Radiation therapy for Stage IV esophageal cancer

Between 1971 and 1991, 269 patients with squamous cell carcinoma of the esophagus were treated by radiation therapy at the Department of Radiology, Gunma University Hospital. Of these, 143 patients with inoperable Stage IV esophageal cancer, according to the classification of Japanese Society for Esophageal Cancer, were investigated. They consisted of 120 males and 23 females ranging from 35 to 93 years of age, with an average age of 68 years. Factors for Stage IV were organ metastasis (M1) in 43 patients, lymph node metastasis (N3(+)4(+)) in 41 patients, invasion into the neighboring structures (A3) in 57 patients and pleural dissemination (Pl1) in 2 patients. Of these, 101 patients (71%) could be irradiated 60 Gy or more, and 2-year and 5-year overall survival rates were 13% and 5%, respectively. Median survival times were 4 months for M1 disease, 6 months for Pl1 disease, 7 months for N3(+)4(+) disease and 10 months for A3 disease. Eleven patients could survive over 2 years (9 patients with A3, 1 patient with N3(+), 1 patient with M1 disease). The rate of the patients who could be discharged from hospital was 84% for A3, 87% for N3(+)4(+) and 53% for M1 cases. The rate of the patients who could be improved from dysphagia was 87%. In conclusion, radiation therapy was safe and effective treatment for Stage IV esophageal cancer to get longer survival time and to improve QOL (quality of life), especially in patients with A3 disease. (author)