Chemotherapy versus Chemoradiotherapy in Inoperable Esophageal Cancer

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Abstract
In a sequential manner, three prospective controlled studies using cytostatics alone and a combination of cytostatics and radiotherapy in 103 patients with inoperable esophageal cancer, were performed. Study A included bleomycin alone and a combination of bleomycin and radiation, study B adriamycin and the combination of adriamycin with radiation, and study C was a combination chemotherapy (bleomycin and adriamycin) versus bleomycin and adriamycin and radiation. In almost three quarters of the patients squamous cell carcinoma was proven. In over half of the patients tumors were localized in the middle third of the esophagus while the upper and lower third were other sites of tumor involvement. In study A, out of 15 patients treated with bleomycin alone, 4 responded to treatment with a response rate ( > 50% tumor regression) of 26%. Combining bleomycin with radiation in 24 patients, response was observed in 15, obtaining a response rate of 62%. The difference in response was statistically significant (p < 0.01). In study B, 15 patients were treated with adriamycin alone and 5 patients responded to treatment so that the response rate was 33%. In combined treatment modality including adriamycin plus radiation, response was observed in 60% of patients treated, i.e. 9 out of 15 patients responded to treatment with a statistically significant difference in treatment results (p < 0.05). Study C consisted of a combination of bleomycin and adriamycin in 16 patients with 3 responders and a response rate of 19%. Combined treatment with these two drugs plus radiation resulted in 9 responders out of 15 patients, a response rate of 60%. The difference in treatment results was also statistically significant (p < 0.01). Except two, all the complete responses were observed in combined treatment modalities. Squamous cell carcinoma was the most responsive to treatment, 80% of all responses were noted in this type of tumor. Remissions obtained by single-agent treatment or by combination chemotherapy were of short duration (2–3 months), while the medical remission duration in combined treatment modalities lasted 9–11 months. Combined treatment modalities also showed markedly prolonged patient survival compared to chemotherapy alone. Toxic side effects were tolerable for patients in studies A and B while in study C toxicity was severe, especially in combined treatment. The results of these studies showed that cytostatics alone, even in combination chemotherapy, produced a lower antitumor activity in esophageal cancer than the combination of these drugs with radiation. Neither combination chemotherapy (bleomycin and adriamycin) nor combined treatment (bleomycin and adriamycin and radiation) have shown better results than administration of these drugs as single agents or their single combination with radiotherapy.

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