Even after a curative resection, locally advanced esophageal cancer is highly progressive and carries a poor prognosis. Studies have shown that chemoradiation offers an alternative to surgery with similar survival rates. Giles Crehange, M.D., of Dijon University Hospital in France and colleagues compared two radiation schemes for efficacy in 446 patients over a two-year period.

The patients were randomized into a group that received a split-course therapy regimen with higher doses per fraction and a second group that received conventional fractionation over a four and one-half week period. At the end of the two-year period, local relapse-free survival was higher for subjects in the conventional protracted therapy group (76.7 percent). Those in the split-course therapy group had a 56.8 percent survival rate. The differences were the same whether or not the patients received surgery.

The authors concluded that conventional chemoradiation with protracted radiation therapy significantly improved local relapse-free survival in patients with locally advanced esophageal cancer. The study appears in the November 1, 2007, issue of the Journal of Clinical Oncology.