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J Korean Soc Ther Radiol Oncol > Volume 27(2); 2009 > Article
The Journal of the Korean Society for Therapeutic Radiology and Oncology 2009;27(2): 71-77. doi: https://doi.org/10.3857/jkstro.2009.27.2.71
Outcome of Locally Advanced Esophageal Cancer Treated with Concurrent Chemo-radiotherapy
Hyunsoo Jang, Seung Hee Kang, Sunyoung Lee, Sun Mi Jo, Young Taek Oh, Mison Chun, Jin Hyuk Choi, Seok Yun Kang
1Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea. shkang@ajou.ac.kr
2Department of Medical Oncology, Ajou University School of Medicine, Suwon, Korea.
3Department of Radiation Oncology, Gonyang University School of Medicine, Daejeon, Korea.
We investigated the outcome and the prognostic factors of patients with locally advanced esophageal cancer who were treated with concurrent chemo-radiotherapy. Materials and
Two hundred forty six patients with esophageal cancer that were treated by radiotherapy between January 1994 and July 2007. Of these, 78 patients who received radiotherapy of > or =45 Gy with concurrent chemotherapy were retrospectively enrolled in this study. We included patients stages IIA, IIB, III, IVA, and IVB with supraclavicular metastasis in the middle/lower esophageal cancer or celiac node metastasis in cervical or upper/middle thoracic esophageal cancer. The median radiation dose was 54 Gy and the combination chemotherapy with 5-FU and cisplatin (FP chemotherapy) was given concurrently with radiotherapy in most patients (88%).
The follow-up period ranged from 2 to 117 months (median 14 months). The treatment response of the 54 patients could be evaluated by computerized tomography or endoscopy. A complete response (CR) was observed in 17 patients, whereas a partial response was observed in 18 patients. In patients with a CR, the median recurrence time was 20 months and the first relapse sites constituted a locoregional failure in 3 patients and a distant failure in 7 patients. The 1-, 2-, and 5-year overall survival (OS) rates were 58.9%, 21.7%, and 12.2%, respectively. The median survival period was 14 months. A univariate analysis indicated that the treatment response and cycles of FP chemotherapy were significant prognostic factors for OS. Daily or weekly administration of cisplatin as a radiosensitizer showed a better treatment response than FP chemotherapy.
This study has shown that results of concurrent chemo-radiotherapy in patients with locally advanced esophageal cancer is comparable to those of other studies. Daily or weekly cisplatin administration may be considered as an alternative treatment in patients that are medically unfit for FP chemotherapy.
Key Words: Esophageal cancer, Concurrent chemoradiation
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