Premium
Ten‐year survival with chemotherapy and radiotherapy in patients with squamous cell carcinoma of the esophagus
Author(s) -
Bidoli Paolo,
Bajetta Emilio,
Stani Simonetta C.,
De Candis Daniela,
Santoro Armando,
Valente Maurizio,
Zucali Roberto,
Valagussa Pinuccia,
Ravasi Gianni,
Bonadonna Gianni
Publication year - 2002
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/cncr.10233
Subject(s) - medicine , radiation therapy , esophagus , surgery , chemotherapy , concomitant , carcinoma , survival rate , gastroenterology
Abstract BACKGROUND The effects of multimodality treatment on the survival of patients with esophageal carcinoma are unclear. The authors performed a prospective, Phase II study to assess the long‐term results of chemotherapy plus radiotherapy (RT) on patients with esophageal squamous cell carcinoma. METHODS Of 106 consecutive patients who were recruited between 1985 and 1992, 101 patients were evaluable. Cisplatin (100 mg/m 2 per day) on Day 1 and fluorouracil (1000 mg/m 2 per day) on Days 1–4 were given for two cycles, with concomitant RT (30 grays [Gy] in 15 fractions) over 19 days. Patients with potentially resectable tumors were then assessed for curative surgery; the other patients received two more courses of chemotherapy and further RT (20 Gy in 10 fractions). RESULTS Of 40 patients who were candidates for surgery, 32 patients underwent surgery, and 24 patients had complete resection; 8 patients (25%) had no residual tumor in the specimen, and 12 patients (37%) had microscopic foci only. Surgical mortality was high (22%). Of 61 nonsurgical patients, 37 patients (61%) achieved complete clinical remission, and 14 patients (23%) achieved partial remission. The median survival for the entire series was 15 months (range, 1–136 months). The overall survival rate was 22% at 5 years and 12% at 10 years. At 10 years, freedom from disease progression was similar in the two groups (24%), whereas the median survival (22 months vs. 12 months) and the overall survival rates (17% vs. 9%) were better in nonsurgical patients compared with surgical patients, respectively, probably in relation to high surgical mortality. The larynx was preserved in 28% of 32 patients with cervical disease sites, with a 10‐year disease free survival rate of 31%. Three deaths were attributed to nonsurgical treatments. CONCLUSIONS Careful multidisciplinary pretreatment evaluation can identify patients who are ineligible for surgery without compromising long‐term results. For patients with inoperable disease, chemoradiotherapy can produce relatively good long‐term results. The combined approach without surgery can permit laryngeal preservation in a useful fraction of patients. Cancer 2002;94:352–61. © 2002 American Cancer Society.