Combined modality therapy for esophageal squamous cell carcinoma

Abstract

Of 55 patients with esophageal squamous cell carcinoma, 30 with localized disease were treated with a combined modality for curative intent. Treatment consisted of mitomycin C (10 mg/m2 day 1) and continuous infusion 5‐FU (1000 mg/m2 day, days 1–4, 29–32) (CT), radiation (XRT) (3000 rad, days 1–21) with nutritional support, and surgery (days 49–64). Surgery consisted of celiotomy, esophagectomy and esophagogastrostomy ± postoperative ventilatory support. Postoperative CT plus an additional 2000 rad XRT was restricted to patients with histologic positive tumor. Since five resected patients with subclinical metastatic tumor had an inferior survival equal to 25 patients treated essentially for palliation, pretreatment celiotomy seems warreanted to identify patients with an inferior prognosis. Of 18 resected patients without disseminated tumor evaluable for this combined modality: six were tumor free, three had intramural and nine transmural tumor; the median survival is 76 weeks and five of six living patients are disease free at 95–190 weeks; and local recurrence occurred in two and in two of seven unresected patients. Since toxicity was minimal except for postoperative pneumonitis (13%) and local recurrence low (13%), two courses of chemotherapy and 5000 rad XRT perhaps obviates the need for resection.

Pulmonary Toxicity of Cytotoxic and Immunosuppressive Agents: A Review

“…An acute and lethal aggravation of carmustineinduced pneumonitis was reported after 5 h ventilation of 90% oxygen (5 1). Postoperative ventilatory support at high oxygen concentration was reported to produce fatal respiratory failure in mitomycin-treated patients, whereas less than 30% oxygen in the inspiration gases was tolerable (165).…”

Cancer of the Esophagus: The Wayne State University experience

“…Radiation continued for five days with a break for two days; two more 5 day cycles were given until a total of 3000 cGy were given. Patients were allowed to rest for three to four weeks before an Ivor-Lewis Esophageal Resection was performed [27]. (See Table 1) This clinical trial for patients with localized SCCE (and the ones which followed) were not designed as phase II programs to test partial or complete responses.…”

“…This defined "complete response" in the preoperative setting. Franklin et al pointed out that mucosal disease responded rather uniformly [27].…”

Systemic Chemotherapy for Advanced Esophageal Cancer

“…Franklin and his colleagues gave radiotherapy concurrently with four-day continuous intravenous infusion of 5-FU and intravenous bolus of mitomycin C on day one. 25 Twenty-eight patients with locally advanced esophageal cancer were treated and 21 were evaluable for response. The overall response rate was 80 percent.…”