Chemoradiotherapy of long-term benefit in inoperable esophageal cancer

NEW YORK (Reuters Health) – Chemotherapy plus radiotherapy can produce "relatively good" long-term results in patients with inoperable squamous cell carcinoma of the esophagus, according to Italian researchers.

Dr. Paolo Bidoli, of the Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, and colleagues conducted a prospective study of the survival of 101 patients with squamous cell carcinoma of the esophagus who were recruited over a 7-year period. The findings are featured in the January 15th issue of Cancer.

Patients were given two courses of treatment with cisplatin and fluorouracil and radiotherapy over a 19-day period. The chemotherapy and radiotherapy courses were then repeated in patients without potentially resectable tumors.

Altogether, 32 patients underwent surgery, and 7 (22%) died from surgical complications. No residual tumor was seen in 8 (25%), and microscopic foci only were seen in 12 (37%). Of 61 nonsurgical patients, 37 (61%) achieved complete clinical remission and 14 (23%) achieved partial remission.

Median survival for surgical patients was 15 months and for nonsurgical patients, 22 months. Overall, 83 of the patients died within 10 years. Survival at 5 years was 22% and had fallen to 12% by 10 years.

Among the nonsurgical patients, the tumor was located in the cervical esophagus in 32, and in 15 of these the larynx could be preserved. Ten-year disease-free survival in this group of 32 patients was 31%. These results, the investigators conclude, "suggest that an organ-sparing approach should be considered more often in such patients."

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