Study on Multimodality treatment for Locally Advanced Esophageal Cancer

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Purpose :To determine the optimal multimodality treatment to improve survival in patients with a locally advanced esophageal cancerMaterial and Methods :The subject were 48 patients with a T4 esophageal cancer who underwent chemoradiotherapy (CRTx) with or without esophagectomy in Kurume University Hospital from 1994 to 1998. Based on informed consent, patients chose one arm among the following three arms of treatment.Arm-1 : Pre- and post-operative chemoradiotherapy (daily low-dosage CDDP/5Fu with hyperfraction radiotherapy, 6OGy)Arm-2 : Postoperative chemoradiotherapy (one-shot high-dosage CDDP/5Fu with sequential standard RTx, 5OGy)Arm-3 : Chemoradiotherapy alone (one-shot high-dosage CDDP/5Fu with concurrent standard RTx, 6OGy)Results :The patients' distribution was 26 in Arm-1, 16 in Arm-2, and 6 in Arm-3. The effective rates after CRTx were 88% (CR : 63%, PR : 25%) after two courses of daily low-dosage CTx with hyperfraction RTx, and 50% (CR : 17%, PR : 33%) after two courses of one-shot high-dosage CTx with standard RTx. The resectable rates were 54% (curative : 35%, palliative 19%) in Arm-1. and 81% (curative : 6%, palliative : 75%) in Arm-2. The 1-, 2-, and 3-year survival rates were 56%, 27%, and 27% in Arm-1, 41%, 21%, and 0% in Arm-2, and 21%, 21%, and 0% in Arm-3. In particular, these survival rates were 79%, 31%, and 31% for patients who underwent esophagectomy in Arm-1.Conclusion :Daily low-dosage CDDP/ 5Fu administration with hyperfraction radiotherapy was more effective for a locally advanced (T4) esophageal cancer than one-shot high-dosage CDDP and 5Fu administration with standard radiotherapy. Preoperative use of the daily low-dosage CTx + hyperfraction RTx increased the rate of curative resection in patients with a T4 esophageal cancer. Pre and post-operative uses of this combination can improve the survival of patients with such a cancer.