Chemoradiation without cisplatin in the radical treatment of carcinoma of the oesophagus

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Abstract
4261 Background: Chemoradiation therapy is increasingly employed as radical treatment for locally advanced oesophageal cancer, capable of achieving cure and competing with surgery as a realistic alternative choice. However, the reported severe and life threatening complication rates, RTOG grade 3/4, using concurrent cisplatin and 5-FU are 20% and 44% respectively (1). We report here the outcome of patients treated with chemoradiation at the Middlesex Hospital, London, UK between 1998 and December 2002.The efficacy and tolerance data of a non-platinum containing chemotherapy regimen is presented. Methods: 43 patients with locally advanced cancer were treated between January 1998 and December 2002. 38 patients were evaluable. (28 male, 10 female, age range 38–86, median 70 years). All were staged by CT criteria. All were WHO PS 2 or better. 23 had squamous cell carcinoma while 15 had adenocarcinoma. All were M0; tumour stages were T4N1 (n=5), T4N0 (n=1), T3N1 (n=25), T3N0 (n=5), T2N1 (n=2). CT planned radiotherapy fields were used, to a dose of 50–60 Gy in 2Gy daily fractions. Chemotherapy consisted of 5-FU 1000mg/m2 as 24hour infusion (D1–4 and D29–32). Single-dose Mitomycin-C 12mg/m2 was given on D1. Results: 1year survival was 58%, three years19% and 4 years 12 %. Two of 8 patients at 5 years are alive.These figures are comparable to results with cisplatin-based chemotherapy e.g. RTOG 85–01 (1). None of the patients required PEG insertion. Only 6% developed G3 neutropenia. 20% patients developed oesophageal stricture and one patient developed grade 2 pneumonitis. Conclusions: MMC and 5-FU chemotherapy is a safe and well tolerated regimen, even in elderly patients, for concurrent chemoradiation of locally advanced oesophageal carcinoma. There is no need for routine PEG insertions for nutritional support as the resulting radiation mucositis is far less intense than with cisplatin-based regimens. Ref 1. Herskovic A et al New Engl J Med 1992; 326: 1593–98. No significant financial relationships to disclose.

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