A controlled evaluation of combined radiation and bleomycin therapy for squamous cell carcinoma of the esophagus

In a controlled, randomized Eastern Cooperative Oncology Group (ECOG) study 77 evaluable patients with squamous cell carcinoma of the esophagus were treated with radiation therapy alone at a recommended dosage of 5000 to 6000 rad administered over five to six weeks in five or six fractions a week or with radiation given in combination with Bleomycin. Whereas the Bleomycin group experienced the additional toxicity of chemotherapy, Bleomycin did not contribute to therapeutic results in terms of either symptomatic palliation or survival. Further application of this approach by the methods we employed is not indicated. Overall treatment results were discouraging; the five year survival in this group of patients with regionally localized squamous cell carcinoma of the esophagus will not exceed 8%. In a non-randomized comparison, patients treated with 6000 rad did not show a therapeutic advantage over those treated with 5000 rad. Most favorable survival after treatment was seen in patients with lesions in the cervical esophagus and middle one-third of the thoracic esophagus. Least favorable survival was seen with lesions of the upper and lower one-third of the thoracic esophagus.