Clinical Analysis Of Late Course Accelerated Hyperfractionation Radiotherapy For Esophageal Carcinoma

Objective To compare the treatment effects and toxicity of late course accelerated hyperfractionation radiotherapy (LCAF), LCAF plus concurrent chemotherapy radiotherapy and the conventional fractionation radiotherapy on esophageal cancer. In order to discover the best treatment measure for esophageal carcinoma. Methods 150 cases which all were diagnosed as squamous carcinoma of esophagus in the thoracic by pathology were divided randomly into three groups. The main factors which were influent on prognosis , age and the length of the tumor, were stratified through stratified randomization. 1.The conventional fractionation (CF) group: patients were irradiated 2.0Gy each time, 5 times a week, to a total does of 60Gy. 2.the late course accelerated fractionation (LCAF) group: patients were first irradiated with CF to 30Gy for 3 weeks, then changed to twice daily, 1.5Gy each time and with the interval of more than 6 hours, till the total dose of 60Gy. 3. LCAF plus concurrent chemotherapy(LCAF+C) group:The radiotherapy technique was the same as the LCAF group, but 20mg DDP and 500mg 5-Fu were added simultaneously in each week, and 5 cycles totally. The examined indexes included the short-term acute toxicity in esophagus and lung, the long-term radiation damage and the toxicity in digestive and hematopoietic system. Results The proportion of three groups were not statistical significance on sex, age, the length of tumor, the location of tumor and X-ray types. All three groups completed their treatment course according their treatment plan. The one year, two years, three years, four years, five years and six years survival rates in CF groups were 54%, 30%, 18%, 18%, 12%, 10% respectively; The survival rate in LCAF group were 76%, 56%, 44%, 42%, 34%, 30% respectively and its in LCAF+C group were 82%, 62%, 50%, 44%, 38%, 34% respectively. The one year, two years, three years, four years, five years and six years local control rates in CF groups were 40%, 32%, 26%, 24%, 22%, 16% respectively; the local control rates in LCAF group were 72%, 60%, 56%, 54%, 48%, 42% respectively and its in LCAF+C group were 78%, 66%, 60%, 56%, 50%, 46% respectively. They were evidently higher in the latter two groups than in the CF group (P <0.01),but there was no statistical significance between the latter two groups (P >0.05). The acute toxicity and side effects were more severe in the LCAF+C group than that in CF group, including grade â…¢ acute esophageal inflammation, gastrointestinal side effection and leukopenia. Among them, the first two side effection were statistical significance in LCAF+C than that in LCAF group. The acute toxicity in LCAF group was between that in CF group and LCAF+C group. The tolerance of the patients to LCAF was better than that of the LCAF+C group. The late complications were esophageal stenosis, esophagorrhagia, esophageal perforation and lung fibrosis. There was no statistical significance between 3 groups. the main cause of death was local recurrence and the out of control of the disease, but that was evidently lower in the latter two groups than that in the CF group. Other cause of death were esophagorrhagia, esophageal perforation, tumor metastases and some other diseases. there was no statistical significance between 3 groups. Conclusions LCAF can significantly improve the local control rate and survival rate of esophageal cancer, and so did the LCAF+C group, but the latter group was with the increase of toxicity. The small dose chemotherapy at the same time can not decrease the far away metastatic rate.