551 High dose radiotherapy (RT), concomitant chemotherapy (CT) and high dose rate brachytherapy for non resectable esophageal cancer

Abstract

RT and concomitant CT is the standard treatment for non resectable esophageal cancer. Usual total radiation dose is 50Gy. In order to enhance local control rate a phase II study was initiated to evaluate the feasibility of a combined treatment with an external radiation dose of 60Gy and 3 cycles of concomitant CT followed by a high dose rate brachytherapy delivering 10Gy (2 applications with 7 days interval). 73 patients (pts), 28 men and 5 women were treated between 1989 and 1993. Stages were evaluated with CT scan and with endoscope sonography for 41 pts: 13 were Stage IIB, 50 Stage III and 10 Stage IV. Treatment consisted in a conventional fractionated RT to a total dose of 60Gy delivered with 2Gy per fraction, one fraction per day and 5 fractions a week. The CT regimen was a combination of Cisplatinum 25mg/m² dl to d4, 5 Fluorouracil 600mg/m² continuous infusion dl to d4. 3 cycles were administered on dl, d22 and d43. Brachytherapy was delivered one week after the end of external radiation therapy. Full radiation therapy dose was delivered for 96% of the patients. CT compliance, evaluated on the drug dose and the CT interval, was good for 77% of the patients. Overall grade 3 and 4 WHO toxicity rates were 23% and 7% respectively. One pt died from treatment toxicity. Local control rate at one year was 74%. Three-year actuarial survival rate was 27%. Distant metastase was the main cause of treatment failure. Predictive factors of late effects related to brachytherapy and evaluation of a swallowing score will be presented, In a multivariate analysis Stage was the only prognostic factor. In conclusion this regimen with high dose RT and 3 cycles of concomitant CT is feasible. Treatment results are very encouraging for pts with locally advanced disease.