Infusional 5-fluorouracil and x-ray therapy for non-resectable esophageal cancer

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Abstract
Six patients with unresectable carcinoma of the esophagus received a combined course of external radiation therapy (1000 rads in four fractions in four days commencing on day 2) combined with constant infusional 5‐fluorouracil (20 mg/kg every 24 hours for five days beginning on day 1). This program was repeated every other week to give a total x‐ray dose of 6000 rads. This regimen has been well‐tolerated by the majority of the patients and resulted in a complete response rate within the x‐ray treatment field of 83% (5/6). All patients who showed a demonstrable systemic response to 5‐fluorouracil reached complete response. The median survival has not yet been reached at six months with post‐treatment survivors alive and without disease (four patients) at one, six, nine, and 22 months. Our previous median survival by x‐ray therapy alone was 4 1/2 months. Toxicity consists primarily of hematologic suppression at a subclinical level. Although the length of therapy is substantial (11 weeks), the program appears tolerable and is capable of inducing long‐term remissions. The program is currently being studied for dose escalation because neither local nor systemic side effects of a doselimiting nature have been observed at 20 mg/kg 5‐FU. Cancer 45:703‐708, 1980.