Esophageal cancer. A prospective phase II study of concomitant-boost external-beam chemoradiation with a top-up endoluminal boost.
OBJECTIVE
To present the results of a prospective phase II study in esophageal carcinoma.


METHODS
Patients received single doses of 1.8 Gy up to 27 Gy, then concomitant boost to a total of 50.4 Gy (PTV2 [planning target volume], single dose 1.8 Gy) and 64.8 Gy (PTV1, single dose 1.2 Gy in the morning and 1.8 Gy in the afternoon) concurrently with 800 mg/m(2)/d 5-fluorouracil and 20 mg/m(2)/d cisplatin (weeks 1 and 5). High-dose-rate brachytherapy (2-3 x 6 Gy) on Fridays of weeks 4-6 used a customized applicator facilitating central placement and circumferential dose homogeneity.


RESULTS
50 patients with squamous cell carcinoma (90%) or adenocarcinoma and mostly advanced tumor stage were treated (82% T3/T4 and 70% N1). Median overall survival (median OS 16 months; 1-year-OS 61%; 2-year OS 29%) was significantly longer for patients without nodal disease (35 vs. 11 months; p = 0.01). Hematotoxicity was grade 3 in 11/50, and grade 4 in 1/50 patients. Four percent of higher-grade nausea or vomiting occurred. Esophageal late toxicity was grade 3 in 9/50 patients, and grade 4 in 2/50 patients.


CONCLUSIONS
Survival was excellent especially for patients without nodal disease in this dose-intensified schedule with acceptable tolerability.
Brunner
Thomas B
TB
Department of Radiation Therapy, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen. thomas.brunner@rob.ox.ac.uk
Rupp
Andreas
A
Melzner
Winfrid
W
Grabenbauer
Gerhard G
GG
Sauer
Rolf
R
D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001918:Brachytherapy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; 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; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D011832:Radiation Injuries / Q000209:etiology; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal; D011882:Radiotherapy, High-Energy; D015996:Survival Rate
D002945:Cisplatin; D005472:Fluorouracil