Concurrent Chemoradiation in Patients with Cancer of the Esophagus / 대한방사선종양학회지

ABSTRACT

PURPOSE: To evaluate survival rate and prognostic factors affecting survival of patients with esophageal cancer treated with concurrent chemoradiation. MATERIALS AND METHODS: Eligibility included biopsy proven invasive carcinoma of the cervical or thoracic esophagus, confined to esophagus and mediastinum with or without regional lymph node and supraclavicular lymph node, and ECOG performance status H0-H2. Patients received radiation therapy with 5940 cGy over 7 weeks and chemotherapy, consisted of 5-FU (1000 mg/m2/day in continuous infusion for 5 days, days 1 to 5 and days 29 to 33) and mitomycin C (8mg/m2 intravenous bolus at day 1). After concurrent chemoradiation, maintenance chemotherapy was followed with 5-FU (1000 mg/m2/day in continuous infusion for 5 days at 9th, 13th, and 17th weeks) and cisplatin (80mg/m2 intravenous bolus at the first day of each cycle). RESULTS: From November 1989 to November 1995, 44 patients were entered in this study. After treatment, complete response rate and partial response rate were 59% and 41%. Overall 1, 2, and 5-year survivals were 59%, 38%, and 9.6% (median 17 months). Prognostic factors affecting survival were response to treatment and T-stage. Among 26 complete responders, there were 6 local recurrences, 3 distant recurrences, 1 local and distant recurrence, and 2 unknown site recurrences. Acute and chronic complication rates with grade 3 or more were 20% and 13.6% and there was no treatment-related mortality. CONCLUSION: Concurrent chemoradiation, compared with historical control groups that treated with radiation alone, improved median survival and did not significantly increase treatment-related complications. Complete responders had longer survival duration than partial responders. Predominant failure pattern was local failure. So, efforts to improve local control should be proposed.