Superiority of Chemo-Radiotherapy Vs. Radiotherapy In Patients with Esophageal Cancer

The Abramson Cancer Center of the University of Pennsylvania
Last Modified: May 21, 1996

Arnold Herskovic, M.D., medical director, Radiation Oncology Department, Oakwood Hospital and Medical Center (Dearborn, MI), presented the results o a study which compared the overall survival of esophageal cancer patients treated with radiotherapy (RT) alone versus treatment with chemo-radiotherapy (CT-RT). The study was conducted by the Radiation Therapy Oncology Group (RTOG).

Traditional treatment with surgery and/or radiotherapy has provided poor results for patients with localized cancer of the esophagus. Earlier studies with combine CT-RT given before surgery, or as total treatment, suggested improved median and two-year survival.

In the study, 61 patients were randomized to receive CT-RT, and 62 to receive RT only. The CT-RT arm consisted of the anticancer drug 5-FU for four days, combined with cisplatin on day one of the chemotherapy cycle. the cycle was repeated four times, two during the radiation and two following. External beam radiation was delivered to the esophagus for five weeks, along with chemotherapy. patients receiving the RT-only arm received a higher dose of radiation.

The median survival was nine months for patients receiving radiation alone, compared to 14 months for patients receiving the combined modalities. There have been 62 deaths in the RT group (100%) versus 45 deaths in the combined CT-RT group (71%). In addition to improved survival, the combined CT-RT group showed superior tumor control and had acceptable side effects.

"The study results indicate that chemo-radiotherapy should become the new standard treatment for patients with esophageal cancer, which has traditionally been a disease with a poor prognosis," Derek Raghavan, M.D., professor and chief, Solid Tumor Oncology, Roswell Cancer Institute (Buffalo, NY), said at a press briefing today.