• Asad Abbas
  • Nasir Ali
  • Shahid Hameed
  • Mazhar Ali Shah


Background: Purpose of this study was to assess the resectability rates in un-resectable (Stages III and IV) cancers of the esophagus, to assess the complete pathological response and to compare the efficacy between two chemotherapy regimens. Methods: From January 1999 to June 2002, medical records of the patients with un-resectable esophageal cancers were reviewed, who received radiation-therapy with concomitant chemotherapy using following regimens:- Arm A:- 5FU 500 mg/m2  intravenous push (IVP) on first 5 and last 5 days of radiation. Arm B:- 5FU 1 Gm/ m2/Day 96 hour continuous infusion (CIV) and Cisplatin 70 mg/ m2 on day one and twenty eight of radiation. At completion of neoadjuvantchemo-radiation patients were offered surgery after four to six weeks. Results: 35 patients had un-resectable esophageal cancer. Twenty-six received arm A, and 9 arm B treatment. Of 26 patients in arm A, in 13 the disease was made resectable and two of them showed complete pathological response in surgical specimen, thirteen had progressive disease. On the other hand, of 9 patients receiving arm B treatment, in 7 the disease was made resectable and out of them 5 showed complete pathological response in surgical specimen and two had progressive disease. Conclusion: Resectability in patients receiving arm B treatment was better than the patients treated arm A. The data is not mature enough to assess the effect on disease free survival or overall survival, this will be seen and published later.Keywords: Un-resectable esophageal  cancer, neo-adjuvant chemoradiation


Roohulla K, Burdy G,M, Hamdani S,R, Javaid I, Kamran S, Nusrat J. Cancer of esophagus, Ten year experience at CENAR, Quetta. J Ayub Med Coll Abottabad. 2001;13(1):4-7.

Malik AM, Khan AH, Khan B, Bashir H. Surgical bypass for palliation of Carcinoma Esophagus. Pak Armed Forces Med J 1999;49(10:39-43.

Slater MS, Holland J, Faigel DO, Sheppard BC, Deveney CW. Does neoadjuvant Chemoradiation downstage esophageal carcinoma. An J Surg 2001; 181 (5):440-4.

Heath EI, Burstness BA, Heitmillar RF, Salem R, Kleinberg L, Kinsely P, et al. Phase II evaluation of pre-operative chemoradiation and postoperative adjuvant chemotherapy for squamous cell and adenocarcinoma of the esophagus: J clin oncol 2000; 18(4): 868-76.

Yano M, Tsujinaka T, Shiosaki H, Inoue M, Doki Y, Yamamoto M, et al. Concurrent chemotherapy (5 FU and Cisplatin) and radiation therapy followed by surgery for T4 squamous cell carcinoma of the esophagus. J Surg Oncol 1999; 70(1):25-32.

Chan An, Wong A. Is combined chemothrapy and radiation therapy equally effective as surgical resection in localized esophageal carcinoma? Int J. Radiat Oncol Bio Phys 1999; 45(2): 265-70.

Earlam R, Cunha-Melo JR. Oesophageal squamous cell carcinoma: I. A critical review of surgery. Br J Surg 1980;67:384-7.

Walsh TN, Noonan N, Hollywood D, Kelly A, Kelling N, Hennessy TPJ. A comparison of multimodality therapy and surgery for esophageal adenocarcinoma. N Eng J Med 1996;335:462-7.

Urba SG, Orringer MB, Turrisi A. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 2001;19:305-9.

Erlam R, Cunham-Melo JR. Esophageal squamous cell carcinoma: II. A critical review of radiotherapy. Br J Surg 1980;67:457-62.

Forastiere AA, Orringer MB, Perez-Tamayo C. Preoperative chemoradiation followed by transhiatal esophagectomy for carcinoma of the esophagus: final report. J Clin Oncol 1993:11:1118-23.

Adelstein DJ, Rice TW, Rybicki LA. Does paclitaxel improve the chemoradiotherapy of lociregionally advanced esophageal cancer? A randomized comparison with fluorouracil-based therapy. J Clin Oncol 2000;18:2032-7.

Blanke C,Chiappori A, Epstein B. A phase II trial of neo-adjuvant paclitaxel and cisplatin with radiotherapy followed by surgery and postoperative taxol with 5FU and leucovorin in patients with locally advanced esophageal cancer. Proc Am Soc Clin Oncol 2000;19:248a.

Urba SG, Orringer M, Iannettoni M. A phase II trial of preoperative cisplatin, paclitaxel, and radiation therapy before transhiatal esophagectomy (THE) in patients with locoregional esophageal cancer (CA). Proc Am Soc Clin Oncol 2000;19:248a