Palliative concurrent chemoradiotherapy in locally advanced and metastatic esophageal cancer patients with dysphagia

Background & objective: Dysphagia is the most common and serious symptom in patients with esophageal cancer. Several management options have been developed to palliate dysphagia in unresectable and metastatic esophageal carcinoma patients. The aim of this prospective study was to evaluate the efficacy and toxicity of palliative chemoradiotherapy in locally advanced and metastatic esophageal cancer as regard improvement of dysphagia, primary tumor response and survival time. Patients & methods: This prospective study was conducted on 25 patients with advanced and metastatic esophageal carcinoma. A radiation dose of 40 Gy/22 fractions was given concomitantly with chemotherapy, consisted of cisplatin 70 mg/m(2) infusion on day 1, plus continuous infusion of 5-fluorouracil at 700 mg/m(2) per day from day 1 to day 4. Results: Dysphagia improved in 18 (72%) of the 25 patients. The median duration of dysphagia improvement was 5 months after treatment in these patients. Overall, treatment was well tolerated; acute haematologic toxicities were limited, with anaemia (80%) the commonest. The most common nonhaematologic toxicity was esophagitis. There were no reports of grade IV toxicities. The activity of the concurrent chemoradiotherapy regimen was good, achieving incomplete response in 18 patients (72%), 5 patients showed stable disease (20%) and 2 patients showed progressive disease (8%). The median overall and progression free survival were 7 and 4 months, respectively. Conclusions: Our study showed that palliative concurrent chemo-radiotherapy is an effective and well tolerated treatment for dysphagia in patients with advanced and metastatic esophageal carcinoma.