Chemotherapy rapidly alternating with twice-a-day accelerated radiation therapy in XXXX involving the hypopharynx or esophagus: an update.

@entity1 @entity135 @entity137 @entity5 @entity957 @entity900 @entity189 @entity418 @entity420 @entity1487
Laboratory studies have suggested that rapidly alternating chemotherapy and radiation therapy might act synergistically. We undertook this study to evaluate the @entity137 and effectiveness of this approach in @entity1 with @entity189 involving the hypopharynx or esophagus. Between 1987 and 1991, we treated 47 @entity1 (23 with @entity189 involving the hypopharynx and 24 with @entity189 involving the esophagus) by three cycles of chemotherapy (during weeks 1, 4, and 7) rapidly alternating with twice-a-day radiation therapy (during weeks 2, 5, and 8). Chemotherapy consisted of @entity900 100 mg/m2 and @entity1487 3-4 g/m2 given over 4 days. Radiation therapy consisted of 180-200 cGy twice each day to 2000 cGy/cycle, total 6000 cGy over 7 weeks. The histology was @entity957 in 44 @entity1 and @entity420 in 3 @entity1 with @entity5 . Median follow-up is 2 years (range 1-5 years). The observed survival rate for all 47 @entity1 was 54% at 1 year and 38% at 2 years. Acute @entity137 was considerable. Twelve @entity1 (25%) died during therapy from @entity137 , without @entity5 progression, leaving 35 @entity1 (18 hypopharynx, 17 esophagus) evaluable for response. Among the hypopharyngeal @entity1 , 83% had a complete response, 11% had a partial response, and 6% had no response. Among the esophageal @entity1 , 94% had a complete response, and 6% had a partial response. Local control was better for the esophageal @entity1 than the hypopharyngeal @entity1 (98% vs. 52% at 2 years, p = 0.038). The incidence of distant metastases was 25% at 2 years and not significantly different between the two groups. A high rate of local control was achieved, particularly in @entity418 , by delivering chemotherapy and radiation therapy in a rapidly alternating fashion. This was achieved at a considerable cost in terms of @entity137 , however. Although our response rates and local control compare favorably with those of other recently published studies of combined modality therapy in esophagus or @entity135 , much additional work is required to reduce the @entity137 and, in @entity5 , to further improve the local control.
