Multimodality treatment of advanced esophageal cancer: A retrospective analysis

Background: The records of 161 patients with inoperable esophageal carcinom a were reviewed to determine the influence of concurrent radiochemotherapy and brachytherapy on overall survival. Patients and Methods: From 1984 to 1999 161 patients suffering from advance d esophageal carcinoma Stage II to IV were treated with radiotherapy alone (131) or radiochemotherapy (30). In 48 patients additional brachytherapy wa s given. Median follow-up was 8 months (1 to 64 months), the median externa l beam dosis was 51 Gy (18 to 66.6 Gy) and the median brachytherapy dose wa s 10 Gy (4 to 25 Gy). Chemotherapy consisted of cisplatin and 5-fluorouraci l. Results: Median survival for all patients was 10 months, 3-year survival ra te 13% and the 5-year survival 5.2%. In univariate analysis the best result s were achieved by concurrent radiochemotherapy with a median overall survi val of 13 months, a 4-year survival of 18% (p = 0.0368), the combination of external radiotherapy and additional brachytherapy with a median overall s urvival of 14 months, a 4-year survival of 12.2% (p = 0.0008). After combin ation of concurrent radiochemotherapy and brachytherapy the 2-year survival rate is 58%. Multivariate analysis revealed simultaneous radiochemotherapy , external beam dose and additional brachytherapy as prognostic factors, Co mbination of concurrent radiochemotherapy and brachytherapy was possible wi thout significant increase of local toxicity. Conclusions: Our retrospective analysis demonstrates that concurrent radioc hemotherapy and additional brachytherapy are effective treatment schedules without significant increase of toxicity and may improve overall survival o f patients with inoperable carcinoma of the esophagus. According to the res ults of this retrospective study, it would be appropriate to conduct a rand omized trial to evaluate the benefit of combination of concurrent radiochem otherapy and brachytherapy.