RADIOTHERAPY WITH HIGH-DOSE-RATE BRACHYTHERAPY BOOST AND CONCOMITANT CHEMOTHERAPY FOR STAGE-IIB AND STAGE-III ESOPHAGEAL-CARCINOMA - RESULTS OF A PILOT-STUDY

Purpose: Radiotherapy (RT) and concomitant chemotherapy (CT) is the st andard treatment for non resectable esophageal cancer. Usual total rad iation dose is 50 Gy. In order to enhance local control rate a Phase I I study was initiated to evaluate the feasibility of a combined treatm ent with an external radiation dose of 60 Gy and three cycles of conco mitant CT, using the three main active drugs (CDDP, 5 FU and MMC), fol lowed by a high dose rate (HDR) brachytherapy delivering 10 Gy. Method s and Materials: Fifty-three patients, 48 men and 5 women, were entere d in this study. Stages were evaluated with CT scan and with endoscopi c sonography. Fifteen were Stage IIB, 38 Stage III. Treatment consiste d of conventional fractionated RT to a total dose of 60 Gy delivered w ith 2 Gy per fraction, one fraction per day and five fractions per wee k. The CT regimen was a combination of Cisplatinum (CDDP) 20 mg/m(2) a nd 5 Fluorouracil (5FU) 600 mg/m(2) continuous infusion, from days 1-4 Mitomycin C (MMC) was given at 6 mg/m(2) on day 1. Three cycles were administered on days 1, 22, and 43. Brachytherapy was delivered one we ek after the end of external radiation therapy. Results: Full radiatio n therapy dose was delivered for 94% of the patients. CT compliance, e valuated on the mean relative dose-intensity was 85% for CDDP, 81% for 5FU and 51% for MMC. Overall grade 3 and 4 WHO toxicity rates were 23 % and 7%, respectively. Haematologic toxicity was the most limiting fa ctor. One patient died from treatment toxicity. Local control rate at one year was 74%. Three-gear actuarial survival rate was 27%. Distant metastasis was the main cause of treatment failure. Swallowing score w as good for 75% of the patients. Stage, performance status and weight loss were prognostic factors. Conclusion: This regimen with high dose RT, HDR brachytherapy and concomitant CT is feasible; however, a high level of haematologic toxicity was observed with the CDDP, 5FU and MMC regimen. Despite a poor compliance with CT, treatment results are ver y encouraging for patients with locally advanced disease. (C) 1997 Els evier Science Inc.