Adriamycin Alone and in Combination with Radiotherapy in the Treatment of Inoperable Esophageal Cancer

Abstract

Thirty-three patients with inoperable esophageal cancer were treated in a randomized study. There were 24 squamous cell, 2 anaplastic, 4 unclassified, and 3 adenocarcinomas. Eighteen patients were treated with 6 cycles of adriamycin with a 3 week rest period between cycles. Adriamycin was administered in doses of 40 mg/m2 body surface daily for 2 days during each cycle. The other group of 15 patients were treated with both adriamycin and radiation. The tumor was irradiated with speed electrons (4500–5200 rads total dose), and during irradiation, 3 cycles of adriamycin were given. All patients previously had had no treatment. In the group of patients treated with adriamycin, the response rate (> 50 % tumor regression) was 33 % (6/18) with 1 complete and 5 partial remissions. In the combined treatment group, there were 4 complete and 5 partial remissions (9/15) with a response rate of 60 %. In both groups of patients, remissions were obtained in the squamous cell carcinomas, except 1 patient with anaplastic carcinoma in the adriamycin-treated group, and 1 adenocarcinoma in the combined treated group. Remissions lasted 2–12 months (M = 3.2 months) in the adriamycin-treated group and 3–15 months (M = 8.6 months) in the combined treatment group. There were no significant differences in the toxic side effects, except a slightly increased myelodepression in the combined treatment modality. One patient of the combined treatment group showed a potentiation of radiation dermititis. The results obtained show that adriamycin does have an antitumor effect on esophageal (squamous cell) carcinoma, which so far has not been proven. Significantly better results with longer remission duration can be obtained when both adriamycin and radiation are combined.

Systemic Chemotherapy for Advanced Esophageal Cancer

“…Kolaric and coworkers compared efficacy of bleomycin, Adriamycin ® , and bleomycin/Adriamycin ® combination alone and each in combination with radiotherapy. 5,6,21 The multimodality regimens gave overall and complete response rates superior to those of chemotherapy-alone arms in these trials. The bleomycin/Adriamycin ® two-drug regimen disappointingly gave no advantage over results obtained by bleomycin or Adriamycin ® in combination with radiotherapy.…”

“…Kolaric, et al reported one complete and five partial responses in 18 patients. 6 The Eastern Cooperative Oncology Group compared the activity of Adriamycin ® with those of methotrexate and 5-fiuorouracil (5-FU) in a randomized study. 7 Responses were seen in one of 18 (five percent), two of 27 (seven percent), and four of 26 (15 percent Data on efficacy of new antitumor agents against esophageal cancer are summarized in Table 1.…”

Combined Treatment Modalities in Esophageal Cancer: Should chemotherapy be included?

“…Another type of comparison has been made in two randomized trials by Kolaric et al (38,123). CT alone has been compared with CT (doxorubicin + bleomycin or doxorubicin alone) given concurrent with RT showing significantly better response rates when combined therapy was used (38,123).…”

“…CT alone has been compared with CT (doxorubicin + bleomycin or doxorubicin alone) given concurrent with RT showing significantly better response rates when combined therapy was used (38,123). In a first study the response rate was 33% vs 60% for doxorubicin and doxorubicin + RT (45-52 Gy, 2 Gy/fraction) respectively (123) and in a second study doxorubicin + bleomycin gave a response rate of 19% and doxorubicin + bleomycin + RT (36-40 Gy, 2 Gy/fraction) a 60% response rate (38).…”

Epirubicin in Advanced Gastrointestinal (GI) Cancer

“…Doxorubicin has shown activity in esophageal and gastric cancer [1][2][3], while in pancreatic and colorectal cancer activity appears low [4,5], Epirubicin is one of a series of new anthracycline antibiotics synthesized in an attempt to identify agents with a superior therapeutic index to the parent com pound doxorubicin. Pharmacokinetics of the two drugs are different and despite the chemical similarity with doxorubicin, epirubicin may have different biologic properties.…”