Chemoradiotherapy of Locally Advanced Esophageal Cancer

作者：Jay S. Cooper, Matthew Guo, Arnold Herskovic, John S. Macdonald, James A. Martenson, Muhyi Al‐Sarraf, Roger W. Byhardt, Anthony H. Russell, Jonathan J. Beitler, Sharon A. Spencer, Sucha O. Asbell, Mary V. Graham, Lawrence Leichman · 发表于：JAMA · 年份：1999 · DOI：10.1001/jama.281.17.1623 · 被引用次数：1981 · 研究领域：Esophageal Cancer Research and Treatment、Head and Neck Cancer Studies、Esophageal and GI Pathology

CONTEXT: Carcinoma of the esophagus traditionally has been treated by surgery or radiation therapy (RT), but 5-year overall survival rates have been only 5% to 10%. We previously reported results of a study conducted from January 1986 to April 1990 of combined chemotherapy and RT vs RT alone when an interim analysis revealed significant benefit for combined therapy. OBJECTIVE: To report the long-term outcomes of a previously reported trial designed to determine if adding chemotherapy during RT improves the survival rate of patients with esophageal carcinoma. DESIGN: Randomized controlled trial conducted 1985 to 1990 with follow-up of at least 5 years, followed by a prospective cohort study conducted between May 1990 and April 1991. SETTING: Multi-institution participation, ranging from tertiary academic referral centers to general community practices. PATIENTS: Patients had squamous cell or adenocarcinoma of the esophagus, T1-3 N0-1 M0, adequate renal and bone marrow reserve, and a Karnofsky score of at least 50. Interventions Combined modality therapy (n = 134): 50 Gy in 25 fractions over 5 weeks, plus cisplatin intravenously on the first day of weeks 1, 5, 8, and 11, and fluorouracil, 1 g/m2 per day by continuous infusion on the first 4 days of weeks 1, 5, 8, and 11. In the randomized study, combined therapy was compared with RT only (n = 62): 64 Gy in 32 fractions over 6.4 weeks. MAIN OUTCOME MEASURES: Overall survival, patterns of failure, and toxic effects. RESULTS: Comb...