title: Radical treatment for oesophageal cancer patients unfit for surgery and chemotherapy. A 10-year experience from the Norwegian Radium Hospital.
abstract: BACKGROUND
  Over a 10-year period from 1990, 445 patients with carcinoma of the oesophagus were admitted to the Norwegian Radium Hospital and 184 of these patients received treatment with curative intent. Even though surgery is the treatment of choice for these patients, many of them suffer from medical conditions that increase the risk for postoperative mortality and morbidity. In a retrospective study, the effect of the curative treatment offered to patients was explored with a particular focus on patients unfit for surgery.
  
  
  METHODS
  Medical data of the 184 patients treated with curative intent were reviewed and additional clinical information was retrieved from local hospitals and general practitioners. Preoperative radiotherapy followed by surgery was the standard curative treatment for operable patients. Medically inoperable patients were offered radical split-course hyperfractionated radiotherapy followed by a brachytherapy boost.
  
  
  RESULTS
  More than 50% (103/184) received non-surgical treatment only. Patients who received radical surgery (n = 81) were younger, had better performance status, less weight loss and dysphagia compared to patients treated with radical radiotherapy (n = 102). One patient received only photodynamic therapy. The 3-year survival was 29% for patients treated with radical surgery, and 8% for patients who received radical radiotherapy. The overall median crude survival for the two groups of patients were 20 months and seven months respectively.
  
  
  CONCLUSIONS
  The hyperfractionated radiotherapy provided symptom relief without extensive toxicity and with a possibility for cure for patients with oesophageal cancer who are unfit for surgery and chemoradiotherapy. The literature supports the curative potential of high dose accelerated hyperfractionated radiotherapy even though the optimal radiotherapy regimen still needs to be explored.
authors.affiliation: Department of Oncology, Division of Cancer Medicine and Radiotherapy, Norwegian Radium Hospital, Oslo University Hospital, Montebello, Oslo, Norway. cecilie.delphin.amdal@radiumhospitalet.no
authors.forename: Cecilie Delphin
authors.initials: CD
authors.lastname: Amdal
authors.forename: Anne-Birgitte
authors.initials: AB
authors.lastname: Jacobsen
authors.forename: Johan E
authors.initials: JE
authors.lastname: Tausjø
authors.forename: Johan N
authors.initials: JN
authors.lastname: Wiig
authors.forename: Trond
authors.initials: T
authors.lastname: Warloe
authors.forename: Karl O
authors.initials: KO
authors.lastname: Karlsen
authors.forename: Berit
authors.initials: B
authors.lastname: Sandstad
authors.forename: Kristin
authors.initials: K
authors.lastname: Bjordal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures; D004938:Esophageal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D011878:Radiotherapy / Q000379:methods