Outcome of chemoradiation in treating carcinoma esophagus

To observe the role of chemoradiation in treating carcinoma of esophagus, its complications and outcome of disease.

Analytical descriptive study.

Conducted at IRNUM in collaboration with Hayatabad Medical Complex (HMC), Peshawar, for one year.

A total of 47 males and 53 females with an average age of 53 +/- 13 years were inducted in this study. Patients having upper end carcinoma or esophageal surgery were excluded from this study. They were treated with radio as well as chemotherapy. Those patients who had completed radiation six months before were planned for repeat endoscopies. Response evaluation was categorized as no evidence of disease, residual disease or stricture formation simulating carcinoma. Seventy percent of endoscoped patients were disease free and 30% were having residual disease. Of these 30%, 10% were having growth while rest of the 20% showed stricture formation due to radiation.

Out of 100 patients, 70% were palliated maximally and no evidence of disease was found on endoscopy done after 1-6 months. Only 30% came up again with dysphagia. Out of these 30%, 20% were having esophageal stricture, which on dilatation improved the quality of life. Rest of the 10% were having stricture hiding the residual disease. Giving 1-2 cycles of chemotherapy before the start of radiation reduced the disease burden and predicted response to radiation by improving dysphagia.

In spite of certain complications like neutropenia, emesis and stricture formation, chemoradiation is still the best treatment option available. It is because of its safety, well-tolerability and cost effectiveness. It is equally good for patients who refuse surgery and those with advanced disease.