Accelerated fractionation in esophageal cancers: a multivariate analysis on 88 patients.
OBJECTIVE
Accelerated fractionation was used to shorten overall treatment time to increase locoregional control and cause-specific survival.


METHODS
Eighty-eight patients with cancer of the esophagus ineligible for surgery were entered in the study between 1986 and 1993. Neoadjuvant chemotherapy was given to 64% of patients. Accelerated radiotherapy using the concomitant boost technique delivered a median dose of 65 Gy in a median overall treatment time of 32 days.


RESULTS
The 3-year actuarial local control rate in patients with T1, T2, and T3 tumors was 71%, 42%, and 33%, respectively. The 3-year cause-specific survival rates were 40%, 22%, and 6%, respectively. Sixteen percent of patients experienced Grade 3 esophagitis. Late toxicity included esophageal stenosis and pulmonary fibrosis in 8% and 9% of the patients, respectively. Multivariate analysis demonstrated that T stage and overall treatment time were prognostic factors for cause-specific survival. T stage and neoadjuvant chemotherapy were independent prognostic factors for locoregional control.


CONCLUSIONS
These findings suggest that accelerated fractionation given in an overall treatment time of <35 days might be beneficial for early-stage cancer of the esophagus. Neoadjuvant chemotherapy is not recommended, as it was a significant adverse prognostic factor in the multivariate analysis for local control. Accelerated fractionation can be carried out with moderate acute and late toxicity.
Girinsky
T
T
Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France.
Auperin
A
A
Marsiglia
H
H
Dhermain
F
F
Randrianarivelo
H
H
Kac
J
J
Ducreux
M
M
Elias
D
D
Rougier
P
P
D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D015999:Multivariate Analysis; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage
D002945:Cisplatin; D005472:Fluorouracil