Chemoradiotherapy of locally advanced esophageal cancer

To investigate whether chemoradiotherapy is effective for solid cancers, combination chemotherapy with cisplatin and protracted infusion 5-fluorouracil (5-FU) and concurrent radiotherapy was used to treat patients with locally advanced squamous cell carcinoma of the esophagus. From January 1990 through December 1999, 59 patients received one of two regimens. In regimen A standard cisplatin (75 mg/m2/day) was administered intravenously over 2 hours on day 1, after which 5-FU was administered of 300 mg/m2/day, followed by radiotherapy (2 Gy/2 fractions/day) on days 2 through 6, 9 through 13, 16 through 20, and 23 through 27. In regimen B cisplatin (5 mg/m2/day) was administered intravenously over 1 hour, followed by radiotherapy (2 Gy/2 fractions/day) on days 1 through 5, 8 through 12, 15 through 19, and 22 through 26. In addition, 5-FU (200 mg/m2/day) was administered intravenously on days 1 through 28. Of the 20 patients receiving regimen A, 9 (45%) showed partial responses; the median progression-free survival was 10.5 months. The overall 5-year survival rate was 31.6%. Of the 39 patients receiving regimen B, 2 (5%) showed complete responses and 28 (72%) showed partial responses; the median progression-free survival was 17.5 months. The overall 4-year survival rate was 35.3%. Common adverse effects in both regimens included myelosuppression (neutropenia) and esophagitis. Gastrointestinal and renal toxicities were the most common toxicities in regimen A but were rare in regimen B. We found that outcomes with regimen B were better those with regimen A. We should consider selecting the operative patients. The most important prognostic factors were the number of metastatic lymph nodes and pathological grade. The results indicate that optimal chemoradiotherapy might require proper evaluation of prognostic factors at the time of diagnosis. Coupled with the need for more effective treatment of distant metastasis is the need for adjuvant therapy. (author)