Swallowing function and weight change observed in a phase I/II study of external-beam radiation, brachytherapy and concurrent chemotherapy in localized cancer of the esophagus (RTOG 9207)

BACKGROUND A multi-institutional, prospective study was designed to determine the feas ibility and tolerance of combined-modality chemotherapy, external-beam irra diation, and esophageal brachytherapy in a potentially curable group of pat ients with adenocarcinoma or squamous cell carcinoma of the esophagus. Swal lowing function and weight were assessed before and after treatment, MATERIALS AND METHODS Planned treatment was with 50 Gy of external-beam irradiation (25 fractions /5 weeks) followed 2 weeks later by esophageal brachytherapy (either a high dose rate of 5 Gy at weeks 8, 9, and 10 for a total of 15 Gy or a low dose rate of 20 Gy at week 8). Chemotherapy was given weeks 1, 5, 8, and 11 wit h cisplatinum, 75 mg/m(2), and 5-fluorouracil, 1000 mg/m(2)/24 hours in a 9 6-hour infusion. Swallowing was graded from 0 (no dysphagia) to 4 (complete obstruction for solids and liquids). Weight "loss" or weight "gain" was de fined as a change in 3-month post- to pretherapy weight of less than or equ al to 5% or > 5%, respectively. RESULTS The estimated survival rate at I and 2 years was 49% and 31%, respectively, and the estimated median survival was 11 months. Swallowing before treatme nt was graded as grade I in 14 patients, grade 2 in 22 patients, grade 3 in nine patients, and grade 4 in four patients. Swallowing grade after treatm ent was reported as improved in 29 patients (59%), unchanged in 12 patients (24.5%), and worse in eight patients (16.5%). The best-improved dysphagia score after treatment in the 29 patients reporting improvement was grade 0 in 19 patients, grade I in five patients, grade 2 in four patients, and gra de 3 in one patient. A posttreatment weight in 42 evaluable patients was ca tegorized as a loss in 29 patients (69%), a gain in four patients (9.5%), a nd stable in nine patients (21.5%). Weight loss was significantly correlate d with high swallowing grade, low performance status, and absence of a feed ing tube. CONCLUSIONS Swallowing function after brachytherapy and concurrent chemorad iation therapy is satisfactory in most surviving patients. Ninety-two perce nt of patients were able to swallow at least liquids at some point after th erapy. Future plans are to compare this with other cooperative group studie s that utilized chemoradiation or surgery, without brachytherapy.