EVALUATION OF MULTIMODALITY TREATMENT OF LOCOREGIONAL ESOPHAGEAL-CARCINOMA BY SOUTHWEST-ONCOLOGY-GROUP-9060

BACKGROUND. Continuous infusion 5-fluorouracil (CI5-FU) has been utili zed concurrently with radiotherapy to improve tumor control. In this p ilot trial, cisplatin, CI5FU, and radiotherapy were utilized for the t reatment of locoregional esophageal carcinoma. It was postulated that the combination would be well tolerated and associated with high respo nse rate and survival duration. METHODS. Thirty-two eligible patients with locoregional squamous cell carcinoma and adenocarcinoma of the es ophagus received a regimen consisting of the following: radiotherapy, 50 Gray (Gy) (30 Gy anteroposterior/posteroanterior regional with 20 G y AP/LPO/RPO boost) over 5 weeks, with CI5-FU 250 mg/m(2)/d for the du ration of radiotherapy and cisplatin 25 mg/m(2)/day on Days 1-3 during Weeks 1 and 4 of the radiotherapy cycle. Upon completion of radiother apy, two additional courses of cisplatin 75 mg/m(2) on Days 1 and 29 a nd CI5-FU 300 mg/m(2)/day on Days 1-21 and 29-50 were delivered. Follo wing imaging and endoscopic reassessment, patients with no evidence of disease received more chemotherapy. Surgery was suggested only for pa tients with residual local disease. RESULTS. Complete response was dem onstrated in 44% of patients, clinically in 12 patients, and during su rgery in 2 others. The median survival was 20 months, and the 1-year s urvival rate was 59%. Toxicity was severe, comprised of esophagitis, i nfection, and gastrointestinal complications. Dose delays and reductio ns occurred in the majority of patients. Four early deaths were noted. CONCLUSIONS. The regimen that was the focus of this trial has been ac tive in the treatment of esophageal carcinoma. However, compared with existing regimens, its complexity and toxicity preclude its future use without modifications. (C) 1996 American Cancer Society.