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Outcome of Locally Advanced Esophageal Cancer Treated with Concurrent Chemo-radiotherapy

국소진행된 식도암에서 동시적 항암화학방사선요법의 결과

  • Jang, Hyun-Soo (Departments of Radiation Oncology, Ajou University School of Medicine) ;
  • Kang, Seung-Hee (Departments of Radiation Oncology, Ajou University School of Medicine) ;
  • Lee, Sun-Young (Department of Radiation Oncology, Gonyang University School of Medicine) ;
  • Jo, Sun-Mi (Departments of Radiation Oncology, Ajou University School of Medicine) ;
  • Oh, Young-Taek (Departments of Radiation Oncology, Ajou University School of Medicine) ;
  • Chun, Mi-Son (Departments of Radiation Oncology, Ajou University School of Medicine) ;
  • Choi, Jin-Hyuk (Departments of Medical Oncology, Ajou University School of Medicine) ;
  • Kang, Seok-Yun (Departments of Medical Oncology, Ajou University School of Medicine)
  • 장현수 (아주대학교 의과대학 방사선종양학교실) ;
  • 강승희 (아주대학교 의과대학 방사선종양학교실) ;
  • 이선영 (건양대학교 의과대학 방사선종양학교실) ;
  • 조선미 (아주대학교 의과대학 방사선종양학교실) ;
  • 오영택 (아주대학교 의과대학 방사선종양학교실) ;
  • 전미선 (아주대학교 의과대학 방사선종양학교실) ;
  • 최진혁 (아주대학교 의과대학 종양내과학교실) ;
  • 강석윤 (아주대학교 의과대학 종양내과학교실)
  • Received : 2009.04.03
  • Accepted : 2009.06.02
  • Published : 2009.06.30

Abstract

Purpose: We investigated the outcome and the prognostic factors of patients with locally advanced esophageal cancer who were treated with concurrent chemo-radiotherapy. Materials and Methods: Two hundred forty six patients with esophageal cancer that were treated by radiotherapy between January 1994 and July 2007. Of these, 78 patients who received radiotherapy of $\geq$45 Gy with concurrent chemotherapy were retrospectively enrolled in this study. We included patients stages IIA, IIB, III, IVA, and IVB with supraclavicular metastasis in the middle/lower esophageal cancer or celiac node metastasis in cervical or upper/middle thoracic esophageal cancer. The median radiation dose was 54 Gy and the combination chemotherapy with 5-FU and cisplatin (FP chemotherapy) was given concurrently with radiotherapy in most patients (88%). Results: The follow-up period ranged from 2 to 117 months (median 14 months). The treatment response of the 54 patients could be evaluated by computerized tomography or endoscopy. A complete response (CR) was observed in 17 patients, whereas a partial response was observed in 18 patients. In patients with a CR, the median recurrence time was 20 months and the first relapse sites constituted a locoregional failure in 3 patients and a distant failure in 7 patients. The 1-, 2-, and 5-year overall survival (OS) rates were 58.9%, 21.7%, and 12.2%, respectively. The median survival period was 14 months. A univariate analysis indicated that the treatment response and cycles of FP chemotherapy were significant prognostic factors for OS. Daily or weekly administration of cisplatin as a radiosensitizer showed a better treatment response than FP chemotherapy. Conclusion: This study has shown that results of concurrent chemo-radiotherapy in patients with locally advanced esophageal cancer is comparable to those of other studies. Daily or weekly cisplatin administration may be considered as an alternative treatment in patients that are medically unfit for FP chemotherapy.

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