PATTERNS OF FAILURE IN CARCINOMA OF THE UPPER ESOPHAGUS AFTER ALTERNATING CHEMORADIOTHERAPY

Alternating chemoradiotherapy has recently been reported to produce en couraging results in patients with advanced bead and neck cancer. We h ave treated 17 patients with squamous cell carcinoma of the upper esop hagus by alternating chemoradiotherapy and by following the patients f or 2 to 5 years, or until their death. Chemotherapy (cisplatin and 5-f luorouracil) was delivered during weeks 1, 4, and 7, and radiotherapy (180 to 200 cGy twice each day to 2,000 cGy) during weeks 2, 5, and 8 (total 6,000 cGy). Three patients (18%) died of toxicity (nadir sepsis ). Ah 14 patients who survived the treatment achieved a complete respo nse as shown by endoscopy and biopsy specimens, with restoration of sw allowing, and none experienced a local relapse. Three patients died of distant metastases (actuarial incidence 32% at 3 years). Tile 5-year survival rate was only 16%, however, because 8 other patients with no evidence of the cancer died of a variety of other causes: radiation pn eumonitis (1), chronic neutropenia (1), esophageal actinomycosis (1), pneumonia (2), stroke (1), myocardial infarction (1), and small-cell l ung cancer (1). Conceivably, some further improvement in the results m ight occur from cytokines, stem cells, and brachytherapy (by decreasin g deaths due to toxicity), but with so many causes of comorbidity it s eems unlikely, for the foreseeable future, that the 5-year survival ra te could be much improved by better treatment of esophageal cancer.