Combination of bleomycin and adriamycin with and without radiation in the treatment of inoperable esophageal cancer. A randomized study

Abstract

In a prospective randomized study, 31 patients with inoperable esophageal cancer were treated with a combination of bleomycin and adriamycin, and with a combination of these cytostatics and radiation. Evaluation of treatment results showed 3 partial remissions and 2 stable-disease cases in the group of 16 patients treated by cytostatic drugs alone; in all other cases, the disease progressed. The response rate achieved in this group was 19%. In the group including 15 patients who were irradiated with a dose of 3600--4000 rad and received simultaneously the same cytostatics with a somewhat lower dose of adriamycin, there were 3 complete remissions, 6 partial remissions, and 4 stable-disease cases, while in 2 cases the disease progressed. The response rate was 60%, which was statistically significant (P less than 0.025) when compared with the results achieved by the group receiving the bleomycin adriamycin combination. The average duration of remissions in the complete-response cases was 11 months, and in the partial-response cases, 5.2 months with combined treatment, and 4.2 months with combination chemotherapy. The toxic side-effects were tolerable for the patients, albeit more intensive with the combined-treatment modality. Four esophagobronchial fistulas (four disease progressions) and one rupture of the aorta were noted during treatment. This study has shown the advantages of chemoradiotherapeutic treatment of inoperable esophageal cancer.

Postoperative cancer therapy for patients with carcinoma of the thoracic esophagus: An attempt of aggressive chemotherapy combined with proper nutritional support for patients with distant node metastasis.

“…Recently, Kolaric et al (1980) reported good results of radiotherapy combined with relatively heavy chemotherapy using Bleomycin and Adriamycin. Byfield et al (1980) also described good results of infusional 5-fluorouracil and radiotherapy for non-resectable esophageal cancer.…”

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.…”

“…However, bleomycin/cis-platinum and bleomycin/Adriamycin ® combinations gave 19 percent response rates each in 58 and 16 patients respectively and showed no advantage over the single-agent activity reported with these antitumor agents. 20,21 Bleomycin/methotrexate combination, on the other hand, resulted in one complete and three partial responses in five patients. 5 The three-drug combination bleomycin/cis-platinum/vinde-sine has been evaluated at Memorial Sloan-Kettering Cancer Center and given encouraging results.…”

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).…”