A RANDOMIZED STUDY OF RADIOTHERAPY ALONE VERSUS RADIOTHERAPY PLUS 5-FLUOROURACIL AND PLATINUM IN PATIENTS WITH INOPERABLE, LOCALLY ADVANCEDSQUAMOUS CANCER OF THE ESOPHAGUS

Squamous cell cancer of the esophagus is the most common cancer among black South African males, and 60% of patients present with localized inoperable disease. Combined chemoradiotherapy has been reported to be superior to radiotherapy alone for localized inoperable esophageal ca ncer in North American patients. A study was carried out to determine if this was also applicable to South African patients, who present wit h more advanced disease. From September 1991 through June 1995, 70 pat ients with locally advanced (T3N0-1MO) squamous cancer of the esophagu s were prospectively randomized to receive radiotherapy alone or radio therapy combined with cisplatin and 5-fluorouracil. There was no stati stically significant survival difference between the two groups. The m edian survival was 144 days in the group receiving radiotherapy alone, and 170 days in the group receiving radiotherapy combined with chemot herapy (p = 0.42). The degree of weight loss before initiation of ther apy had a significant effect on survival regardless of the treatment a rm. Radiotherapy in combination with chemotherapy, as administered in this study for South African patients with locally advanced, inoperabl e squamous cancer of the esophagus, is no better than radiotherapy alo ne.