Cancer of the esophagus is usually treated with surgery or radiation therapy resulting in 5 year survivals of 5 to 20%. Attempts have been made to improve outcomes by adding chemotherapy to surgery or to radiation therapy. However, the benefits of adding chemotherapy to other treatments is not clear.
The Radiation Oncology Study Group performed a randomized clinical trial between 1986 and 1990, which compared the combination of chemotherapy and radiation therapy to radiation therapy alone for patients with localized cancer of the esophagus. Following this randomized trial they treated additional patients with combined therapy. Patients entered on these trials had either squamous cell cancer or adenocarcinoma of the esophagus that had not spread beyond the esophagus. One hundred and thirty-four patients received radiation therapy plus cisplatin and fluorouracil chemotherapy and 62 received radiation therapy alone. The minimum follow-up is now over 5 years.
In the randomized trial combined treatment was associated with a 2% death rate from toxicity compared to 0% for the radiation group. In the second portion of the trial there were no deaths from combined treatment suggesting an improvement in supportive care with time and experience. In the randomized part of the trial the 5-year survival for the combined treatment group was 26% compared to 0% for patients receiving only radiation therapy. Twenty-two percent of patients survived at least 8 years after treatment. Patients treated subsequent to the randomized trial with combined therapy had a 5-year survival of 14%. The number of local recurrences and distant relapses were fewer in patients receiving combined therapy than in patients receiving radiation therapy alone. There were no relapses after 5 years of observation.
These doctors concluded that radiation combined with chemotherapy improves the survival of patients with localized squamous cell or adenocarcinoma of the esophagus when compared to radiation therapy alone. (
Journal of the American Medical Society, Vol 281, No 17, pp 1623-1627, 1999)