Esophageal cancer located at the neck and upper thorax treated with concurrent chemoradiation: a single-institution experience.
BACKGROUND
To characterize the treatment and outcome of patients with cervical and upper thoracic esophageal cancer, the authors retrospectively reviewed the 11-year experience from The University of Texas M. D. Anderson Cancer Center.


METHODS
Thirty-five patients with M0 cervical or upper thoracic esophageal cancer and treated with concurrent chemoradiotherapy were analyzed. Median radiation dose was 50.4 Gy (range, 24.5-64.8) Gy delivered with 1.8-Gy daily fractions over 5.5 weeks. Chemotherapy was 5-fluorouracil based. Response after treatment was evaluated on the basis of radiography, biopsy, or both. The survival rates were calculated by means of the Kaplan-Meier method.


RESULTS
The median follow-up for the surviving patients was 39 months. The actuarial 5-year overall survival (OS), cause-specific survival, disease-free survival, local relapse-free survival, and distant metastasis-free survival rates were 18.6%, 27.6%, 22.4%, 47.7%, and 57.0%, respectively. Patients who received a radiation dose of greater than or equal to 50 Gy had a higher complete response rate than those who received less than 50 Gy (79.2% versus 27.3%; p = 0.003). On multivariate analysis, radiation dose was the only protective factor associated with the rates of OS (p = 0.006), cause-specific survival (p = 0.003), and local relapse-free survival (p = 0.001); tumor stage was the only factor associated with rate of disease-free survival (p = 0.007).


CONCLUSIONS
Concurrent chemoradiotherapy is an effective treatment modality for patients with cervical and upper thoracic esophageal cancer. The authors' results suggest that a total radiation dose of 50 to 65 Gy with a concurrent chemotherapy regimen may improve local control and the OS rate in this rare type of esophageal cancer.
Wang
Shulian
S
Department of Radiation Oncology, Cancer Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Liao
Zhongxing
Z
Chen
Yuan
Y
Chang
Joe Y
JY
Jeter
Melanda
M
Guerrero
Thomas
T
Ajani
Jaffer
J
Phan
Alexandria
A
Swisher
Stephen
S
Allen
Pamela
P
Cox
James D
JD
Komaki
Ritsuko
R
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D000970:Antineoplastic Agents