Feasibility of daily concurrent chemoradiation therapy as nonsurgical management for esophageal cancer: Our experience and theoretical background

Background and Objectives: Many combination patterns of chemotherapy and ra diotherapy (chemoradiation therapy; CRT) for the treatment of esophageal ca ncer indicate that the optimal doses of chemotherapeutic agents and of chem otherapy and radiotherapy regimens remain unclear. The feasibility and prom ising outcome of our newly developed definitive CRT for nonsurgical managem ent of esophageal cancer, essentially based on the theoretical backgrounds of the radiosensitizing and biochemical modulation effects of chemotherapeu tic agents, is investigated. Methods: Six nonoperated esophageal cancer patients were treated by daily c oncurrent CRT, which consisted of continuous 5-fluorouracil administration with leucovorin, combined with a low dose of daily cisplatin administration before each fraction of radiation. Response to CRT and toxicities and surv ivals were evaluated. Results: Complete and partial responses were seen in 2 patients each. Histo logic examination of the biopsy specimens in the primary site showed no can cer cells in 4 patients; 1 of them survived for 31 months after CRT. The ot her 2 patients showed good-quality survival, having dramatic relief from dy sphagia. There were no treatment-related deaths. Conclusions: The daily concurrent CRT is rational and promising and compare s well with other series of definitive CRT. The CRT based on the theoretica l background is feasible as a nonsurgical management option for esophageal cancer patients. J. Surg. Oncol. 2000:74:134-137. (C) 2000 Wiley-Liss, Inc.