Neo-adjuvant chemotherapy followed radiotherapy vs radiotherapy alone in squamous cell carcinoma oesophagus.

In an ongoing randomized study, chemotherapy with cisplatin and Fluorouracil followed by radiotherapy was compared with radiotherapy alone in Squamous Cell Carcinoma Oesophagus. Between March 94 and Oct.94, 48 patients with Squamous Cell Carcinoma of the Oesophagus entered in the study. There were 24 patients each in CT+RT and RT arm respectively. There was one death because of Chemotherapy toxicity, 2 patients were lost to follow-up, one each in CT+RT and RT arm respectively. So 43 patients had completed prescribed treatment program and were followed for 2 months post treatment for assessment of immediate local tumor control and toxicity. Immediate post chemotherapy result showed complete tumor regression in 8(36.4 percent) and 10(45.5 percent)in the CT + RT arm and in 2(9.1 percent) in the RT arm(p0.05). At the end of treatment 85 percent of patients achieved complete dysphagia relief in CT + RT arm and 65 percent in RT arm(p0.05). Patients tolerated CT + RT protocol well with toxicity caused delay in CT in 3(12.5 percent) patients with no dose reduction. In RT arm not a single patient developed any grade 3 and 4 toxicity, these were mucositis(12 percent), vomiting (10 percent) and anemia(8 percent). This study shows that multimodel therapy is a better therapeutic option compared to RT alone in non-surgical management of Squamous Cell Carcinoma of the Oesophagus. Toxicity of CT is acceptable with good immediate tumor control. Long term follow-up of the study will give us exact idea about survival and recurrence pattern. Earlier systemic treatment may treat distant micrometastatic disease estimated to be present in as many as 85 percent of patients and smaller tumor bulk makes treatment more efficacious.