[Multidisciplinary preoperative treatment of esophageal cancer]

Abstract

To obtain a better prognosis, multidisciplinary treatment is essential for esophageal cancer. We prescribed hyperthermia combined with irradiation and chemotherapy (HCR) preoperatively for patients with resectable esophageal squamous cell carcinoma. The local effect of the HCR therapy was better than that of chemotherapy and radiotherapy (CR), showing 19.3% of the complete response rate. The five-year survival rate of stage III and IV patients given preoperative HCR was 18.5%, compared with 10.4% in the CR therapy group and 10.5% in the preoperative no treatment group. Moreover, preoperative HCR therapy improved prognosis of cases with far advanced cancer which invades the neighboring organs, showing 20.1% of 3-year survival rate. To evaluate the effectiveness of hyperthermia more objectively, we started a prospective randomized trial from 1988, comparing HCR therapy and CR therapy. The local effect is better in HCR therapy. When treated with cisplatin, the rate of complete response (Grade 3) in HCR therapy was 35.3%, which is as high as for the multi-drug combined treatment reported from other institutes previously. More effective multidisciplinary treatment together with basic research are necessary for a better therapeutic outcome.