ACCELERATED FRACTIONATION IN ESOPHAGEAL CANCERS - A MULTIVARIATE-ANALYSIS ON 88 PATIENTS

Purpose: Accelerated fractionation was used to shorten overall treatme nt time to increase locoregional control and cause-specific survival. Methods and Materials: Eighty-eight patients with cancer of the esopha gus ineligible for surgery mere entered in the study between 1986 and 1993. Neoadjuvant chemotherapy was given to 64% of patients. Accelerat ed radiotherapy using the concomitant boost technique delivered a medi an dose of 65 Gy in a median overall treatment time of 32 days. Result s: The 3-year actuarial local control rate in patients with TI, T2, an d T3 tumors was 71%, 42%, and 33%, respectively, The 3-year cause-spec ific survival rates were 40%, 22%, and 6%, respectively. Sixteen perce nt of patients experienced Grade 3 esophagitis. Late toxicity included esophageal stenosis and pulmonary fibrosis in 8% and 9% of the patien ts, respectively. Multivariate analysis demonstrated that T stage and overall treatment time were prognostic factors for cause-specific surv ival. T stage and neoadjuvant chemotherapy mere independent prognostic factors for locoregional control, Conclusion: These findings suggest that accelerated fractionation given in an overall treatment time of < 35 days might be beneficial for early-stage cancer of the esophagus, N eodajuvant chemotherapy is not recommended, as it was a significant ad verse prognostic factor in the multivariate analysis for local control . Accelerated fractionation can be carried out with moderate acute and late toxicity. (C) 1997 Elsevier Science Inc.