Phase II Study of Concurrent Chemoradiotherapy at the Dose of 50.4 Gy with Elective Nodal Irradiation for Stage IIIII Esophageal Carcinoma

Definitive chemoradiotherapy is one of the curative options for resectable esophageal squamous cell carcinoma with organ preservation. We evaluated the efficacy and toxicity of radiotherapy at a dose of 50.4 Gy concurrent with chemotherapy for Stage IIIII esophageal cancer. Esophageal cancer patients with clinical Stage IIIII (T1N1M0 or T2-3N0-1M0) were eligible. Radiotherapy was administered to a total dose of 50.4 Gy with elective nodal irradiation of 41.4 Gy. Concurrent chemotherapy comprised two courses of 5-fluorouracil (1000 mg/m(2)/day) on days 14 and 2-h infusion of cisplatin (75 mg/m(2)) on Day 1; this was repeated every 4 weeks. Two courses of 5-fluorouracil with cisplatin were added. Fifty-one patients were enrolled in the study from June 2006 to May 2008. The characteristics of the 51 patients enrolled were as follows: median age 64 years; male/female, 45/6; performance status 0/1, 32/19 patients; Stage IIA/IIB/III, 9/20/22 patients, respectively. A complete response was achieved in 36 patients (70.6). The 1- and 3-year overall survival rate was 88.2 and 63.8, respectively. The median 1- and 3-year progression-free survival rate was 66.7 (80 CI: 5774) and 56.6 (80 CI: 47.164.9), respectively. Acute toxicities included Grade 3/4 anorexia (45), esophagitis (35) and febrile neutropenia (20). Eight patients (15.6) underwent salvage surgery due to residual or recurrent disease. There were no deaths related to salvage surgery. Chemoradiation therapy at a dose of 50.4 Gy with elective nodal irradiation is promising with a manageable tolerability profile in esophageal cancer patients.