Response to chemoradiation in patients with squamous cell carcinoma of esophagus treated at Shohada-e-Tajrish hospital

ABSTRACT

Esophageal carcinoma is among the first ten common malignancies worldwide, with a high prevalence in Iran. Previously, surgery or radiotherapy were the only modalities of therapy; however, due to unsatisfactory outcomes, other therapeutic approaches such as chemoradiation are now under assessment as the first line treatment. Preliminary results have shown reduced local recurrence and better survival. It was a quasi experimental study. Patients with squamous cell carcinoma of esophagus who had the following criteria were enrolled lack of previous therapy, no metastasis, performance status of 0-2, and normal liver, kidney and bone marrow function tests. Chemoradiation was carried out through one of the following regimens 1- Cisplatin 40mg/m2/weekly + 50-60Gy radiation; or, 2- Cisplatin 75mg/m2 for the first day + 5-FU 1000mg/m2 for the first 4 days of weeks 1, 5, 9, and 13 + 50Gy radiation. Following the therapy, biopsies of suspected lesions and CT scan of local lymph nodes were obtained to evaluate the response rate. Of 39 patients with non-metastatic squamous cell carcinoma of esophagus who had been referred to our unit during a 5-year period [1998-2003], 30 met the inclusion criteria. The study population included 23 males and 7 females with a mean age of 65 years [35-77 years]. Tumor location was as follows upper third of esophagus in 6, middle third in 12, and lower third in 12 patients. Twenty-one patients were put on the first protocol and the remaining nine patients on the second regimen. There were 2 deaths, one due to fever and neutropenia, and the other of uncertain cause. Clinical response to therapy was reported in 23 [76.6%] patients. Chemoradiation showed a low complication rate and high efficacy. It can be safely recommended for inoperable patients. Further clinical trials are necessary before definite recommendations can be made