Combined Therapy for Esophageal Carcinoma

Seven patients with squamous cell carcinoma of the esophagus received radiation therapy in twice weekly 400 md fractions over five weeks followed by eosphagectomy. Four of these patients developed severe interstitlal pulmonary infiltrates and died of pulmonary insufficiency 18-SO days after surgery. In three of these patients the infiltrates were detected within 24 hours Carcinoma of the esophagus has an extremely poor prognosis with 80 to 90 percent of patients dying within a year, and less than 5 percent of patients surviving five years.’4 The surgical mortality For editorial comment see page 400 for resection of the esophageal tumor is high, and most of these patients suffer either local recurrence or metastatic disease. Preoperative irradiation may increase the number of patients who may undergo resection and decrease local recurrences.4 To test this modality, we began a new treatment protocol in which patients were treated with large fraction radiation therapy followed by esophagogastrectomy. Radiation therapy was delivered in fractions of 400 rads minimum tumor dose, twice weekly for five weeks for a total of 4,000 rads. This has resulted in the development of a progressive interstitial pulmonary infiltrate in four of the seven patients treated in this manner. The radiographic appearance and presumed explanation for its occurrence is presented.