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The Annals of Thoracic Surgery, Vol 51, 189-193, Copyright © 1991 by The Society of Thoracic Surgeons

ARTICLES

Esophageal malignancies: is preoperative radiotherapy the way to go?

OP Yadava, AJ Hodge, LR Matz and JB Donlon
Department of Cardio-Thoracic Surgery, Royal Perth Hospital, Australia.

During the period 1969 to 1988, 68 patients with esophageal malignancy were subjected to preoperative radiotherapy consisting of 30 Gy over 3 weeks followed by esophagectomy after a wait of 2 weeks. Sixty-two of 68 patients (91%) were followed up retrospectively (5-year survival rate, 17.2%; 10-year survival rate, 4.8%). Radiosensitivity of the tumor was graded by a radiation effect scoring method devised by us, and this was found to correlate with long-term prognosis (p = 0.05). Radiotherapy "sterilized" malignant involvement of adventitia and draining lymph nodes in 8 patients and thereby converted "palliative" into potentially "curative" resections with a mean survival of 57.2 months in this group of patients. Preoperative radiotherapy was found to increase the survival, decrease the incidence of residual tumor at the resected stump, reduce the incidence of local recurrence, and increase the resectability rate.