12^th World Cancer Conference

Aim: This study evaluates long term clinical results of the patients treated with dose escalated volumetric modulated arc therapy (RA) and concurrent chemotherapy.

 

Materials & Methods: 81 suitable patients (33 upper third, 29 middle third and 19 lower third) of squamous cell carcinoma of esophagus with good nutrition and performance status were treated defi nitively with RA and concurrent weekly ciplatin-33mg/m2. Patients unable to swallow semi-solids underwent either a nasogastric tube placement or stent or a feeding jejunostomy prior to treatment. The gross tumor volume with margin received a total dose of 5940cGy and the involved regional nodal regions received

54Gy and elective nodal regions received 50.4Gy.

 

Results: Th e planned radiotherapy dose was delivered in all except 1 patient. Majority (86%) of the patients received 4 or more cycles of weekly cisplatin. At 4 weeks following treatment, 15% of patients had persistent local disease and at a median follow-up of 38 months, 12% of patients had failed locoregionally as fi rst site of relapse and 12% of patients had distant only metastasis as fi rst site of relapse. The 3 yr disease free survival and overall survival were 33% and 38% respectively. Five years overall survival was 25%. None ofthe patients had acute hematological or mucosal grade IV toxicities and treatment interruptions except in a patient who died during the treatment due to infection. Th e stricture requiring repeated dilatation was seen 33% and none of them had esophageal perforation or fi stula. None of the patients had symptomatic pneumonitis.

 

Conclusion: In comparison with RTOG 8501, 5FU was safely excluded in our patients without detriment in survival, higher total dose (59.6Gy vs. 50.4Gy) and higher elective nodal radiation (50.4Gy vs. 30Gy) dose led to improved locoregional control (locoregional failures of 27% vs. 38-48%). Dose escalation with RA and concurrent cisplatinum resulted in good long term outcomes with acceptable toxicities.