Induction chemotherapy followed by concurrent chemotherapy and high-dose radiotherapy for locally advanced squamous cell carcinoma of the upper-thoracic and midthoracic esophagus

The purpose of this study was to evaluate the efficacy and toxicity of an i nduction chemotherapy schedule followed by high-dose radiotherapy and concu rrent chemotherapy for locally advanced squamous cell carcinomas of the upp er and midthoracic esophagus. Patients were treated with three courses of f luorouracil, leucovorin, etoposide, and cisplatin-containing induction chem otherapy followed by high-dose external beam radiotherapy to 65 Gy in 6 wee ks for T4 and obstructing T3 tumors. Transversable T3 tumors received 60 Gy in 6 weeks by external radiotherapy, followed by two high-dose-rate esopha geal brachytherapy fractions of 4 Gy in 5-mm tissue depth. Concurrent to ra diotherapy, cisplatin and etoposide were given. Long-term survival of 22 pa tients was 41% and 31% at 2 and 3 years, respectively, with a median follow -up of 39 months. The probability of locoregional tumor recurrence was 60% at 3 years for all patients and 30% for those with a partial or complete re sponse to induction chemotherapy. Acute toxicity of this schedule was moder ate. Long-term survivors had a good swallowing function. This schedule offe rs a considerable chance of long-term survival for patients with locally ad vanced squamous cell carcinomas of the upper and midthoracic esophagus. Loc al in-field recurrences are the main risk after definitive radiochemotherap y. Dose escalation of radiotherapy is possible because of the observed low late toxicity.