A pilot study of post-operative radiotherapy with concurrent chemotherapy for high-risk squamous cell carcinoma of the cervical esophagus.

OBJECTIVE After complete resection of carcinomas of the head and neck, including carcinoma of the cervical esophagus, the pattern of first failure is more often locoregional than distant metastasis. We retrospectively evaluated the safety and efficacy of the combination of post-operative radiation and concurrent chemotherapy with low-dose cisplatin for high-risk squamous cell carcinoma of the cervical esophagus. METHODS From 2005 through 2008, 34 patients with previously untreated squamous cell carcinoma of the cervical esophagus underwent cervical esophagectomy with or without laryngectomy. Of these 34 patients, 11 with disease-positive lymph nodes in the upper mediastinum (M1 lymph/Stage IV) confirmed by pathologic examination were enrolled. Patients received radiotherapy (66 Gy in 33 fractions) and concurrent low-dose cisplatin. RESULTS Nine patients completed the planned radiotherapy and two or more courses of chemotherapy. Grade 3 toxicities during chemoradiotherapy were leukopenia (36% of patients), neutropenia (18%) and mucositis (9%). At a median follow-up time of 39.5 months, the overall 1- and 3-year survival rates were 91 and 71%, respectively. CONCLUSIONS The combination of post-operative radiation and concurrent chemotherapy with low-dose cisplatin is well tolerated and has the potential to improve the rates of locoregional control and overall survival in patients with high-risk advanced squamous cell carcinoma of the esophagus.