Clinical study of radiotherapy plus chemotherapy for patients with middle-and advance-stage esophageal carcinoma

Objective To evaluate the efficacy of radiotherapy combined with chemotherapy in treatment of patients with middle-and advanced-stage esophageal cancer.Methods 186 patients with middle-and advanced-stage esophageal cancer were randomized into two groups: 92 treated with radiotherapy combined with chemotherapy(R-C)and 94 with radiotherapy alone(R).The chemotherapy regimen included tegafur 800 mg on d1-d5,injectio natarii norcantharidatis 20 mg on d1-d5,cisplatin 30 mg on dl-d3.When radiotherapy(RT) was started,chemotherapy(CT) was started on the same day.The patients were irradiated with anteroposterior(AP)and posteroanterior(PA)fields to a dose of 40 Gy in 4.0 weeks,followed by a boost of 24-28 Gy in 2.4-2.8 weeks through oblique fields.Results The 3-and 5-year survival rates were 22.0% and 15.9% in the R+C group and 13.8% and 8.8% in the R group.The difference was statistically significant in 5-year survival rate(P=0.040).The toxic and side effects were tolerable and similar in the two groups.The leading cause of death in both groups was local recurrence.The 1-,3-,5-year local recurrence rates had significant differences between the two groups.Twenty two patients(37.0%)in the R+C group and twenty nine(39.0%)in the R group died of distant metastasis and/or lymph node metastasis,the difference was not statistically significant(χ2 =3.17,P0.05).Conclusion Chemotherapy with tegafur,cisplatin plus injectio natarii norcantharidatis plus radiotherapy can improve the outcome of esophageal cancer.Although with the toxic and side effects of the combined modality are severer than radiation alone,yet they are well tolerated.