Prospective randonmized study on inductive chemotherapy plus radiotherapy for patients with upper and middle esophageal carcinoma

Objective To evaluate the effect of radiotherapy combined with inductive chemotherapy for patients with upper and middle esophageal cancer. Methods 162 patients with upper and middle esophageal cancer were randomized into two groups, with 82 treated by inductive chemotherapy combined with radiotherapy (C+R) and 80 by radiotherapy alone(R). The chemotherapy regimen included 5 fluorouracil 500?mg/m 2 on d1 d5 by continuous infusion for 120 hours, cisplatin 60?mg/m 2 on d1 and bleomycinA5 8?mg on d1,d3,d5 intravenously. Three to seven days after chemotherapy, the patients were irradiated with anteroposterior(AP) and posteroanterior(PA) fields to a dose of 40 44 Gy in 4.0 4.4 weeks followed by a boost of 24 28 Gy in 2.4 2.8 weeks through oblique fields. Results The 5 and 10 year survival rates were 22.0%, 15.9% for the C+R group and 13.8% , 8.8% for the R group. The difference was statistically significant(P=0.034). The toxic and side effects were tolerable and similar in the two groups. Nineteen patients(23%) in the C+R group and thirty one(39%) in the R group died from distant metastasis and /or lymph node metastasis, even though the difference was not statistically significant ( χ 2=3.47, P0.05). Conclusions Inductive chemotherapy with 5 fluorouracil, cisplatin, bleomycinA5 plus radiotherapy may improve the outcome of esophageal cancer, with the toxic and side effects of the combined modality severer than radiation alone, but they are well tolerated.