Clinical studies of postoperative arterial Infusion chemotherapy in patients with pathologic T 3 esophageal squamous carcinoma

OBJECTIVE To evaluate how arterial infusion chemotherapy after radical surgery influences long-term survival of patients with pathologic T 3 (pT 3 ) esophageal squamous carcinoma. METHODS We divided 190 patients with pathologic pT 3 esophageal squamous carcinoma, confirmed by consecutive radical surgery, into an experimental group (surgery + intra −arterial infusion, 56 T 3 N 0 M 0 and 52 T 3 N 1 M 0 cases), and the remaining patients into a control group (surgery alone, 48 T 3 N 0 M 0 and 34 T 3 N 1 M 0 cases). The experimental group was sub-grouped into 56 cases (26 T 3 N 0 M 0 and 30 T 3 N 1 M 0 cases) receiving 1 or 2 periods of chemotherapy, while 52 cases (30 T 3 N 0 M 0 and 22 T 3 N 1 M 0 cases) underwent 3 or more than 3 periods of chemotherapy. We used one to seven courses of selected arterial infusion chemotherapy of cisplatin (80 mg/m 2 of body-surface area) and fluorouracil (800 mg/m 2 ) with or without epirubicin at 3–4 weeks post operation. The interval between each period was 3–4 weeks. All cases were followed-up for more than 5 years. Survival rates were calculated by the Kaplan-Meier methods and survival differences between patients with and without selected arterial infusion chemotherapy were compared with the Log-rank test. Prognostic variables were entered into a Cox regression analysis model controlling for age, site, lymph node status, and treatment received. RESULTS The overall survival rates were not significantly different between the experimental group and the control group, but there was better survival for patients who received 3 or more than 3 courses of chemotherapy. Lymph node status (N) was an important factor in the prognosis. CONCLUSION Trans-catheter arterial infusion chemotherapy is a safe and effective method of therapy. Postoperative selective arterial infusion chemotherapy can improve the survival rate in patients with esophageal squamous carcinoma who were previously treated by radical surgery. However, this modality of therapy needs further investigation.