title: Radiotherapy with high dose rate brachytherapy boost and concomitant chemotherapy for Stages IIB and III esophageal carcinoma: results of a pilot study.
abstract: OBJECTIVE
  Radiotherapy (RT) and concomitant chemotherapy (CT) is the standard treatment for non resectable esophageal cancer. Usual total radiation dose is 50 Gy. In order to enhance local control rate a Phase II study was initiated to evaluate the feasibility of a combined treatment with an external radiation dose of 60 Gy and three cycles of concomitant CT, using the three main active drugs (CDDP, 5 FU and MMC), followed by a high dose rate (HDR) brachytherapy delivering 10 Gy.
  
  
  METHODS
  Fifty-three patients, 48 men and 5 women, were entered in this study. Stages were evaluated with CT scan and with endoscopic sonography. Fifteen were Stage IIB, 38 Stage III. Treatment consisted of conventional fractionated RT to a total dose of 60 Gy delivered with 2 Gy per fraction, one fraction per day and five fractions per week. The CT regimen was a combination of Cisplatinum (CDDP) 20 mg/m2 and 5 Fluorouracil (5FU) 600 mg/m2 continuous infusion, from days 1-4 Mitomycin C (MMC) was given at 6 mg/m2 on day 1. Three cycles were administered on days 1, 22, and 43. Brachytherapy was delivered one week after the end of external radiation therapy.
  
  
  RESULTS
  Full radiation therapy dose was delivered for 94% of the patients. CT compliance, evaluated on the mean relative dose-intensity was 85% for CDDP, 81% for 5FU and 51% for MMC. Overall grade 3 and 4 WHO toxicity rates were 23% and 7%, respectively. Haematologic toxicity was the most limiting factor. One patient died from treatment toxicity. Local control rate at one year was 74%. Three-year actuarial survival rate was 27%. Distant metastasis was the main cause of treatment failure. Swallowing score was good for 75% of the patients. Stage, performance status and weight loss were prognostic factors.
  
  
  CONCLUSIONS
  This regimen with high dose RT, HDR brachytherapy and concomitant CT is feasible; however, a high level of haematologic toxicity was observed with the CDDP, 5FU and MMC regimen. Despite a poor compliance with CT, treatment results are very encouraging for patients with locally advanced disease.
authors.affiliation: Clinique d'Oncologie et Radiothérapie, Centre Hospitalier et Universitaire de Tours, France.
authors.forename: G
authors.initials: G
authors.lastname: Calais
authors.forename: E
authors.initials: E
authors.lastname: Dorval
authors.forename: P
authors.initials: P
authors.lastname: Louisot
authors.forename: P
authors.initials: P
authors.lastname: Bourlier
authors.forename: V
authors.initials: V
authors.lastname: Klein
authors.forename: S
authors.initials: S
authors.lastname: Chapet
authors.forename: A
authors.initials: A
authors.lastname: Reynaud-Bougnoux
authors.forename: N
authors.initials: N
authors.lastname: Huten
authors.forename: L
authors.initials: L
authors.lastname: De Calan
authors.forename: H
authors.initials: H
authors.lastname: Aget
authors.forename: O
authors.initials: O
authors.lastname: Le Floch
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D004947:Esophagus / Q000528:radiation effects; D005240:Feasibility Studies; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010865:Pilot Projects; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D015996:Survival Rate; D017211:Treatment Failure
chemical_list: D002945:Cisplatin; D005472:Fluorouracil