Clinical and pathological evaluation of response to chemotherapy in patients with esophageal carcinoma.

Overview

Pretreatment clinical staging, radiographic response to chemotherapy, and posttreatment pathological staging were assessed in 39 patients with epidermoid carcinoma of the esophagus. Thirty patients received combined modality therapy with cisplatin, vindesine, and bleomycin followed by surgery; nine patients were treated with the same chemotherapy with or without radiation therapy. Using barium esophagrams as the measure of response, radiographic objective regressions were quantitated and considered as complete (CR), partial (PR), and minor or no radiographic response. Sixty percent of patients had CR or PR. However, surgical or endoscopic restaging showed residual microscopic or macroscopic disease in nine patients, with complete radiographic regression. Downstaging of the primary tumor following chemotherapy (pretreatment clinical staging as compared to posttreatment pathological staging) was common. Chemotherapy-induced objective regressions in esophageal carcinoma can be achieved frequently and can be quantitated, using serial barium esophagrams. Complete radiographic regressions should be confirmed by repeat endoscopy or surgery. Downstaging of the primary tumor is commonly noted in responding patients, but it is too soon to determine whether or not this will effect their long-term prognosis.