A prospective trial of short-course radiotherapy plus chemotherapy for palliation of dysphagia from advanced esophageal cancer

Purpose: Between 1994 and 1997, 22 patients with dysphagia from advanced in curable esophageal cancer were enrolled in a phase I/II prospective study t o assess the palliative benefit and toxicity of a short course of radiother apy with chemotherapy. Methods: The study population included 17 men and five women with a median age of 69 (range 43-84). Patients were treated with 30 Gy in ten fractions to the mediastinum with a concurrent single course of chemotherapy (5-FU, 1 000 mg/m(2), days 1-4 and mitomycin-C 10 mg/ m(2), day 1), Swallowing abili ty was recorded each day on a self-administered diary card using the five p oint dysphagia index of the MRC (UK), The median baseline MRC swallowing sc ore was 4 (cannot swallow solids). Results: Treatment was generally well tolerated, but seven (32%) patients h ad transient worsening of dysphagia scores immediately following treatment because of esophagitis; fifteen (68%) achieved a complete response (score 1 : no difficulty on swallowing! with a median time to normalization of swall owing of 5 weeks. For these patients, the median dysphagia-free interval fr om time of onset of improvement was 11 weeks (ranee 1-131 weeks) and 11 (73 %) remained dysphagia-free until death.. The remaining patients had no or m arginal improvement. Univariate analysis showed no difference between respo nders and non-responders with respect to age, gender, or histology. Median survival for the entire study population was 20 weeks (range 3-135 weeks). Conclusions: This prospective trial shows that a short course of radiothera py plus chemotherapy may produce complete relief of swallowing difficulties in a substantial proportion of patients with acceptable toxicity. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.