Esophageal cancer is still a virulent disease that leads to death. Surgery has been regarded as the treatment of choice in patients suffering this type of cancer and recent improvements in surgical techniques and perioperative management have significantly increased the resection rate and reduced the operative mortality. Nevertheless, long-term survival rates remain poor. The poor prognosis reflects the fact that the disease is usually advanced at the time of diagnosis. Therefore, a combination of chemotherapy and radiotherapy has recently been developed as a treatment for advanced esophageal cancer patients. Chemoradiation therapy is based on the concept of the biochemical modulation effects and radiosensitizing effects of the chemotherapeutic agents. How ever, the optimal choice of chemotherapeutic agents and their doses, as well as the chemotherapy and radiotherapy regimens have not been precisely established. We report a case of concurrent chemoradiation protocol by which a complete response was achieved. 5-FU (1,800 mg/body/day) was continuously infused over 24 hours and cisplatin (45 mg/ body/day) was administered 1 hour before radiotherapy for 3 days. This chemotherapy course was repeated once more after 4 weeks. The radiotherapy (180 cGy/day) was scheduled for 5 consecutive days, followed by a 2-day withdrawal, and a total dose of 5,940 cGy within 7 weeks. Our concurrent chemoradiation therapy is deemed rational, effective and safe because an endoscopically and pathologically complete response was achieved 1 year after chemoradiation therapy without any severe side effects. Therefore, we believe that our concurrent chemoradiation therapy can be recommended as a treatment for advanced esophageal cancer patients.
Cisplatin ; Diagnosis ; Drug Therapy ; Esophageal Neoplasms* ; Fluorouracil ; Humans ; Mortality ; Prognosis ; Radiation-Sensitizing Agents ; Radiotherapy ; Survival Rate

We investigated the patterns of pretreatment expression of the epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), and cyclooxygenase-2 (COX-2) by immunohistochemical staining and determined their correlation with treatment response and survival in 44 patients with esophageal squamous cell carcinoma (ESCC) treated with definitive concurrent chemoradiotherapy (CCRT). The definitive CCRT consisted of a median dose of 54 Gy (range: 40.0-68.4 Gy) and two cycles of concurrent administration of mostly 5-fluorouracil + cisplatinum. High expression of EGFR, VEGF, and COX-2 was found in 79.5%, 31.8%, and 38.6%, respectively. The Cox regression analysis for overall survival (OS) showed that both the treatment response and COX-2 expression were significant. The 3-yr OS rates of patients that achieved a complete response and those that did not were 46.7% and 5.3%, respectively (P = 0.006). The logistic regression analysis for treatment response with various parameters showed that only a high expression of VEGF was significantly associated with a complete response. Unlike other well-known studies, higher expression of VEGF was significantly correlated with a complete response to CCRT in this study. However, higher expression of COX-2 was significantly associated with shorter survival. These results suggest that VEGF might be a predictive factor for treatment response and COX-2 a prognostic factor for OS in patients with ESCC after definitive CCRT.
Aged ; Antineoplastic Agents/therapeutic use ; Carcinoma, Squamous Cell/drug therapy/*mortality/radiotherapy/*therapy ; Cisplatin/therapeutic use ; Combined Modality Therapy ; Cyclooxygenase 2/*metabolism ; Drug Therapy, Combination ; Esophageal Neoplasms/drug therapy/*mortality/radiotherapy/*therapy ; Female ; Fluorouracil/therapeutic use ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Staging ; Predictive Value of Tests ; Radiation Dosage ; Receptor, Epidermal Growth Factor/metabolism ; Regression Analysis ; Survival Rate ; Vascular Endothelial Growth Factor A/*metabolism