Efficacy Of Gimeracil And Oteracil Porassium Capsules On The Treatmentt Of Elderly Medium And Late Stage Esophageals Squamous Cell Carcinoma With Concomitant Simple Intensity Modulated Radiation Therary (sIMRT) Radiation Therapy

ObjectiveThe objective of this study was to observe the curative effects and side effects ofgimeracil and oteracil porassium capsules (TS-1) combined with simplifiedintensity-modulated radiation therapy (sIMRT) for elder patients with medium and latestage esophgeal squamous cell carcinoma (ESCC). The effects of treatment with guiderailand oteracil porassium capsules (TS-1) combined with simple intensity modulatedradiation therapy (sIMRT) and correlative factors were analysed and discussed to shortterm results and survival rate. The clinical effects for elder patients with esophageal cancerwere also investigated.MethodsFrom Aug.2011to Nov.2012,60patients of elder patients with medium and latestage esophageal squamous cell carcinoma (ESCC) who fulfilled the criteria wererandomly divided into TS-1+radiotherapy group (30cases) and radiotherapy alone group(30cases). CT simulator was used to immobilize and scan the treatment position of thepatients. The images were transferred by the physical therapists to the varian eclipsetreatment planning system. Based on the results from the images, the3D model wasreconstructed by radiation therapy planning system. Based on the findings ofesophagogram, esophagoscopy and CT images, the doctors could outline the grossesophageal tumor volume （GTV）, clinical target volume (CTV), planning target volume(PTV) and organs at risk (OAR). Intensity modulated radiotherapy plan was designed by physicists for each patient. The dose distribution for GTV, CTV, PTV and normal tissuesaround was optimized by the varian eclipse treatment planning system. The tumor dosewas180~200cGy/f. The total dose was5400cGy~6000cGy/28-30f.Combined treatment group received TS-1treatment40mg bid, Since the first day ofradiotherapy with chemothertoapy simultaneously, and administration for2weeksfollowed by a1-week rest until the end of the radiotheraphy treatment. In the patients ofcombined group, the rates of complete response, partial respinse and total respinse were5cases,19cases and75.0%respectively. In the patients of single radiotherapy group, theywere2cases,10cases and46.2%respectively. There was statistival significance (P=0.007).As for side effects, both groups enjoy good tolerance as a whole and no severe untowardeffect hand happened. In conclusion, TS-1combined with simple intensity modulatedradiotherapy. In conclusion, TS-1combined sIMRT is effective and safe for treatment ofelder patients with medium and late stage esophgeal squamous cell carcinoma (ESCC).Upper digestive tract radiograph, chest CT and upper abdomenultrasound wereperformed before and after the treatment.ResultsFrom the results of esophageal barium meal, it could be found that the average lengthof the damaged area of esophageal mucosa was4.86cm. From the results of gastroscope, itcould be found that the average length of luminal stenosis segment was about4.08cm. Theaverage length of tumor scanned by CT was6.14cm. The tumor overall reaction rate was96.7%(60/62). All patients were successful to complete the whole plan.There were60patients completed the plan and the therapeutic effects could be evaluated. Evaluation ofthe short-term effects after treatments:Among the patients with combination therapy, the rates of complete remission CR, PRand CR＋PR were63.3%(19/30),26.67%(8/30) and89.97%, respectively. Lymph noderesponse rate is76.5％（13/17）The percents of grade I/II and grade III of acute esophagitisoccurred were70.0%（21/30）, and23.33%（7/30）, respectively. The percent of grade I/IIand grade III of radioinduced trachitis were46.67%（14/30）and0.00%, respectively. Thepercents of grade0, I and II of radiation pneumonitis were33.33%（10/30）,26.67%（8/30）and3级3.3%（1/30）, respectively. The percents of grade I/II and grade III of acuteesophagitis occurred were63.33%（19/30）and10.0%（3/30）, respectively. The percentsof grade I/II and grade III of the white blood cells decline rate were63.33%（19/30）and10.0%（3/30）respectively. The percents of grade I/II and grade III of the hemoglobin decline rate were46.67%（14/30）,10%（3/30）, respectively. The percents of the patientswhose weight decreased more than10%in the pretherapy and post-treatment were13.33%（4/30）.But Among the patients with the radiotherapy therapy, the rates of completeremission CR, PR and CR＋PR were50.0％（15/30）,23.33％（7/30） and73.3％,respectively. Lymph node response rate is62.5％（10/16）,The percents of grade I/II andgrade III of acute esophagitis occurred were60.0%（18/30）, and13.33%（4/30）,respectively. The percent of grade I/II and grade III of radioinduced trachitis were40.0%（12/30）and0.00%, respectively. The percents of grade0, I and II of radiationpneumonitis were30.0%（9/30）,26.67%（8/30）and3级3.3%（1/30）, respectively. Thepercents of grade I/II and grade III of acute esophagitis occurred were63.33%（19/30）and10.0%（3/30）, respectively. The percents of the patients whose weight decreased more than10%in the pretherapy and post-treatment were13.33%（4/30）. The percents of grade I,IIand grade III of the white blood cells decline rate were26.67%（8/30）,3.3%（1/30）and0.00%, respectively. The percents of grade I/II and grade III of the hemoglobindecline rate were33.33%（10/30）,10%（3/30）, respectively. The percents of the patientswhose weight decreased more than10%in the pretherapy and post-treatment were16.67%（5/30）.Untill the end of the experiment, there were3distal metastases and4patients died.The died reason for3patients was the out of the control and the recurrence of theoesophagus. One patient died in the great blood clotting of lesions of esophagus cancer.Calculated with Kaplan-Mierer, the percent of survival of the patients in1year aftertreatment was83.66%. Among them, the survival percents in1year after treatment ofpatients with length of esophageal carcinoma scanned by enhanced CT less than5cm andthe patients with length of esophageal carcinoma scanned by enhanced CT more than5cm were84.20%and67.68%, respectively. The survival percents in1year after treatmentof patients with whose weight decreased less than10%in the pretherapy andpost-treatment and the patients with whose weight decreased more than10%in thepretherapy and post-treatment were86.18%and66.71%, respectively.ConclusionThere was good efficacy and survival rate in1year of the treatment with and adversereaction of S-I combined with the simpled intensity modulated radiation therapy (sIMRT)to esophageal squamous cell carcinoma in the senile patients. The optimized treatment plan was efficient and safe for the senile patients. The sensibility of patient to the radiotherapyor chemoradiotherapy could be changed by the nutriture before treatment. sIMRT cangenerate desirable dose distribution for esophageal squamous cell carcinoma， which issimilar to sophisticated IMRT but obviously better than3D-CRT． The short-term efficacyof sIMRT is satisfactory and its acute toxicities are tolerable．However, it is still not clearwhat is the complications and the percent of the later stage of esophageal squamous cellcarcinoma.