotherapy (cisplatin and 5-fluorouracil). The preoperative therapy was well tolerated. Forty-nine of these patients underwent esophageal resection (total or subtotal) and 6 patients died subsequently (12.2%). The morbidity was not dramatically affected by preoperative treatment. Histopathologic studies showed no residual disease in the resected specimen of 11 patients (19.2%), only some residual microscopic clusters of neoplastic cells in 8 patients (14%) and macroscopic cancer in the remaining patients (66.8%). The estimated overall Kaplan-Meier survival at 1, 2, and 3 years was 53.6%, 28.6%, and 21.5%, respectively. Our study, like other reports, demonstrates an improved survival in the group of patients who had a complete response after radiotherapy or chemotherapy (p = 0.002). Moreover, the lack of diagnostic procedures to evaluate the presence of residual tumor after radiotherapy and chemotherapy, suggests that only surgical resection can provide an accurate prognostic information and a complete treatment.
