Concurrent chemotherapy combined with late course accelerated hyperfractionated radiotherapy for advanced esophageal carcinoma

Objective In order to explore a more effective treatment regiment to improve the local control and the survival rate while reducing distant metastases.This study was aimed to evaluate the effect and toxicity of late accelerated hyperfractionated radiotherapy(LAHF)versus conventional radiotherapy(CF)for patients with advanced esophageal carcinoma.Both groups received concomitant chemotherapy. Methods Eighty patients with advanced esophageal squamous cell carcinoma were included.The eligible criteria included the tumor mass being less than 12 cm in length,and without distant metastases.The patients were randomized into LAHF and CF group.The general conditions of the patients of these two groups did not have statistical significant difference.For the CF group,70 Gy were given in 35 fractions over 49 days,whereas for the LAHF group,radiotherapy was divided into two phases:40 Gy in the first phase with fraction dose 2 Gy per day,27 Gy were given during the second phase with 1.5 Gy per fraction and two fractions a day.The total dose in LAHF group was 67 Gy in 38 fractions over 42 days.The chemotherapy were delivered concurrently with FUDR 500 mg/m +2 and cisplatin 20 mg/m +2 given twice weekly for 3 weeks. Results Thirty-one cases of 1 to 2 grade (77.5%) and 9 cases of 3 to 4 grade (22.5%)in LAHF group showed short-term effect,which was superior to that 22 cases of 1 to 2 grade (55.0%) and 18 cases of 3 to 4 grade (45.0%) in CF group did ( P 0.05).The 1- and 2-year local control rate were 77.14%,51.86% in LAHF group and 55.21%,31.28% in CF group,respectively( P =0.049).The 1- and 2-year survival rate were 72.22%,48.64% in LAHF group and 54.09%,27.33% in CF group,respectively( P =0.041).The acute esophagitis was more severe and lasted longer in LAHF than that in CF group.Leucocytopenia,gastrointestinal tract side-reaction acute pneumonitis, and bone marrow depression induced by radiation were not significant difference between these two groups. Conclusion Combined with concomitant chemotherapy,short-term effect,local control and survival rates in LAHF group were better than that in CF group.The incidence of acute esophageal mucositis was relatively higher in LAHF group,but can be tolerated by most patients. ;