Tumour control and dysphagia improvement in patients with locally advanced T3/ T4 oesophageal squamous cell cancer after definitive radio-chemotherapy

Introduction . Squamous cell carcinoma of the esophagus (scc) is usually diagnosed in an advanced stage resulting in limited curative options. The aim was to evaluate immediate and long-term effects of combined chemo-radiotherapy of loco-regionally advanced scc in terms of dysphagia relief and tumour response. Material and methods . Between 1997 and 2000, 35 pts with scc completed full definitive non-surgical treatment. Men - 31, women - 4; mean age: 51. Tumour stage: T4 - 5, T3 - 30, node stage: N0 - 8, N1 - 27; dysphagia at presentation: WHO III° - 17%, II° - 46%, I° - 37%. Irradiation: conventional fractionation to a dose of 56-60 Gy to tumour, 54-60 Gy to enlarged lymph nodes, 40-44 Gy electively to regional lymph nodes in combination with 2 courses of i.v. chemotherapy: 5-fluorouracil: 800 mg/m2/24h (day: 1-4, 22-25), cisplatin: 80 mg/m2 (day: 1, 22) followed by HDR brachytherapy boost using 192Ir - 6 Gy after a one week interval. During follow-up the patients were scored according to the swallowing function, weight change and pain control. Tumour regression and late radiotherapy side effects were observed. Results . Initial improvement in dysphagia occurred in 20/35 patients (57%) during treatment. Durable improvement at 1-year was evidenced in 19/35 (54%) pts. 31% were dysphagia-free at 1 year. Average duration of dysphagia improvement was 11 months. Only patients with marked improvement in the swallowing function documented during treatment were able to maintain this function for a longer time. We achieved an overall response rate to treatment of 52%. CR (local control) was noted in 26% of pts and local progression (PD) in 34% at 12 months. The median time to tumour progression was 5.4 months. Systemic failure was noted in 20% of patients. The median time to metastases was 8 months and median survival - 12.5 months with a 1-year observed survival of 54%, 2-year- 31% and 3-year - 23%. Conclusions . 1. Primary concurrent chemo-radiotherapy for advanced T3/T4 N0-1 scc of the oesophagus seems to be a reasonable modality to control short- and long-term dysphagia and pain. 2. The rate and degree of the initial improvement of the swallowing function is a good prognostic tool for assessing the long-term swallowing status. 3. Relatively low local control rate of 26%, due to advanced stage of the disease in our patients, indicates the need for further evaluation of a more efficient treatment modality in this tumour with poor prognostis.