Concurrent chemoradiotherapy for squamous cell carcinoma of thoracic esophagus: Feasibility and outcome of large regional field and high-dose external beam boost irradiation

Objective: To assess the feasibility and outcome of concurrent chemoradioth erapy (CT-RT) with large regional field and high-dose external beam boost i rradiation in thoracic esophageal cancer. Methods: Patients with clinical stage T1 (submucosal)-4N0-1M0 (UICC 1997) s quamous cell carcinoma of the thoracic esophagus were eligible. Radiotherap y consisted of regional irradiation (extending from supraclavicular fossa t o the paracardial area) with 39.6 Gy followed by high-dose external beam bo ost up to 66.6 Gy (1.8 Gy/day, five times per week). Two-hour infusion of c isplatin (80 mg/m(2) on day 1) and continuous infusion of 5-fluorouracil (8 00 mg/m(2)/day on days 2-6) were administered concurrently with radiotherap y, every 3-4 weeks, for two cycles. Results: Thirty patients (stage I, 3; stage II, 11; stage III , 16) were en tered into the study. Twenty-one patients (70%) completed the planned treat ment. In elderly (greater than or equal to 70 years) patients, four of six withdrew. Grade 3 and 4 toxicities (NCl-CTC) were observed in 20 (67%) and three (10%) patients, respectively. Major toxicities were blood, gastrointe stinal (i.e. nausea and esophagitis) and pulmonary. There was no grade 5 (f atal) toxicity. The median follow-up period for surviving patients was 27 m onths (range: 9-49 months). The median survival time was 21 months. The 1- and 2-year survival rates were 65 and 49% for all 30 patients. The incidenc e of esophageal stricture (grade 1-2: RTOG) was 21%. No patient suffered fi stula formation. Conclusions: Despite poor compliance for elderly patients and frequent seve re toxicities, our concurrent CT-RT resulted in a favorable outcome in thor acic esophageal cancer.