Split-course accelerated radiation therapy combined with carboplatin and 5-fluorouracil for palliation of metastatic or unresectable carcinoma of the esophagus.
BACKGROUND
Patients with metastatic or unresectable carcinoma of the esophagus have poor survival, but often require palliation of dysphagia.


METHODS
Twenty-seven patients with unresectable carcinoma of the esophagus were treated with carboplatin, 5-fluorouracil, and split-course accelerated radiation therapy. Seventy-four percent of patients had adenocarcinoma, and 26% had squamous cell carcinoma.


RESULTS
The regimen was well tolerated; 25% of the patients had disease improvement after completing therapy, although the majority of these patients had all of their disease within the radiation field. Ninety-three percent (13/14) of the patients who experienced disease progression during therapy progressed in areas treated with chemotherapy alone. Median survival was 6 months. Fifty-nine percent of the 17 patients who presented with dysphagia achieved durable relief of that symptom.


CONCLUSIONS
Carboplatin and 5-fluorouracil have low activity in patients with metastatic esophageal cancer. However, in combination with radiation therapy, this regimen is tolerable when the primary goal is palliation of dysphagia near the end of life. Future studies should focus on identifying more active regimens with response and survival as endpoints.
Urba
S G
SG
University of Michigan Medical Center, Ann Arbor, Michigan 48109.
Turrisi
A T
AT
D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010166:Palliative Care; D016896:Treatment Outcome
D016190:Carboplatin; D005472:Fluorouracil