Combined modality therapy for esophageal cancer

Combined Modality Treatment for Esophageal Cancer

We have performed a review of recent literature about combined modality therapy in esophageal cancer. Radiobiological principles and radio-chemotherapy interactions modalities in clinical experiences have been considered. Therapeutic schedules, modalities of implementation, and the most relevant clinical results obtained by the major clinical research groups have been emphasized. We also comment on the current role of surgery and on the clinical questions arising in combined radio-chemotherapy treatment.

Preliminary results of radiotherapy with or without weekly paclitaxel in locally advanced non-small cell lung cancer

PURPOSE

In this study our objective was to evaluate the therapeutic significance of concurrent paclitaxel and radiotherapy compared with radiotherapy alone.

PATIENTS AND METHODS

Patients with stage III A/B NSCLC were randomly assigned to receive either radiotherapy alone (group 2) or concurrent weekly paclitaxel with radiotherapy (group 1) in GMMA. Radiotherapy was given as a split-course schedule with the total dose of 56 Gy. Paclitaxel, 60 mg/m(2), was administered only to group 1 on the first day of each radiotherapy week. To assess differences between values, P values were calculated with the chi(2) test. A Mann Whitney U-test was used to assess significant differences between the two values. Actuarial survival curves were calculated by the Kaplan-Meier method.

RESULTS

There were 25 patients who underwent chemoradiotherapy and 26 who underwent radiotherapy only. Median follow-up was 14 months. The overall response rate was 92% and 70% for groups 1 and 2, respectively ( P= 0.003). Median survival was 15.2 months for group 1, and 12.0 months for group 2 ( P= 0.027).

CONCLUSION

Based on this response and the toxicity profile, outpatient split-course radiotherapy and weekly paclitaxel seems to be feasible and safe.

Prospective trial of concurrent chemoradiotherapy with protracted infusion of 5-fluorouracil and cisplatin for T4 esophageal cancer with or without fistula

PURPOSE

A prospective trial of concurrent chemoradiotherapy (CT-RT) with a protracted infusion of 5-fluorouracil and cisplatin was performed to evaluate the safety and efficacy of this protocol for T4 esophageal cancer (UICC 1997).

METHODS AND MATERIALS

Between 1998 and 2000, 28 patients with T4 esophageal squamous cell carcinomas were treated with concurrent CT-RT. Of the 28 patients, 15 had Stage III, 5 Stage IVA, and 8 Stage IV disease. Five of the T4 tumors had evidence of fistula before treatment. Patients received a protracted infusion of 5-fluorouracil 300 mg/m(2)/24 h on Days 1-14, a 1-h infusion of cisplatin 10 mg/body on Days 1-5 and 8-12, and concurrent radiation at a dose of 30 Gy in 15 fractions during 3 weeks. This schedule was repeated twice, with a 1-week split, for a total RT dose of 60 Gy during 7 weeks for 25 patients. For the remaining 3 patients, 30 Gy of preoperative CT-RT was administered.

RESULTS

Of the 25 patients who were treated with the full dose of CT-RT, 14 (56%) completed the two courses of the CT-RT protocol, and 8 patients (32%) received the full dose of RT but a reduced dose of chemotherapy. Eight (32%) of the 25 tumors showed complete regression. Although Grade 3 hematologic toxicities were frequently noted, Grade 4 or more hematologic toxicities were few. Of the 5 T4 fistulous tumors, 2 demonstrated the disappearance of the fistula after CT-RT. However, the worsening or development of an esophageal fistula was noted in 5 patients. The 2-year survival rate for patients with Stage III was 27%, and the median survival time for those with Stage III and Stage IVA+IV was 12 and 5 months, respectively.

CONCLUSION

Despite its significant toxicity for esophageal fistula, this concurrent CT-RT protocol of protracted 5-fluorouracil infusion and cisplatin appears feasible and effective for T4 esophageal cancer with or without fistulas.