Definitive and Neoadjuvant Radiochemotherapy of Squamous Cell Carcinoma of the Oesophagus

Abstract

In cases of advanced carcinoma of the oesophagus with no metastatic spread, a concurrent radiochemotherapy can improve the patient’s prognosis in comparison to radiotherapy alone. This approach increases the treatmentrelated toxicity, in particular haematological side effects. Therefore therapy must be adapted to the general condition of the patient, demanding an intensive supportive treatment and monitoring of the patient. At present the optimal radiation dose and the role of brachytherapy for the reduction of the still high rate of local recurrences has not been determined. The value of neoadjuvant radiochemotherapy for operable or inoperable tumours is unclear. Meta-analyses did show an improvement of the prognosis, however most of the randomised studies found improvement only for the recurrence rate but not for survival. The reasons for this are numerous; however, the high postoperative lethality after radiochemotherapy in some studies is conspicuous. Conversely, the initial results of randomised studies show that operative measures could possibly be forgone if a complete remission is achieved by concurrent radiochemotherapy. Nevertheless, this approach must also be regarded critically, as the local recurrence rate after radiochemotherapy alone is high and long-term results are not available.

To study the short-term outcome of multimodality treatment on morbidity and quality of life in patients with carcinoma oesophagus

“…Though, Fietkau et al thought that simultaneous CRT should be considered as the standard treatment for inoperable carcinoma of the oesophagus with the median survival time between 13 and 18 months. 22 The reason why Fietkau's result was better than ours may be that there were more inoperable stage III /IV patients in present study as compared with the stage II/III patients in Fietkau's study.…”

Intraluminal brachytherapy in oesophageal cancer: defining its role and introducing the technique

“…Unsurprisingly therefore, local failure is frequently observed as a result of relative underdosage of the primary tumour site. This has only partially been mitigated by the introduction of treatment regimens incorporating concomitant chemotherapy, designed to differentially enhance radiosensitivity of the tumour tissue [4]. Intraluminal brachytherapy offers an elegant way of delivering high doses to the oesophageal wall with great spatial precision, while avoiding the need to traverse organs-at-risk as would be the case with percutaneous modes of dose delivery.…”

Significance of Radiation Therapy for Adenocarcinomas of the Esophagus, Gastroesophageal Junction and Gastric Cancer with Special Reference to the MAGIC Trial

“…Concurrent radiochemotherapy should be used as the standard treatment for patients with locally advanced esophageal carcinoma who cannot be managed by primary complete resection or who are functionally inoperable [4,15,16,23,39,58,66,76].…”

“…Radiation therapy plays an important role in the treatment of squamous cell carcinomas of the esophagus, and is used in both the definitive treatment situation and the neoadjuvant approach [23]. On the other hand, in the subgroup of adenocarcinomas of the esophagus or tumors of the gastroesophageal junction and stomach, the clinical value of irradiation remains a contentious issue.…”