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Locally advanced esophageal and GE Junction cancer: Chemotherapy and radiation

Posted Jun 24 2009 7:01pm

Esophageal cancer, including cancer arising from the gastro-esophageal junction, is a challenging disease worldwide. At diagnosis, approximately 50% of patients present with disease that extends beyond the site of origin in the esophagus. The Radiation Therapy Oncology Group (RTOG) study 85-01 compared treatment with 4 cycles of cisplatin plus 5-FU with radiation therapy (50 Gy in 25 fractions) to radiation therapy (64 Gy in 32 fractions) in patients with local-regional thoracic esophageal cancer (T1-3, N0-1, M0) (23) Ninety percent of the patients had squamous cell carcinoma. Patients treated with both chemotherapy and radiation therapy had a significantly better average duration of survival (14 months vs 9 months, p < 0.0001) and more of these patients were alive 5 years after treatment (27% vs 0 %, p < 0.0001). Combined chemotherapy plus radiotherapy became the new standard of care for patients with esophageal cancer that was not amenable to surgical removal. At this point, several other chemo regimens have been studied and are consdired standard with radiation, among them capecitabine as noted above.

DeNittis AS. Esophagus. In: Perez CA, Brady LW, Halperin EC (eds): Principles and Practice of Radiation Oncology. 4th edition. Lippincott Williams & Wilkins. 2004, pp 1282-1305.

Blackstock AW, Tepper JE. Esophageal cancer. In: Gunderson L, Tepper J (eds): Clinical Radiation Oncology. 1st edition. Churchill Livingstone. 2000, pp 629-644.

Arnott SJ, Duncan W, Gignoux M, et al. Preoperative radiotherapy in esophageal carcinoma: a meta-analysis using individual patient data (Oesophageal Cancer Collaborative Group). Int J Radiat Oncol Biol Phys 1998; 41:579-83.

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