From the results of recent studies, it is likely that multimodality
therapy with chemotherapy and radiation treatment may improve the
overall outcome of locally advanced upper gastrointestinal (GI) malignancies,
including esophageal, gastric, pancreatic, and biliary tract carcinomas.
However, more effective, more optimal, and less toxic chemotherapy
regimen(s) with concomitant radiotherapy are needed beyond
the concurrent continuous-infusion fluorouracil (5-FU) with radiation
that is commonly applied in general practice. Epirubicin (Ellence),
cisplatin, and irinotecan (Camptosar) are all active cytotoxic chemotherapy
agents in upper GI cancers. Two phase I studies were designed
to test the tolerability of the combination of radiotherapy with infusional
5-FU, epirubicin, and cisplatin (ECF) or 5-FU, irinotecan, and
epirubicin (EIF) in the treatment of locally advanced upper GI malignancies.