This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Darnton, S.J. Articles by Ferry, D.R. Search for Related Content PubMed PubMed Citation Articles by Darnton, S.J. Articles by Ferry, D.R. Related Articles Related Correspondence Social Bookmarking                            What's this?

Preoperative Mitomycin, Ifosfamide, and Cisplatin Followed by Esophagectomy in Squamous Cell Carcinoma of the Esophagus: Pathologic Complete Response Induced by Chemotherapy Leads to Long-Term Survival

S.J. Darnton, V.R. Archer, D.D. Stocken, P.J. Mulholland, A.G. Casson, D.R. Ferry

From the Birmingham Heartlands Hospital and Cancer Research UK, Trials Unit, Institute of Cancer Research, University of Birmingham, Birmingham, United Kingdom.

Address reprint requests to S.J. Darnton, PhD, Department of Thoracic Surgery, Birmingham Heartlands Hospital, Birmingham B9 5SS, United Kingdom; e-mail: jane.darnton{at}heartsol.wmids.nhs.uk.

Purpose: Squamous cell carcinoma of the esophagus remains an aggressive disease with a poor prognosis, even after curative-intent surgery. This article analyzes the impact of preoperative chemotherapy with mitomycin, ifosfamide, and cisplatin (MIC) on a cohort of 68 patients.

Patients and Methods: From 1988 to 1994, 68 patients with potentially operable squamous cell carcinoma of the esophagus were entered onto two phase II trials of neoadjuvant chemotherapy with mitomycin 6 mg/m², ifosfamide 3 g/m², and cisplatin 50 mg/m² and received between two and four cycles of treatment at 3-weekly intervals. Two patients were removed from the analysis when they were found to have malignancy other than squamous cell carcinoma of the esophagus.

Results: Forty (61%) of 66 patients had a radiologic response to chemotherapy (18 complete responses and 22 partial responses), and 52 (79%) of 66 patients went on to have the primary tumor resected. There were nine pathologic complete responders, seven of whom remain fit and well after at least 60 months of follow-up. The overall median survival was 12.4 months (95% confidence interval, 9.6 to 18.8 months). The complete response and node-negative patients survived significantly longer than those in other categories (log-rank ² = 18.8; P < .001): on average 13 months longer than the node-positive or nonresected category (22.0 v 9.4 months). The toxicity of the regimen was low.

Conclusion: MIC is an easily administered, well-tolerated, and efficacious regimen as neoadjuvant therapy for patients with squamous cell carcinoma of the esophagus. These results warrant further investigation.

S.J.D. was supported by the Oesophageal Cancer Fund, Birmingham Heartlands Hospital, Birmingham, United Kingdom.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Correspondence

• Pathologic Complete Response and Survival Advantage in Esophageal Cancer: Old News
  Michael J. Kraut
  JCO 2004 22: 2513 [Full Text]

This article has been cited by other articles:

				M. G. Luthra, J. A. Ajani, J. Izzo, J. Ensor, T.-T. Wu, A. Rashid, L. Zhang, A. Phan, N. Fukami, and R. Luthra Decreased Expression of Gene Cluster at Chromosome 1q21 Defines Molecular Subgroups of Chemoradiotherapy Response in Esophageal Cancers Clin. Cancer Res., February 1, 2007; 13(3): 912 - 919. [Abstract] [Full Text] [PDF]

				R. J. Korst, A. L. Kansler, J. L. Port, P. C. Lee, Y. Kerem, and N. K. Altorki Downstaging of T or N Predicts Long-Term Survival After Preoperative Chemotherapy and Radical Resection for Esophageal Carcinoma Ann. Thorac. Surg., August 1, 2006; 82(2): 480 - 485. [Abstract] [Full Text] [PDF]

				R. Luthra, T.-T. Wu, M. G. Luthra, J. Izzo, E. Lopez-Alvarez, L. Zhang, J. Bailey, J. H. Lee, R. Bresalier, A. Rashid, et al. Gene Expression Profiling of Localized Esophageal Carcinomas: Association With Pathologic Response to Preoperative Chemoradiation J. Clin. Oncol., January 10, 2006; 24(2): 259 - 267. [Abstract] [Full Text] [PDF]

				L. R. Chirieac, S. G. Swisher, A. M. Correa, J. A. Ajani, R. R. Komaki, A. Rashid, S. R. Hamilton, and T.-T. Wu Signet-Ring Cell or Mucinous Histology after Preoperative Chemoradiation and Survival in Patients with Esophageal or Esophagogastric Junction Adenocarcinoma Clin. Cancer Res., March 15, 2005; 11(6): 2229 - 2236. [Abstract] [Full Text] [PDF]

				M. J. Kraut Pathologic Complete Response and Survival Advantage in Esophageal Cancer: Old News J. Clin. Oncol., June 15, 2004; 22(12): 2513 - 2513. [Full Text] [PDF]

				A. G. Casson, S. J. Darnton, V. Archer, D. Ferry, D. Stocken, and P. Mulholland In Reply: J. Clin. Oncol., June 15, 2004; 22(12): 2513 - 2514. [Full Text]