目的：食道癌是一種非常惡性及常常在疾病後期才診斷出來的疾病。即使經過積極的外科手術治療，存活率仍然不盡理想。RTOG8501及一些研究機構已經證實同步化學放射線治療可以增加存活率及局部控制。鑑於國外設計的化學藥物劑量對於本國人來說可能副作用太大而不適合，我們設計了一套週期性及低劑量的同步化學放射線治療來治療局部進展性的食道癌。除此之外，遠端轉移常是治療失敗的主因之一。因此，除了同步化學放射線治療之外，我們再加上全身性的化學治療當作我們治療食道癌的計畫。材料與方法：從1999年六月到2003年二月共有27位局部進展性而不適合開刀的病人。其中16位病人接受同步化學放射線治療及全身性的化學治療，其餘11位病人只單獨接受放射線治療。放射線治療對於兩組的設計劑量相同，為60 Gy。同步化學治療為每週一次低劑量的cisplatin（30 mg/m2），共6次。間隔3到4週後，給于全身性的化學治療。設計劑量為每月一次，每次 cisplatin（20 mg/m2）加5-FU（1000 mg/m2）D1~D5，共 4 次。 結果：治療結果在這兩個組別對於中值存活（15 months vs. 5 months），2年存活率（57% vs. 18%）及局部控制（43% vs. 100%）有明顯的差異（p < .05）。對於副作用的發生及耐受度是可以接受的。結論：在這個研究設計之下，週期性及低劑量的同步化學放射線治療合併全身性的化學治療，對於局部進展性的食道癌，不但在副作用上是可以接受的，而且在存活率及局部控制上是有幫助的。

Purpose : Carcinoma of the esophagus is a virulent malignancy often diagnosed in its late stage. Despite aggressive surgical resection, the overall 5-year survival reported is poor. Several researchers have investigated the use of concurrent chemoradiotherapy (CCRT) in the management of esophageal cancer and demonstrated a significant survival improvement. We conducted a pilot study to evaluate the efficacy and toxicity of an outpatient CCRT regimen using weekly cisplatin as a radiosensitizer. Materials and Methods : We retrospectively reviewed the charts of patients with esophageal carcinoma treated at our institution from July 1999 to February 2003. Patients were included in the study if they had T3 to T4, N0, and M0 stage disease. There were sixteen patients enrolled into definite concurrent chemoradiotherapy (CCRT) with systemic adjuvant chemotherapy group whereas eleven patients into radiation alone (RT) group. RT for both groups was delivered with total dose of 60 Gy. In addition to RT, the CCRT group received concurrent chemotherapy consisting of 6 weekly doses of CDDP (30 mg/m2). CCRT was followed by adjuvant chemotherapy consisting of 4 monthly cycles of CDDP (20 mg/m2/day) plus 5-FU (1000 mg/m2/day) for 5 consecutive days. This study looked at survival, treatment response, toxicity and pattern of failure in enrolled patients. Results : A total of 27 patients fulfilled the study criteria. The most frequent symptom, present in over 90%, was progressive dysphagia. During therapy, 88% (14/16) of patients on CCRT and 81% (9/11) receiving RT had symptom relief. There are significant differences between the two groups (CCRT vs. RT) in terms of median survival (15 months vs. 5 months), 2-year survival (57% vs. 18%, p = 0.003) and local regional failure rate (43% vs. 100%, p = 0.003). Both the hematological and non-hematological toxicities developed in the two groups are generally comparable and acceptable. Conclusion : In this preliminary study, we have demonstrated that a weekly outpatient CCRT regimen using low-dose cisplatin, followed by 4 cycles of adjuvant chemotherapy with cisplatin and 5-FU, improves survival and locoregional control of locally advanced esophageal cancer with acceptable toxicity. Large-scale, prospective randomized trials of this regimen are warranted.