RADICAL RADIOTHERAPY FOR CARCINOMA OF THE ESOPHAGUS - AN EFFECTIVE ALTERNATIVE TO SURGERY

Background and purpose: Despite advances in operative and postoperativ e care, long term survival rates following radical oesophagectomy are poor. Surgery remains the mainstay of radical treatment despite variou s series reporting similar results for treatment with radiotherapy, in particular in the upper third of the oesophagus. We have studied a co hort of patients treated with definitive radiotherapy to examine the i nfluence on survival of changes in diagnostic scanning and radiotherap y computer planning as well as various patient and disease related pro gnostic factors. Patients and methods: From 1985 to 1994, 101 patients with clinically localised carcinoma of the oesophagus were treated at the Christie Hospital with definitive radiotherapy. This included 11 patients with oesophageal adenocarcinoma. Diagnostic and planning tech niques changed over the period studied, with increasing use of both di agnostic and radiotherapy planning CT scanning. Radiotherapy doses ran ged from 45 to 52.5 Gy in 15 or 16 fractions over 3 weeks. Results: Th e 3- and 5-year survival figures were 27% and 21%, respectively, corre cted for intercurrent deaths. Survival was better for adenocarcinoma t han squamous cell carcinoma, though not statically significantly. The only significant prognostic factor (P = 0.01) was the use of diagnosti c CT scanning (42% versus 13% 5-year survival with or without diagnost ic CT scanning, respectively) which was associated with an increase in field size. Radiotherapy was well tolerated with no acute mortality o r significant morbidity. Late stenosis requiring oesophageal was seen in five of 20 patients surviving 3 years or more. Conclusions: Surviva l following well planned radiotherapy is an effective alternative to s urgery for both squamous cell and adenocarcinoma. Advances in staging and three-dimensional planning and the use of multimodality treatment may further improve survival. (C) 1998 Elsevier Science Ireland Ltd. A ll rights reserved.