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/m<sup>2</sup> dl to d4, 5 Fluorouracil 600mg/m<sup>2</sup> 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.
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