National Taiwan University Hospital Pilot Study of Chemoradiotherapy for Esophageal Carcinoma

Introduction: Chemoradiotherapy has demonstrated efficacy in esophageal cancer but with poor result. Combined ehemo-radiotherapy and surgery may further increase the local control rate. A pilot study was initiated by using low dose continuous infusion (CI) of 5-FU and daily low dose cisplatin (CDDP) injection with radiotherapy (RT) followed by surgery in patients with locoregional squamous cell carcinoma of the esophagus. Methods: The treatment consisted of RT to the esophagus 5000 cGy in 4 weeks, CI of 5-FU (225 mg/m^2/day) over 28 days and CDDP (6mg/m^2/day) iv injection 30 minutes before RT. Patients were then restaged by esophagogram, panendoscopy and CT scan. Esophagectomy will be performed on approximately three to five weeks after completion of concurrent chemoradiotherapy.Results: From October 1993 to August 1994, 13 men and 3 women were en rolled. All were evaluated for toxicity and response. The median age was 62 years old, the median pretreatment weight loss was 6 kilograms, and the median serum albumin level was 3.7 gm/dl. Grade III and IV leukopenia were noted in 7 patients and 2 patients, respectively. Three patients had Grade IV thrombocytopenia. Seven patients (44%) showed complete remission on restaging. The 2-year survival rate is 37%.Conclusion: This treatment regimen provides a high local tumor control. However, the toxicity of the treatment was unacceptably high.