Adjuvant Therapy

Use of chemotherapy combined with radiotherapy preoperatively (neoadjuvant therapy) has been shown to improve overall survival when compared to surgery alone. There are currently several randomized controlled studies underway to evaluate this further. The protocol includes 5-fluorouracin and cisplatinin with 4500 cGy radiotherapy over 3 weeks. There is a 3-6 week recovery period during which time WBC is followed with repeat CT scanning. The patient is restaged and surgery performed if possible. In the study conducted at the University of Michigan, 91% were resectable with a 24 month median survival compared to 14 month with surgery alone.1 One significant randomized controlled study in 1996 showed a survival advantage in patients with adenocarcinoma treated with neoadjuvant therapy.3

References

1. Greenfield LJ, Mulholland M, Oldham KT et al. Surgery Scientific Principals and Practice. 2nd ed. Philadelphia: Lippincott-Raven, 1997.

2. Sabiston DC, Lyerly HK. Textbook of surgery. 15th ed. Philadelphia: W.B. Saunders Co., 1997.

3. Walsh TN, Noonan N, Hollywood D et al. A comparison of multi-modal therapy and surgery for esophageal adenocarcinoma. N Engl J Med 1996; 335:462-7.

4. Hulscher JBF, Tijssen JGP, Obertop H et al. Transthoracic versus transhiatal resection for carcinoma of the esophagus: A meta-analysis. Ann Thorac Surg 2001; 72: 306-313.

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