Concurrent chemoradiotherapy or endoscopic stenting for advanced squamous cell carcinoma of esophagus: a case-control study.
BACKGROUND
We evaluated the role of chemoradiotherapy (CRT) for patients with inoperable squamous esophageal cancer.


METHODS
Patients with locally advanced or metastatic squamous esophageal carcinoma who received CRT were recruited. The CRT consists of continuous infusion of 5-fluorouracil at 200 mg/m(2)/day, and cisplatin at 60 mg/m(2) on days 1 and 22, with concurrent radiotherapy for a total of 50 to 60 Gy in 25 to 30 fractions over 6 weeks. Efficacy was assessed by endoscopy and computed tomographic scan before and 8 weeks after completion of the treatment program. Median survival and the need for palliative esophageal stenting were compared with another group of patients who received endoscopic stenting.


RESULTS
From 1996 to 2003, a total of 36 consecutive patients (33 male, mean +/- SD age 63.2 +/- 9.5 years) with T4 disease (81%) with or without cervical nodal metastasis (50%) received CRT, while 36 patients treated with endoscopic stenting alone were recruited as controls. Both groups were comparable in demographics, pretreatment dysphagia score, comorbidities, and tumor characteristics. CRT was completed in 32 patients (89%). There was no treatment-related mortality. Tumor volume was greatly reduced after CRT in 19 patients. Four patients (11%) received salvage esophagectomy 9 to 42 months after CRT. Compared with the stenting group, CRT statistically significantly improved 5-year survival (15% vs. 0%, P = .01), median survival (10.8 months vs. 4.0 months, P < .005), and need for stenting (22% vs. 100%, P = .005).


CONCLUSIONS
Palliative CRT can effectively improve the symptoms of dysphagia in patients with inoperable squamous esophageal carcinoma. It results in better survival compared with endoscopic stenting in these patients.
Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
Simon K H
SK
Wong
Philip W Y
PW
Chiu
S F
SF
Leung
K Y
KY
Cheung
Angus C W
AC
Chan
Alex C M
AC
Au-Yeung
James F
JF
Griffith
Sydney S C
SS
Chung
Enders K W
EK
Ng
D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D016022:Case-Control Studies; D002945:Cisplatin / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D015897:Comorbidity; D003680:Deglutition Disorders / Q000188:drug therapy / Q000532:radiotherapy; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D004945:Esophagoscopy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis
D000964:Antimetabolites, Antineoplastic; D002945:Cisplatin; D005472:Fluorouracil