Oesophageal and
gastric cancers are common
tumors that represent a number of challenges for oncologists, gastroenterologists and surgeons. The prognosis remains poor with the majority of patients presenting with advanced disease. Combined
chemotherapy and
radiotherapy has demonstrated a survival benefit in patients with loco-regional oesophageal
cancer compared to
radiotherapy alone. In an interim analysis we have observed a 62% response rate using a chemoradiation regimen based on protracted venous infusion of
5-fluorouracil and
cisplatin combined with
radiotherapy in patients with inoperable oesophageal
cancer. Improved outcomes with loco-regional disease has rekindled interest in preoperative
therapy. In a trial comparing preoperative chemoradiation to surgery alone in patients with operable oesophageal
adenocarcinoma, survival was improved with multimodality treatment. In addition, a study including both adeno- and
squamous carcinomas demonstrated a trend towards improved survival. A complete pathological response to chemoradiation was associated with significantly improved survival.
Gastric cancer is one of the most chemosensitive solid
tumors of the gastrointestinal tract with the majority of patients being suitable for palliative
chemotherapy. The ECF (
epirubicin,
cisplatin, protracted venous infusion
5-fluorouracil) regimen was developed in the Gastrointestinal unit of the Royal Marsden Hospital and first reported in 1991. In a prospective randomised trial including 274 patients ECF has been compared with the standard combination of
5-fluorouracil,
adriamycin and
methotrexate (FAMTX) in patients with previously untreated
gastric cancer. Overall response rate, failure-free and overall survival were significantly improved with ECE, ECF also demonstrated improved quality of life and cost effectiveness when compared to the
FAMTX regimen. ECF should now be regarded as the standard treatment for advanced oesophago-
gastric cancer against which new
therapies should be compared. In addition the Medical Research Council are conducting a trial randomising patients between surgery alone and perioperative
chemotherapy using the
ECF regimen in operable
gastric cancer.