M. Murakami et al., NEOADJUVANT CONCURRENT CHEMORADIOTHERAPY FOLLOWED BY DEFINITIVE HIGH-DOSE RADIOTHERAPY OR SURGERY FOR OPERABLE THORACIC ESOPHAGEAL-CARCINOMA, International journal of radiation oncology, biology, physics, 40(5), 1998, pp. 1049-1059
Citations number
31
Categorie Soggetti
Oncology,"Radiology,Nuclear Medicine & Medical Imaging
Purpose: A prospective clinical trial was undertaken to investigate th
e feasibility of concurrent chemoradiotherapy for esophageal carcinoma
s. Materials and Methods: Between June 1989 and May 1996, forty patien
ts with operable squamous cell carcinoma of the thoracic esophagus (St
age 0 to III: UICC 1987), ages 45 to 78 years (mean: 64), were enrolle
d in a study of neoadjuvant concurrent chemoradiotherapy followed by d
efinitive high-dose radiotherapy (CRT group) or surgery (CRT-S group).
Neoadjuvant chemoradiotherapy consisted of 44 Gy in 40 fractions for
4 weeks (2.2 Gy/2 Fr/day) through 10-MVX rays, with 2 courses of cispl
atin (80-100 mg/body, mean: 60 mg/m(2), Day 1, bolus injection) and 5-
fluorouracil (500-1000 mg/body/day, mean: 400 mg/m(2), Days 1-4, conti
nuous infusion). After completion of neoadjuvant chemoradiotherapy, an
intermediate clinical response was assessed by barium swallow, esopha
goscopy with/without biopsy, EUS in most cases, thoracic and upper abd
ominal CT scan, and cervical US. Definitive chemoradiotherapy was perf
ormed in patients when regression of more than 75% was evident (CRT Gr
oup), and esophageal resection was indicated in those who remained at
less than 75% (CRT-S Group). In CRT Group, a cumulative dose of 60-70
Gy for Tis, T1 and 65-75 Gy for T2-T4 tumor with high-dose-rate intral
uminal brachytherapy and a total of 3 courses of chemotherapy were pla
nned. In CRT-S Group, intraoperative radiotherapy for abdominal lympha
tic system and postoperative supraclavicular irradiation were added. R
esults: At the time of intermediate assessment, complete response (CR)
was observed in 16 patients, a partial response (PR) in 22, and no ch
ange (NC) in 2. Thirty responding patients (CR, 16; PR, 14) entered th
e CRT Group, and 10 nonresponding patients (PR, 8; NC, 2) were followe
d by surgery (CRT-S Group). Radiotherapy was completed satisfactorily,
but chemotherapy was suspended in 26 patients (65%) because of acute
toxicity. Clinical CR rate at the completion of treatment showed 90% i
n CRT Group, and pathologic CR rate 10% in CRT-S Group. The overall me
dian survival was 45 months, survival at 1, 2, and 3 years being 100%,
72%, and 56%, respectively. Local-regional failure was observed in 7
patients (all in CRT Group), distant failure in 6 (3 in CRT Group, 3 i
n CRT-S Group) and local-regional with distant failure in 1 (CRT Group
). Four patients with local-regional recurrence in the CRT Group were
salvaged by surgery. Overall survival at 2 and 3 years for CRT vs. CRT
-S Group was 72%, 64% vs. 75%, 38%, respectively. No treatment-related
mortality was observed. The rate of the 'esophagus conservation' was
65% (Stage 0: 1 of 1, 100%; Stage I: 11 of 12, 92%; Stage II: 8 of 17,
47%; Stage III: 6 of 10, 60%). Conclusion: Our results demonstrated t
hat almost all early disease (Stage 0-I) and about half of advanced di
sease (Stage II-III) could be conserved, their esophagus treated by th
e multidisciplinary approach centering on high-dose radiotherapy and c
oncurrent chemotherapy. (C) 1998 Elsevier Science Inc.