Radiotherapy preceded by multidrug chemotherapy in carcinoma of the esophagus: a pilot study of the Radiation Therapy Oncology Group.

Abstract

This is a report on R.T.O.G. #77-07, a phase II pilot study aimed at determining the toxicity, primary tumor control, and survival achieved with a combination of triple-drug chemotherapy prior to radiotherapy in carcinoma of the esophagus. The drugs used were vincristine, bleomycin, and methotrexate. A total of 26 cases were registered, one of which died during chemotherapy; 11 had only one chemotherapy course, and 14 had two chemotherapy courses as planned. Drug toxicity could be evaluated in 23 patients: one died from liver damage secondary to chemotherapy effect (4%), two had nausea and vomiting (9%), one had weakness and skin rash (4%), and one had fever and vomiting (4%). There was no complete tumor response to chemotherapy in 22 evaluable cases; 12 of 22 (55%) showed some measurable tumor reduction. Radiation toxicity could be evaluated in 25 patients: 1 of 25 (4%) developed clinical pericarditis, and 2 of 25 (8%) developed severe esophagitis. A complete response to radiotherapy was observed in 15 of 25 (60%) patients; 7 of 25 (28%) showed a partial response; and 3 of 25 (12%) had no measurable tumor reduction. The median survival in 25 evaluable cases was 22 months. In 11 patients who received a single course of chemotherapy, the median survival was 19 months, while in 14 patients who received two courses of chemotherapy, the median survival was only 9 months. However, this difference is not statistically significant.