AGGRESSIVE CONCURRENT CHEMORADIOTHERAPY AND SURGICAL RESECTION FOR PROXIMAL ESOPHAGEAL SQUAMOUS-CELL CARCINOMA

Background. Proximal esophageal cancer has been a disease associated w ith relatively poor treatment success, partly due to advanced disease at presentation and the morbidity of the surgery required. Therefore, most patients receive palliative radiation therapy, and disease contro l is poor. Methods. Between July 1990 and December 1992, nine consecut ive patients with proximal esophageal squamous cell carcinoma were tre ated with aggressive concurrent chemoradiotherapy followed by surgical resection. Treatment consisted of cisplatin (20 mg/m(2)/day) and 5-fl uorouracil (1000 mg/m(2)/day), both given as continuous intravenous in fusions over 4 days concurrent with accelerated fractionation external beam radiation therapy (150 cGy twice a day to a dose of 2400 cGy). T hree weeks after beginning treatment, a second course of chemotherapy and accelerated fractionation radiation therapy was administered to a total preoperative radiation therapy dose of 4500 cGy. After restaging of their disease, patients next underwent surgical resection. A singl e postoperative course of chemotherapy and 2400 cGy of concurrent acce lerated fractionation radiation therapy was administered to those pati ents with residual tumor in the resection specimen. Two of these nine patients also were given 4-day etoposide infusions (75 mg/m(2)/day) as part of their chemotherapy and received lower induction radiation the rapy doses. Results. Although significant toxicity was experienced, th ere were no deaths attributable to the chemoradiotherapy and only one perioperative death. All nine patients underwent surgery; five require d pharyngolaryn-goesophagectomy. No residual tumor was found in the re section specimen in three of the nine patients. Continuous locoregiona l tumor control was achieved in all patients. Only two developed dista nt metastases. Conclusions. These results, using aggressive multimodal ity treatment, suggest that excellent locoregional control and long te rm, disease free survival can be achieved in selected patients with pr oximal esophageal cancer.