A randomized trial comparing radiation therapy versus concomitant radiation therapy and chemotherapy in carcinoma of the thoracic esophagus

Abstract

From September 1982 to December 1985, 59 previously untreated patients with Stage II squamous cell carcinoma of the thoracic esophagus were randomly assigned to receive radiation therapy (RT) alone versus the concomitant use of RT and chemotherapy (CT) with 5-fluorouracil (5-FU), mitomycin C, and bleomycin (RT + CT). Thirty-one patients were randomized to the RT regimen and 28 to the RT + CT regimen. The complete local response rate was 58% for the RT group and 75% for the RT + CT group (P = 0.77). The median duration of response was 8 months for both groups. The overall 5-year survival rates were 6% and 16% (P = 0.16) for the RT and RT + CT groups, respectively. Acute toxicities were more pronounced in the RT + CT group. This clinical trial did not detect a difference in outcome with combined-technique therapy. This result must be interpreted with caution because of the small number of patients entered in this trial. Confirmation of the value or lack of value for combined therapy will require additional larger clinical trials.

Safety and Efficacy of Concurrent Cisplatin and Radiotherapy in Inoperable or Metastatic Squamous Cell Esophageal Cancer

“…This is evident from a review of the patterns of failure in esophageal cancers where the use of chemotherapy resulted in a decrease in the incidence of local failure from 25% -84% to 15%-39% and the incidence of distant failure from 23%-65% to 6% -25% (13). Two prospective single arm studies and one randomized trial using concurrent chemoradiation have shown a reduction in local failure but an increase in distant failure with the addition of CT to RT, thereby suggesting an alteration in the failure patterns from local failure to one dominated by distant metastasis (8,14,15). However, the Intergroup trial using 2 cycles of concurrent and 2 cycles of adjuvant 5-FU »CDDP demonstrated a 46% vs. 68% local failure for the CT »RT and RT group, respectively, and a distant metastatic rate of 16% vs. 30%, respectively, which was highly signi cant and translated into a signi cant survival gain (1).…”

Nonsurgical Management of Esophageal Cancer

“…In the ECOG EST-1282 trial (Araujo et al, 1991),patients who received combined modality therapy had a significantly increased median survival compared with those receiving radiation alone (15 months vs. 9 months; P = .04) but experienced no improvement in 5-year survival (9% vs. 7%). However, this was not a pure nonsurgical trial because approximately 50% of patients in each arm underwent surgery after receiving 40 Gy of radiation.…”

Planejamento tridimensional para radioterapia de tumores de esôfago: comparação de técnicas de tratamento e análise de probabilidade de complicações

“…No que se refere à localização, cerca de 20% dos casos de câncer de esôfago se localizam no esôfago cervical, 50% no esôfago médio-torácico e o restante no esôfago distal (5,6) . O tratamento preferencial dessas lesões é a ressecção cirúrgica com margens adequadas, e em lesões localmente avançadas e irressecáveis o tratamento se baseia na radioterapia concomitante à quimioterapia (7) .…”