Esophageal cancer radiation alone

Although radiation alone has been utilized historically in the treatment of medically inoperable esophageal cancers and continues to be used today in the palliative setting, the standard of care for the nonsurgical management of localized esophageal cancer remains concurrent chemoradiation. For those patients who are unable to tolerate surgery or... 

A landmark trial was an intergroup study (RTOG 85-01) in which patients with locally advanced esophageal cancer were randomized to chemotherapy and radiation or radiation alone. Chemotherapy consisted of 5-FU (1000 mg/m2/24 h x 4 d) and cisplatin (75 mg/m2, d 1). Radiation therapy (5000 cGy/25 fractions) was initiated concurrently with d 1 of chemotherapy. Chemotherapy was given q 4 wk during radiation (cycles 1, 2) and q 3 wk following radiation (cycles 3,4). The radiation alone arm consisted of 6400 cGy/32 fractions. Only 50% of patients were able to complete all four cycles of chemotherapy. 

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