The value of preoperative radiotherapy in esophageal cancer: Results of a study of the E.O.R.T.C.

Abstract

Abstract Attempts to combine radiation therapy and surgery in patients with operable carcinoma of the esophagus began 30 years ago. The first reported surgical series showed a low rate of resectability and a high postoperative mortality. Results of radiation therapy alone were also disappointing in the long run, especially in patients who appeared to be excellent operative risks with small localized tumors. The rationale for a combined approach was that x‐ray therapy could bring about a reduction of tumor activity and bulk, an improvement in nutritional state through the restoration of the ability to swallow, a reduction of transplantability of the tumor, and a curative effect on periesophageal regional disease which is not treated well by surgery. On the other hand, surgery often allowed an extended resection, clearing residual foci or distant esophageal wall extension. The limit of a combined approach is the toxicity of the preoperative radiation which must be mild enough to allow surgery to proceed without excessive delay or increased mortality. Numerous radiotherapy schedules were tried using different fields, doses, and fractionations, most of them in nonrandomized studies. Two prospective randomized trials have been recently reported. The final results of a third prospective trial, run by the E.O.R.T.C., will be presented .