Effect of Definitive Concurrent Chemo Radiotherapy in Patients with Inoperable Esophageal Squamous Cell Carcinoma - A Prospective Study

Abstract

Introduction: Cancer of the esophagus is a highly lethal malignancy, particularly in the developing world. Despite advances in both surgery and radiotherapy, the treatment of esophageal cancer remains a challenge for both surgeons and oncologists. The biggest problem affecting patient outcome is late presentation, as most symptomatic patients present with advanced disease. Definitive concurrent Chemoradiotherapy (dCRT) remains as an alternative for those patients unsuitable for surgery due to medical co-morbidities or extensive locoregional disease. Objectives: Aim of this study was to assess the outcome of patients treated with dCRT in our center and compare it with treatment outcome in major clinical trials in order to audit our treatment protocol. Material and Methods: The study was done in Department of Radiotherapy and oncology, Government Medical College, Thrissur, Kerala. It was a single arm prospective study. Forty consecutive patients with inoperable esophageal squamous cell carcinoma who met the inclusion criteria were taken for dCRT with Cisplatin + 5 FluroUracil (5-FU) and 50.4Gy in 28 fractions. Results: Median follow-up was for 15.8 months. Two patients lost to follow-up. The overall survival rate was 84.2% and mean survival period was 17.8 months. Progression free survival was 68.4% with mean progression-free survival duration of 16.4 months. Overall survival and progressionfree survival were comparable to those of RTOG 85-01 trial and INT0123 trial. Conclusion: Definitive Concurrent chemo-radiation with cisplatin and 5-FU was well tolerated, promising a reasonable therapeutic option for patients with inoperable locally advanced squamous cell carcinoma of the esophagus.