INDUCTION CHEMOTHERAPY IN THE TREATMENT OF PATIENTS WITH CARCINOMA OFTHE ESOPHAGUS

A prospective randomized phase III trial was carried out at Songklanag arind Hospital from August 1988 to December 1990. The objectives of th e study were to evaluate the effect of chemotherapy regimen in squamou s cell carcinoma of the esophagus and to determine whether induction c hemotherapy improves symptom-free period and survival in these patient s compared to surgical treatment alone. Twenty-four patients were rand omized to receive 2 cycles of chemotherapy, cis-platinum 100 Mg/M2 int ravenously on day 1, bleomycin 10 Mg/M2 loading dose on day 3, followe d by 10 Mg/M2/day continuous intravenous infusion on days 4 through 7, and vinblastine 3 Mg/M2 given intravenously on days 1, 8, 15, 22. The cycle was repeated on day 29. Fifteen patients completed 2 courses of chemotherapy and among these, 2 patients had a complete clinical resp onse (13%), 6 (40%) had a partial response, and 7 patients (47%) had n o response. Four patients died during chemotherapy treatment. Grade 3 hematologic toxicity (ECOG criteria) was observed in 47% (7/15) of pat ients. Twenty-two patients were randomized to conventional treatment ( surgery alone). Median survival time was 17 months in both groups. How ever, early survival appeared to be better in the control group. Kapla n-Meier survivals at 6 months were 69% and 89% and at 3 years were 31% and 36% for the induction chemotherapy group and control group, respe ctively. The survival time differences were not statistically signific ant (P = 0.186). These findings demonstrate that although this chemoth erapy regimen had some effect on squamous cell carcinoma of esophagus, it did not improve survival. On the contrary, survival seems to be be tter in the control group. The 6-month survival discrepancy between bo th groups might be due to the poor nutritional status of our patients, who may better tolerate smaller dosages of chemotherapy. (C) 1994 Wil ey-Liss, Inc.