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A Phase I/II study of external beam radiation, brachytherapy, and concurrent chemotherapy for patients with localized carcinoma of the esophagus (Radiation Therapy Oncology Group Study 9207)
Author(s) -
Gaspar Laurie E.,
Winter Kathryn,
Kocha Walter I.,
Coia Lawrence R.,
Herskovic Arnold,
Graham Mary
Publication year - 2000
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(20000301)88:5<988::aid-cncr7>3.0.co;2-u
Subject(s) - medicine , brachytherapy , esophagus , regimen , radiation therapy , chemotherapy , external beam radiotherapy , adenocarcinoma , carcinoma , surgery , nuclear medicine , cancer
BACKGROUND A multiinstitutional, prospective study of the Radiation Therapy Oncology Group (RTOG) was designed to determine the feasibility and toxicity of chemotherapy, external beam radiation, and esophageal brachytherapy (EB) in a potentially curable group of patients with adenocarcinoma or squamous cell carcinoma of the esophagus. A preliminary analysis indicated a 17% 1‐year actuarial risk of treatment‐related fistulas. A final analysis of this study was considered important to determine the median survival time, local control, and late toxicity associated with this treatment regimen. METHODS Planned treatment was 50 grays (Gy) of external beam radiation (25 fractions given over 5 weeks) followed 2 weeks later by EB (either high‐dose‐rate 5 Gy during Weeks 8, 9, and 10, for a total of 15 Gy, or low‐dose‐rate 20 Gy during Week 8). Chemotherapy was given during Weeks 1, 5, 8, and 11, with cisplatin 75 mg/m 2 and 5‐fluorouracil 1000 mg/m 2 /24 hours in a 96‐hour infusion. RESULTS Of the 49 eligible patients, 45 (92%) had squamous histology and 4 (6%) had adenocarcinoma. Forty‐seven patients (96%) completed external beam radiation plus at least 2 courses of chemotherapy, whereas 34 patients (69%) were able to complete external beam radiation, EB, and at least 2 courses of chemotherapy. The estimated survival rate at 12 months was 49%, with an estimated median survival of 11 months. Life‐threatening toxicity or treatment‐related death occurred in 12 (24%) and 5 (10%) cases, respectively. Treatment‐related esophageal fistulas occurred in 6 cases (12% overall, 14% of patients starting EB) at 0.5–6.2 months from the first day of brachytherapy, leading to death in 3 cases. CONCLUSIONS In this study, severe toxicity, including treatment‐related fistulas, occurred within 7 months of brachytherapy. Based on the 12% incidence of fistulas, the authors continue to urge caution in employing EB, particularly when used in conjunction with chemotherapy. Cancer 2000;88:988–95. © 2000 American Cancer Society.