Preliminary study of uneven fractionation radiotherapy combined with chemotherapy for esophageal cancer.

Between March 1992 and September 1993, nine patients were treated with combined-modality therapy of uneven fractionation radiotherapy and chemotherapy (CDDP+ 5-FU) before esophagectomy. All patients had a T4 tumor that was evident on the chest CT scan, MRI, or bronchofiberscopy. In the uneven fractionation radiotherapy, patients received 5 Gy on Fridays and daily doses of 1.2 Gy the following Monday through Thursday for 22 days, to yield a total dose of 34.4 Gy. CDDP (40 mg/body) was administered intravenously as a slow infusion just before each 5 Gy treatment for a total of five doses. 5-FU (300 mg/m2/day) was also administered intravenously as a slow infusion for each of the 22 treatment days. As restaging failed to document a significant response (improvement to T3 or better), a further dose of irradiation was given in two patients (22%). Five patients (56%) had a partial response. The tumors in eight patients (89%) could be resected after this combined modality treatment. Histological assessment of the resected specimens indicated grade 3 in two patients and grade 2 in six patients. At a median follow-up of 14 months, seven patients are alive and four patients are clinically disease free. Uneven fractionation radiotherapy combined with chemotherapy improved local control and the resectable rate in these patients.