Palliative radiation schedules with and without chemotherapy in advanced carcinoma of the esophagus

In a prospective randomized study, 272 patients with advanced oesophageal cancer were treated with radiation and bleomycin or vinblastine or a combination of both cytostatics. Two radiation schedules were tested, the one involving larger fractions in a shorter period of time. Evaluation of the treatment results showed that 67% of patients experienced significant relief of dysphagia. The median survival was 3 months and the 1-year survival 7%. No statistical difference in survival was noted among the different chemotherapy or radiation groups (level of significance 5%). It was concluded that monochemotherapy as given in this study made no difference in the treatment result. The larger radiation fraction and shorter treatment time schedule was as effective as the more conventional schedule and is the preferred treatment because of the shorter hospitalization period. A pharyngostomy tube proved effective in feeding the patients. Oesophageal cancer is a systemic disease and polychemotherapy will have to play a prominent part in a multimodality treatment approach if results are to improve.