Role of Preoperative Chemotherapy in Squamous Cell Carcinoma of Esophagus in Kashmir, a Cancer Belt - A Pilot Study

Background: Esophageal carcinoma is the fifth leading gastrointestinal malignancy and is one of the leadingcauses of cancer related death. Despite improvements in surgical technique over the last few decades, the outcomehas been dismal, with overall 5 year survival not exceeding 15%-25%. Aims and
Objectives: To evaluate theeffect of preoperative chemotherapy on resectability, complication rate and overall survival in patients withsquamous cell carcinoma esophagus. Materials and
Methods: 50 patients with histologically confirmed squamouscell carcinoma (SCC), with localised or loco-regional disease (stage 4 excluded) were divided into 2 groups.Group A patients were subjected to 2-3 cycles of pre-operative chemotherapy (5FU-CDDP), whereas Group Bpatients were directly operated on. Observations: 3 (12%) patients in group A showed complete pathologicalresponse to chemotherapy and 18 (72%) showed a partial response, with four patients (16%) showing resistanceto chemotherapy. There was no statistically significant difference in terms of response to chemotherapy withrespect to degree of differentiation of tumor. There was no significant difference in the overall resectability ratesbetween the two groups (p>0.05), but R0 resection was achieved in 20 (80%) of group A and only 10 (40%) ofgroup B, the difference being statistically significant (p<0.05). The rate of overall complications was also muchhigher in the control group. Initially there was no significant difference in the survival between the two groups,but later (20 months) the study group showed a slight non-significant advantage.
Conclusion: Preoperativechemotherapy significantly increases the rate of R0 resection without significantly increasing postoperativemorbidity and mortality in patients with squamous cell carcinoma of esophagus. However, to assess the impacton survival the study period needs to be extended.