Chemoradiotherapy of Locally Advanced Esophageal Cancer

Abstract

The risk of esophageal cancer is growing; over the past 20 years the incidence rate has increased 14.8%.¹ Moreover, carcinomas of the esophagus have been among the most resistant to treatment. Mean survival following traditional therapy has approximated only 9 months. Earlam and Cuhna-Melo's² 1980 review of 122 articles describing the surgical care of 83,783 cases of squamous cell carcinoma of the esophagus revealed a paltry 5-year survival rate of 4%. Their subsequent review of the role of radiation therapy (RT) found an almost equally dismal rate of 6%.³ While improvements in technique have occurred and more modern surgical series tend to report survival rates in the 20% range, at least some investigators believe the major explanation for this has been earlier detection of tumors.⁴ The first evidence that the integration of chemotherapy with RT could improve outcome surfaced in the early 1980s. Several pilot studies using cisplatin and fluorouracil suggested that median survival could be lenghtened to 13 months.^5-11