Chemoradiation for Esophageal Cancer

OBJECTIVES: The aim of this study was to retrospectively evaluate toxicity and efficacy of 3 chemoradiation regimens. METHODS: Between 1997 and 2007, 94 patients with esophageal cancer were treated with chemoradiation in our institute. Treatment consisted of radiotherapy to 50 Gy in 25 fractions with concurrent cisplatin and 5-fluorouracil (group A, n = 65), radiotherapy to 50.4 Gy in 28 fractions with concurrent carboplatin and paclitaxel (group B, n = 16) or radiotherapy to 66 Gy in 33 fractions with low-dose cisplatin (group C, n = 13). Toxicity was scored according to Common Terminology Criteria version 3.0. RESULTS: Chemoradiation was planned as neoadjuvant (n = 58) or definitive (n = 36) treatment. Grade 3/4 hematological toxicity occurred in 18 (19%) patients and grade 3 nonhematologic toxicity in 8 (9%) patients. During treatment, 2 patients died (1 from duodenal ulcer bleeding and 1 from stroke). Overall, 81 (86%) patients completed the planned treatment (86%, 94%, and 77% in groups A, B, and C, respectively). Clinically complete or partial response was observed in 28 of 92 (30%) patients (21%, 50%, and 54% in groups A, B, and C, respectively). After clinical and radiologic response evaluation, treatment plan was changed in 14 (15%) patients. A total of 45 patients underwent surgery. Pathologic complete response and downstaging were seen in 12 (27%) and 34 (76%) operated patients, respectively. With a median follow-up of 15 (range, 1-108) months, the 3-year survival was 41% for all patients. CONCLUSION: With individual treatment planning, different regimens of chemoradiation for esophageal cancer resulted in acceptable rates of toxicity and efficacy.