Swallowing function in patients with esophageal cancer treated with concurrent radiation and chemotherapy

Abstract

Background. Major goals of concurrent radiation and chemotherapy in the treatment of esophageal cancer are the early restoration and long‐term maintenance of swallowing function. The purpose of this study was to determine the impact of concurrent radiation and chemotherapy on swallowing function. Methods. Between September 1980 and September 1990, 120 patients with esophageal cancer were treated at the Fox Chase Cancer Center on the basis of one of three prospective nonrandomized protocols using concurrent chemotherapy and radiation. Swallowing function was retrospectively assessed in these patients by use of a swallowing‐function scoring system. In addition, patients who had long‐term control of their esophageal cancer underwent a more detailed analysis of swallowing function. Results. Initial improvement in dysphagia occurred in 88% of the 102 assessable patients, with a median time to improvement of 2 weeks. There was no difference in overall percentage of initial improvement for patients with adenocarcinoma versus squamous cell carcinoma. Patients with distal tumors, however, showed both earlier and higher frequency of initial improvement than did patients with tumors in the upper two‐thirds of the thoracic esophagus (95% versus 79%). Local relapse‐free survival of definitively treated patients at 3 years was 60% and was significantly better for patients with Stage I (76%) versus Stage II cancers (55%) (P < 0.05). All 25 patients treated with curative intent who survived for more than 1 year without evidence of disease were able to eat soft or solid foods and had a benign stricture rate of only 12%. Even in patients with advanced disease who were treated with palliative intent, 91% had an initial improvement in swallowing function and 67% had improvement in swallowing function that lasted until death. Conclusions. High‐dose concurrent radiation and chemotherapy provides rapid improvement in dysphagia, and this improvement results in normal or near‐normal swallowing function of long duration.

Radio(chemo)therapy Plus Resection Versus Radio(chemo)therapy Alone for the Treatment of Stage III Esophageal Cancer*

“…Late toxicity in our patients treated with RCT alone was lower than in other series. Benign stricture occurred in 8% of our patients versus 12-17%, pneumonitis in 4% versus 5%, and fistula in 2% versus 5% [2,4,14].…”

Split-course chemoradiotherapy with S-1, a novel oral fluorouracil, and cisplatin for distant metastases of oesophageal cancer stage IVb

“…In spite of high dose radiation together with chemotherapy like bolus mitomycin C and continuous infusion of 5-FU are reported to provide a rapid and an initial improvement of dysphagia in nearly 90% of patients with OC [12], but radical doses of radiation treatment over five to six weeks might be inappropriate for patients with distant metastatic OC who are expected to have a short survival times. Further, there is increasing evidence that low dose radiotherapy together with chemotherapy provides good palliation of dysphagia with limited side effects [26,27].…”

“…All patients had squamous cell carcinoma and most had moderate to severe dysphagia for solid foods or could eat only soft form of food. The degree of dysphagia was defined according to the modification of the method described by Coia, et al [12]. Briefly, patient can eat solids without dysphagia (asymptomatic), eat solids with dysphagia, eat soft or pureed foods only, drink liquid only, no swallowing ability at all.…”

Clinical results of multimodality therapy for esophageal cancer with distant metastasis

“…Response rates to chemotherapy alone have ranged from approximately 20% to 40% for metastatic disease (7)(8)(9). With respect to palliative concurrent chemoradiotherapy (CCRT) in patients with distant metastasis, previous studies have shown considerable improvement of dysphagia (10)(11)(12). In CCRT, the radiation dose has been controversial and may not achieve the recommended dose.…”