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Pathologic Complete Response and Survival Advantage in Esophageal Cancer: Old News

Providence Cancer Institute, Southfield, MI

To the Editor:

Darnton et al report in the November 1, 2003, issue of the Journal of Clinical Oncology, the results of two phase II trials in esophageal carcinoma performed at their institution.¹ These trials employed preoperative chemotherapy before definitive surgery, and the results of the trials indicate a statistically significant survival advantage for those patients achieving a pathologic complete response.

I would like to point out that this is not new information. In a series of trials performed in the late 1970s and early 1980s at Wayne State University in Detroit, MI, Lawrence Leichman and the late Zwi Steiger and colleagues were able to demonstrate similar findings, employing mitomycin and high-dose infusional fluorouracil with concurrent radiotherapy.^2-4 Cisplatin was substituted for mitomycin in the later trials, with equivalent or better results, and less toxicity. In an article published in the Journal of Clinical Oncology in February 1984, Leichman et al⁴ presented data for 21 patients with locally advanced squamous cell carcinoma of the esophagus (mostly T3/NX) treated with cisplatin, fluorouracil, and concurrent radiation. In 15 patients, this was followed by esophagectomy with resection for cure, and seven of these patients had a pathologic complete response. The median survival of the pathologic complete response group was 24 months.

In oncology, as in all of medicine, we stand on the shoulders of giants. To advance the field, we need to acknowledge and build on the accomplishments of our predecessors.

Author's Disclosures of Potential Conflicts of Interest

The author indicated no potential conflicts of interest.

REFERENCES

1. Darnton SJ, Archer VR, Stocken DD, et al: 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. J Clin Oncol 21:4009–4015, 2003[Abstract/Free Full Text]

2. Steiger Z, Franklin R, Wilson RF, et al: Complete eradication of squamous cell carcinoma of the esophagus with combined chemotherapy and radiotherapy. Am Surg 47:95–98, 1981[Medline]

3. Steiger Z, Franklin R, Wilson RF, et al: Eradication and palliation of squamous cell carcinoma of the esophagus with chemotherapy, radiotherapy, and surgical therapy. J Thorac Cardiovasc Surg 82:713–719, 1981[Abstract]

4. Leichman L, Steiger Z, Seydel HG, et al: Preoperative chemotherapy and radiation therapy for patients with cancer of the esophagus: A potentially curative approach. J Clin Oncol 2:75–79, 1984[Abstract]

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Related Reply

• In Reply:
  Alan G. Casson, S. Jane Darnton, Venice Archer, David Ferry, Deborah Stocken, and Paul Mulholland
  JCO 2004 22: 2513-2514 [Full Text]

Related Article

• 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, and D.R. Ferry
  JCO 2003 21: 4009-4015 [Abstract] [Full Text]

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