Preoperative chemotherapy and radiation for advanced esophageal carcinoma: Comparison between once a day radiation and hyperfractionation, a single-institution experience

The purpose of this study was to determine the toxicity and efficacy of single daily fractionation as compared with twice-a-day radiation therapy in combination with chemotherapy for preoperative locally advanced thoracic esophageal carcinoma. A retrospective survey was done of 42 patients undergoing concurrent chemotherapy and radiation for preoperative locally advanced thoracic esophageal carcinoma. Twenty-five patients had 5-fluorouracil ([5-FU]), 1,000 mg/m 2 /d by continuous infusion, days 1-5, and days 22-26), cisplatin (100 mg/m 2 intravenously, days 2 and 22), and radiation to a total dose of 4,500 to 5,040 cGy in 180 cGy/fraction every day. Seventeen patients received 5-FU (300 mg/m 2 /d by continuous infusion, days I and 21), cisplatin (20 mg/m ? /d for 1 hour, days 1-5 and days 17-20), vinblastine (I mg/m 2 intravenously, days 1-5 and days 17-21) and accelerated hyperfractionated radiation 150 cGy twice a day to a total dose of 4,500 cGy. Response rate, survival, local regional failure rates, and treatment toxicity of the two groups were compared. Surgery was aborted in one patient and another patient refused surgery in the single daily-fractionation group.