Late-course accelerated hyperfractionated and three dimensional conformal radiotherapy plus concurrent chemotherapy on stage III esophageal carcinoma

Objective To analyze the result of late course accelerated hyperfractionation (LCAFR) and three dimensional conformal radiotherapy plus concurrent chemotherapy (LCAFR+C)on stage Ⅲ esophageal carcinoma. Methods Ninety-eight patients with stage Ⅲ esophageal carcinoma were divided randomly into two groups:1. LCAFR group: patients were treated with conventional fractionated radiotherapy during the first two-thirds of the treatment to a dose of 40?Gy in 20 fractions over 4 weeks, then followed by LCAFR with reduced fields using three dimensional conformal radiotherapy to a dose of 15-24?Gy over 7-12 days, 1.5Gy per fraction, to the total dose of 55-64?Gy in 30～36 fractions over 35-40 days. 2. LCAFR+C group:The radiotherapy schedule was the same as the LCAFR group,but with concurrent chemotherapy of DDP 20?mg d1-5, LF 200?mg and 5-Fu 500?mg d 6-10 , 28 days in one cycle to totally 5 cycles. Results The 1-, 2-, and 3-year actuarial survival rates were 73%, 53%, 35% and 76%, 73%, 55% respectively (χ 2=4.12,P0.05). The 1-, 2-, and 3-year local control rates were 76%, 59%, 49% and 82%, 76%, 69% respectively (χ 2=4.22,P0.05). The Cox multivariate model indicated that the tumor location was the sole prognostic factor, ie, the results were superior to others if the tumor was located either in cervical or upper segment. Conclusions Late-course accelerated hyperfractionation can be taken as the first choice for patients with stage Ⅲ cervical and upper thoracic esophageal carcinoma. Three dimensional conformal radiotherapy plus concurrent chemotherapy can improve the local control and survival rates,but with increased toxicity.