HIGH-DOSE EXTERNAL-BEAM RADIATION-THERAPY WITH OR WITHOUT CONCOMITANTCHEMOTHERAPY FOR ESOPHAGEAL-CARCINOMA

Esophageal cancer patients treated with radiotherapy (RTx) are most of ten those with malignancies too extensive for surgery or those who dee med medically unsuitable for an aggressive surgical approach. Summariz ing RTx series, the 2-year survival rate is in the range of 10% and at 5 years about 5%. Although not randomly compared, these results are n ot significantly worse than those achieved with surgery in more advanc ed tumors. In stage I/II tumors, more recent trials reported of 5-year survival rates varying between 12% and 20%. These data indicate that irradiation may be administered with curative intention but usually on ly for patients who are also candidates for primary surgery. On the ot her hand, modern RTx (doses > 60 Gy) +/- endoluminal after-loading may provide good palliation (relief of dysphagia) for patients with good prognostic factors such as weight loss of less than 10% body weight, g ood performance status, younger age, and location of the tumor. In the perioperative setting, RTx reduced the frequency of the local recurre nces but did not increase the overall resection and R0 resection rates and did not improve survival due to more patients relapsing at distan t sites. Combined chemoradiotherapy has shown to be superior to RTx al one with respect to local control, disease free survival and overall s urvival and in a marked reduction of distant failures. These data supp ort the use of chemoradiotherapy as standard treatment of locally adva nced and nonresectable esophageal cancer. They also provide a basis fo r randomized trials comparing chemoradiotherapy alone versus preoperat ive treatment modalities.