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Bryan H. Burmeister, FRACR; Graeme Dickie, FRACR, FRACP; B. Mark Smithers, FRACS; Robert Hodge, FRACS; Karen Morton

Arch Otolaryngol Head Neck Surg. 2000;126:205-208.

Objective  To review the experience of 2 institutions in the management of localized carcinoma of the cervical esophagus with chemoradiation therapy.

Design  A series of 34 patients received chemoradiation therapy for a 5-year period. All patients were treated with curative intent. Three different regimens were used, all involving concomitant chemotherapy and high-dose radiation therapy. Data relating to toxic effects, local control of disease, and disease-free and overall survival were prospectively collected.

Setting  Two combined clinics at separate major hospitals where multidisciplinary care is the standard practice for this disease.

Patients  Patients with biopsy-proved carcinoma of the cervical esophagus.

Interventions  Patients received 3 different chemotherapy regimens. Two of the regimens used a combination of cisplatin and fluorouracil. The high-dose cisplatin regimen was a large dose of cisplatin (80 mg/m²) given on days 1 and 22 followed by a 96-hour infusion of fluorouracil (800 mg/m²) from days 2 to 5 and from days 23 to 26. The low-dose cisplatin regimen was cisplatin, 20 mg/m², from days 1 to 5 and from days 22 to 26 and the same 96-hour infusion of fluorouracil. The third regimen used fluorouracil alone. The mean radiation dose administered was 61.2 Gy in 29.6 fractions during 41.8 days using 4- or 6-mV photons and a shrinking field technique.

Results  The results of treatment have shown a high rate of local control, although some patients developed metastases. The local complete response rate following treatment was 91%, and the rate of local control of disease was 88%. The projected actuarial 5-year survival rate was 55%. Death from other causes was common. The acute toxic effects of the treatment were acceptable, with only 5 patients requiring nasogastric feeding or gavage. Two patients died of complications related to strictures.

Conclusion  Concomitant chemoradiation therapy should be the treatment of choice for carcinoma of the cervical esophagus.

From the Queensland Radium Institute, South Brisbane (Dr Burmeister), the Division of Oncology (Dr Dickie and Ms Morton) and Department of Otolarygology (Dr Hodge), Royal Brisbane Hospital, Brisbane, and the Department of Surgery, University of Queensland, Princess Alexandra Hospital, Woolloongabba (Dr Smithers), Australia.

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