Simultaneous 5-Fluorouracil, Cisplatinum and Radiation Therapy for Patients with Locally Advanced Squamous Cell Carcinoma of the Esophagus

Abstract

Background: Diagnostic tools and operative methods of esophageal cancer were improved during the last years, but the 5-year survival of patients with nonresect-able squamous cell carcinoma of the esophagus is still below 5%. With a combined modality therapy (chemotherapy and simultaneous radiation therapy) tumor regression can be achieved for secondary resection. The intention of this investigation was to reduce tumor mass and obtain secondary operability. Patients and Methods: In our investigation 24 patients with a primarily inoperable squamous cell carcinoma of the esophagus received on days 1-5 and days 29-33 a chemotherapy with 5-fluorouracil as a continuous infusion of 1,000 mg/m2 daily over 24 h and cisplatinum 20 mg/m2 as short infusion daily over 60 min, combined with a simultaneous radiotherapy using a total dose of 30 Gy. Results: Of the 20 evaluable patients 2 had a complete and 12 a partial remission, suggesting an overall response rate of 70%. The median duration of response in the group without esophageal resection was 8.3 months. The survival after 1 year was 54%. 9/24 patients underwent secondary surgery. Esophagus resection was performed in 5 patients; in 3 patients the carcinoma was not resectable, in 1 patient resection was not done because of a formerly undetected lung metastasis. Conclusions: In patients with primarily nonresectable esophageal carcinoma after combined radio-/chemotherapy and tumor regression an attempt should be made to resect carcinoma in a secondary surgical intervention.