Bifractionated accelerated irradiation in the treatment of unresectable esophageal carcinomas

From 1986 to 1990, 60 patients with unresectable esophageal carcinomas were treated by bifractionated accelerated irradiation, alone or after neoadjuvant chemotherapy (39 patients). Mean age was 62 years, poor performance status was the first cause of non resectability (32 patients), then locoregional extension (20 patients) and finally second concomitant head and neck cancers (eight patients). A weight loss exceeding 10% was noted in 21 cases and 43 tumours exceeded 5 cm in length. The accelerated irradiation delivered a mean dose of 66 Gy in 29 days, and 87% of patients fully completed the planned treatment without interruption. Grade III radioepithelitis were observed in 12% of cases. For patients with a tumour of less than 5 cm, the local control rate at 2 years is 70%; survival excluding deaths due to intercurrent diseases and overall survival are respectively 63 and 40%. For patients with a tumour exceeding 5 cm, the local control rate at 2 years is 20%; overall survival and survival excluding deaths due to intercurrent disease at 2 years is 10%. This study suggests that bifractionated accelerated irradiation is feasible in these patients, with acceptable acute toxicity. Although follow-up is limited (20-50 months), local control seems to have been improved, especially for tumours of less than 5 cm. These encouraging results should be confirmed by randomized trials evaluating accelerated irradiation