Late course accelerated hyperfractionated radiotherapy with concurrent chemotherapy for esophageal carcinoma

Objective To evaluate the efficacy and toxicity of late course accelerated hyperfractionated(LCAF) three-dimensional conformal radiotherapy with concurrent chemotherapy for esophageal carcinoma patients.Methods Forty six patients with esophageal carcinoma underwent late course accelerated three-dimensional conformal radiotherapy with concurrent chemotherapy,including 23 patients receiving hyperfractionated radiotherapy(LCAF+C group) and 23 receiving conventional fractionated radiotherapy(control group).The protocol for LCAFR+C group was first radiotherapy 1.8 Gy/f×23(DT 41.4 Gy),once per day;then 1.5 Gy/f×(14～18)(DT 21～27 Gy),twice per day;that for control group was 2.0 Gy/f×23,once per day,the local boost 60～66 Gy/(30～33)f for 40-45 d.In the same period both groups received two cycles of TP(paclitaxel plus cisplatin) chemotherapy.The main outcome measures included 1,2-year local control rates and survival rates,the acute toxicities of esophagus and trachea,and lung radiation injury.Results After 9-39 months of follow-up the LCAFR+C group showed a trend of better results in 1,2-year local control rates and survival rates compared to control group,but no statistical difference was detected(65.2%,56.5% vs 52.2%,39.1%;69.6%,34.8% vs 47.8%,21.7%;all P0.05).The acute toxicity of the LCAFR+C was more serious including Ⅲ～Ⅳ grade acute esophagitis and bronchitis,compared to control group(both P0.05).There was no significant difference in radiation-induced pulmonary fibrosis between two groups(P0.05).Conclusion LCAFR+C treatment has a trend of increased local control and long-term survival and also higher acute toxicity for patients with esophageal carcinoma.