Concurrent radiotherapy and continuous 5-fluorouracil infusion in the management of locally advanced esophageal cancer.

From 1987 to 1989, a total of 22 patients with locally advanced non-metastatic esophageal cancer were treated by a combination of radiation therapy (RT) and chemotherapy (CT). RT, consisting of 250 cGy tumor dose per fraction with four fractions per week up to a total dose of 6000 cGy, was given concurrently with CT: 96 hours of continuous 5-fluorouracil (5-FU) infusion at a dose level of 250 g/kg/day. RT+CT was repeated every other week for a total of six cycles in 11 weeks. Toxicity data revealed that only mild to moderate mucositis, nausea/vomiting and myelosuppression occurred, and no patients developed unacceptable levels of toxicity necessitating discontinuation of the 5-FU infusion. Complete response (CR) was noted in nine out of 22 (41%) patients. The median progression-free survival period (MPFS) was 10 months, and the median absolute survival (MAS) was 13 months. Corresponding figures for our 61 previously RT treated patients (matched for sex, age, histopathology, tumor extent and location with current study group) were: CR rate, 8%; MPFS, three months; and MAS, six months. Kaplan and Meiers' survival curves and Log Rank test revealed a statistically significant difference in favor of the combined modality group (PFS, p = 0.0001; AS, p = 0.0001). The relatively good response rate and survival data appear to warrant further dose escalation in 5-FU since no major dose limiting toxicities were observed at 25 mg/kg/day.