| Objective: To observe the safety and feasibility of three-dimensional conformal hypofractionated radiotherapy(2.5-3.0Gy/d)combined with concurrent chemotherapy in treating patients with esophageal cancer and evaluate the short-term efficacy and toxicity of hypofractionated radiocheomtherapy compared with the conventional radiochemotherapy.To investigate the reliability and effectiveness of this method so that provide a reference for further researches.Methods: From Feb.2016 to Jan.2017,19 eligible patients with esophageal squamous cell cancer were enrolled to receive three-dimensional conformal radiotherapy.There were 7 patients in hypofractionation group and12 patients in conventional fractionation group.The prescription dose in hypofractionation group was 45-54 Gy,2.5-3.0 Gy per fraction,1 fraction per day,5 fractions per week.The prescription dose in conventional fractionation group was 54Gy-60 Gy,1.8-2.0 Gy per fraction,1 fraction per day,5 fractions per week.All patients were treated with concurrent paclitaxel chemotherapy by intravenous infusion once a week.All patients underwent the examinations of esophageal barium meal and neck+chest+upper abdomen CT scans before and after the radiotherapy.The radiotherapeutic effect was evaluated by esophageal barium meal combined with CT scans: the patients who had a complete remission(CR)as evaluated by barium meal and had the maximal esophageal wall thickness of?1.20 cm and the volumes of residual lymph nodes of?1.00 cm3 on CT were defined as CR;the patients who had a partial remission(PR)as evaluated by barium meal or had the maximal esophageal wall thickness of>1.20 cm or those who had a CR evaluated by barium meal and had the maximal esophageal wall thickness of?1.20 cm and the volumes of residual lymph nodes of >1.00 cm3 on CT were defined as PR;the casesevaluated by barium meal as no remission(NR)or showing metastasis were defined as NR or progressive disease.In addition,toxicity was observed and the safety,effectiveness and feasibility of hypofractionated radiocheomtherapy were evaluated.Results: All patients have completed the treatment without interruption.From the beginning of radiotherapy to January 31,2017,nobody lost follow-up and the following rate in two groups were 100%.The median follow-up time in hypofractionation group was 8.4 months(range 1.3-10.7months)and the median follow-up time in conventional fractionation group was 6.8 months(range 2.7-11.8 months).In hypofractionation group,5patients(71.4%)achieved CR and 2 patients(28.6%)achieved PR while 7patients(58.3%)achieved CR and 5 patients(41.7%)achieved PR in conventional fractionation group.No significant difference was found during two groups(P=0.656).The toxicity of blood system manifested as leukopenia and the incidence in two groups were 71.4% and 41.7%(P=0.350).Gastrointestinal reactions manifested as nausea and the incidence in two groups were 14.3% and 16.7%(P=1.00).There was no vomiting,diarrhea or constipation observed.The incidence of acute radiation esophagitis were100% in two groups.The incidence of grade 1,grade 2 and grade 3 were14.3%vs16.7%,0%vs8.3%,85.7%vs75.0%,respectively.The incidence of acute radiation pneumonia in conventional fractionation group was slightly higher than that in hypofractionation group(8.3%vs0%,P=1.00).Until the follow-up date,the incidence of late esophageal injury(28.5%vs0%,P=0.123)and late pulmonary injury(28.5%vs8.3%,P=0.523)were higher in hypofractionation group than in conventional fractionation group.There was no grade>or=3 late toxicity observed.Conclusion: Three-dimensional conformal hypofractionated radiochemotherapy is safe and feasible in treating patients with esophageal cancer.The short-term efficacy is satisfactory.Compared with conventional conformal radiochemotherapy,the incidence of acute and late toxicities has no significant increase.Because of the small sample,the early stage and shorttime of the follow-up,further more randomized control trials are needed to confirm. |
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