ABSTRACT
Despite advances in operative and postoperative care, long term survival rates following radical oesophagectomy are poor. Surgery remains the mainstay of radical treatment despite various series reporting similar results for treatment with radiotherapy, in particalar in the upper third of the oesophagus. We have studied a cohort of patients treated with definitive radiotherapy to examine the influence on survival of changes in diagnostic scanning and radiotherapy computer planning as well as various patient and disease related prognostic factors. From 1990 to 1996, 85 patients with clinically localised carcinoma of the oesophagus were treated at the department of clinical oncology and Gastro-Enterology Center, Mansoura university with definitive radiotherapy. This included 9 patients with oesophageal adenocarcinoma Diagnosis using barium swallow and endoscopy and biopsy were done for all cases. Radiotherapy doses fixed for all the patient 6500 cGy in 6.5-7 weeks. The 3- and 5-year survival figures were 27% and 21%, respectively, corrected for intercurrent deaths. Survival was better for adenocarcinoma than squamous cell carcinoma, though not statistically significant The only significant prognostic factor [P=0.01] was the use of diagnostic CT scanning [42% versus 13% 5-year survival with or without diagnostic CT scanning, respectively] which was associated with an increase infield size. Radiotherapy was well tolerated with no acute mortality or significant morbidity. Late stenosis requiring oesophageal dilatation was seen in four of twenty patients surviving 3 years or more. Survival following well planned radiotherapy is an effective alternative to surgery for both squamous cell and adenocarcinoma. Advances in staging and computerized planning and the use of multimodality treatment may further improve survival