| Objective: To observe the side effects, treatment effects, survival rates and local control rates of advanced esophageal cancer between concurrent chemo-radiotherapy and radiotherapy alone for finding benifited patients by sub-group analysis.Methods: From Sep.2006 to Oct.2009, 155 patients of advanced esophageal cancer were retrospected.78 patients were treated by radiotherapy alone and 77 were treated by concurrent chemo-radiotherapy, 6 of whom were treated combined with sodium glycididazole as sensiting agent while 7 of whom were treated by placebo as a comparion group. The total dose of radiotherapy was 58Gy~64Gy while it was 58Gy~66Gy in radiotherapy alone, the median dose was 60Gy, all deliverd in 1.8~2Gy per fraction per day, 5 fractions per week. Chemotherapy was started from the beginning of radiotheraphy by LFP(DDP 12.5 mg/m2,5-Fu 450~500mg/m2, CF 200mg, d1-5) at the 1st and 5th week.Consolidation chemotherapy with the same schema were given by 1~3 cycles after concurrent chemoradiotherapy. Sodium glycididazole and placebo agent were given 700mg/m2 in 100ml sodium chloride on Mondy, Tuesday and Friday per week in 30 minutes before radiotherapy in concurrent chemo-radiotherapy.And radiotherapy was reguired in less than 60 minutes. Toxicity, short time effects,survival rate and local control rate were evaluated.Results:(1)All patients completed the radiotherapy on schedule.35 patients (45.45%) received more than 3 cycles of chemotherapy, 22 patients (28.57%) received 2ycles of chemotherapy while 20 patients (25.97 %) only received 1 cycle. (2)In concurrent chemo-radiotherapy and radiotherapy alone, leucocytopenia occurred in 81.82%(63/77) and 48.72%(38/78) (χ2 =19.279,P=0.000).Grade2 and grade3 developed in 40.26%(31/77),9.90%(7/77) and 14.10%(11/78),0 respectively. And it was significant by Chi-Square. They were 18.18%(14/77),29.87%(23/77) ,38.96%(30/77),12.99%(10/77) and 26.92%(21/78),48.72%(38/78),17.95%(14/78),6.41%(5/78) of acute radiation esophagitis of grade 0,1,2,3 in concurrent chemo-radiotheraphy group and radiotheraphy alone group. The rates of acute radiation pneumonitis of grade 0,1,2,3 were 62.34%(48/77),22.08%(17/77),10.39%(8/77),5.19%(4/77)and85.89%(67/78),10.26%(8/78),3.85%(3/78),0 repectively.(3)The effect was evaluated after the treatment, the complete remisson rate was 59.74%(46/77),the partial remission rate was 36.36%(28/77) and 3 patients were non-remission(3.90%) ,the overall response rate was up to 96.10% (74/77) in concurrent chemo-radiotherapy group, while the complete response rate, the partial response rate and overall response rate were 61.54%(48/78),35.9%(28/78) and 97.43%(76/78) respectively. (4)The overall 1-year,2-year and 3-year survival rates were 85.3%,54.9% and 52.0% of concurrent chemo-radiotherapy group ,as they were 78.6%,58.7% and 40.5% in radiotherapy alone respectively.And there were not significant difference between two groups(χ2 =0.037,P=0.847).The 1-year,2-year and 3-year local control rates were 87.8%,68.4%,68.4% and 82.6%,67.2%,64.0% respectively(χ2 =0.357,P=0.550). By further study,sub-group analysis were studied including CT lengths of≤5cm,5~7cm and>7cm,GTV greatest diameters of≤4cm and >4cm, the status of trachea and aortic invading, GTV volumes≤40cm3 and >40cm3, patients of stage T2-3 orT4,N0 or N1 by TNM of UICC according to CT image.All of the suvival rates and local control rates were not significantly improved between radiation combinded with concurrent chemotheraphy and radiotherapy alone by Logrank-test.Conclusions: Three dimensional conformal radiotherapy combining with concurrent chemotherapy can be considered effective with tolerated side effects of most patients. It might be high rates of bone marrow depression, acute radiation esophagitis and pneumonitis in radiation combinded with concurrent chemotheraphy.The suvival rates and local control rates were not significantly improved between two groups. It did not achieve better suvival rates and local control rates in any sub-group.And the patients died of distant metastases didn't reduce in radiation combinded with concurrent chemotheraphy group. Further study on three dimensional conformal radiotherapy combining with concurrent chemotherapy was necessary.
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