Hyperfractionated radiotherapy combined with chemotherapy for advanced esophageal carcinoma

Purpose:To evaluate the effect of late accelerated hyperfractionated radiotherapy (LCAHFR) combined with chemotherapy on advanced esophageal cancer.Methods:176 cases of advanced esophageal cancer were treated from March 1994 to March 1997.Patient were divided into 2 groups, including radiotherapy alone group (80 cases) receiving conventional irradiation to a total of 64～70 Gy and combined treatment group (96 cases) which received LCAHFR groups plus chemotherapy with PF regimen. Combined treatment group patients were treated with conventional fractionated radiotherapy during the firs two thirds of the treatment to a dose about 40 Gy/20 F/4 weeks. This was followed by accelerated hyper fractioned radiotherapy using reduced fields, twice daily at 1.5 Gy per fraction to a dose about 24～30 Gy.All cases of the combined treatment group were treated with PF(DDP 20 mg iv drip on days 1 to 5,and 5 FU 750 mg iv drip on days 1 to 5,Every 28 days as one cycle).All patients were followed for ≥ 5 years.Results:The short term results of LCAHFR combined with chemotherapy was better than that of radiotherapy alone. The difference between these two groups was statistically significant( P 0.05).The difference of the short term results of the supraclavicular lymph node between these two groups was not statistically significant( P 0.05).The one , three and five year survival rate were 69.8%,51.1%,29.2% in combined group and 46.3%,21.3%,11.3% in simple irradiation alone group. The survival rates in the combined group were much better than those in simple radiotherapy group( P 0.05).The local control rates in the combined treatment group were much better than those in simple radiotherapy group( P 0.05). There was no significant different in distant metastasis between the two groups. The acute tracheitis and acute esophagitis in the combined treatment group was more than that in the simple group( P 0.05).Conclusions:Late course accelerated hyperfractionated radiotherapy for advanced esophageal is effective and merits further study in the clinic. However, the acute reaction in the combined treatment group was more than that in the simple radiotherapy.