Abstract:

Objective To evaluate the efficacy and toxicity of concurrent chemotherapy based on 3D-CRT combined with late-course accelerated hyperfractionated radiotherapy in the treatment of advanced esophageal cancer. Methods Patients  with advanced esophageal cancer（n=122） were enrolled from January 2012 to July 2014 and randomly divided into two groups： the control group（n=62） received concurrent chemoradiotherapy based on 3D-CRT，while the intervention group（n=60）  received the same chemoradiotherapy in combination with late-course accelerated hyperfractionated radiotherapy. Both groups received chemotherapy of paclitaxel and cisplatin. On the second day after chemotherapy，3D-CRT was administered to both groups using a linear accelerator；total dose of PTV was 46 Gy/23 F. The control group received conventional fractionated radiotherapy to achieve a DT of 62 Gy. The intervention group received a DT of 62.8 Gy，with doses of 1.4 Gy administered twice a day at least 6 h apart. Both groups were given another 1-2 rounds of chemotherapy after the end of radiotherapy. Results The total effective rate was significantly higher in the intervention group（88.3%） than in the control group（64.5%，P<0.05）. Local control rates in the intervention group were 74.3% at 1 year and 58.7% at 2 years，significantly greater than the rates of 53.6% and 32.6% in the control group（P<0.05）. The survival rates in the intervention group were 66.7% at 1 year and 55.0% at 2 years，similar to the rates of 53.2% and 43.5% in the control group （P>0.05）. The two groups showed similar occurrence of adverse reactions，which were primarily level 1 and 2 events. Conclusions Combining concurrent chemoradiotherapy based on 3D-CRT with late-course accelerated hyperfractionated radiotherapy may improve therapeutic efficacy and long-term survival of patients with advanced esophageal cancer. This combination therapy is not associated with higher toxicity than concurrent chemoradiotherapy on its own.

Key words: Esophageal neoplasms, Three-dimensional conformal radiation therapy, Concurrent chemotherapy, Late-course accele-rated hyperfractionation, Efficacy