Late course acceleratedthree-dimensional conformal radiotherapy for esophageal carcinoma

Abstract

：Objective To investigatethe result and side effect of late course accelerated three-di-mensional conformalradiotherapy (3DCRT) for esophageal carcinoma. Methods From July 2003 to March 2006, 55patients with esophageal carcinoma receiving 3DCRT were randomly divided into late courseaccel-erated radiation group (group A, 27 patients) and conventional fractionation group(group B, 28 patients). The prescribed dose in group B was 64 -66 Gy, 2 Gy per fraction, 1fraction per day, 5 fractions per week for about 6.5 weeks. Patients in group A receivedconventional fractionation irradiation for the first 4 weeks. Then the dose was increasedto 3 Gy per fraction to a total dose of 67 -70 Gy. The treatment course in group A wasabout 6 weeks. The treatment response, acute site effects, 1-, 3-and 5-year local controlrates and o-verall survival rates of the two groups were observed. Results In group A, 23patients (85%) achievedcomplete response (CR) and 4(15%) achieved partial response (PR).While in group B, 16 patients (57%) achieved CR and 12(43%) achieved PR. The CR rate wassignificant higher in group A (χ~2 = 5.24,P=0.022). The 1-,3-, 5-year local control rates were 85%, 54%, 54% in group A, and 70%, 56%, 33 % in groupB (χ~2 = 0.68, P = 0.409), respectively. The 1 -,3-,5-year overallsurvival rates of the two groups were 81%, 37%, 29% and 61%, 39%, 23% (χ~2 =0.06, P = O. 804), respectively. Both lo-cal control and overall survival were similarbetween the two groups. The incidences of acute radiation esoph-agitis in the two groupswere similar (85% vs. 89% ;χ~2 =0. 00,P=0. 959), and theincidence of radiation pneumonitis was slightly higher in group A than in group B (67% vs43% ;χ~2=3.14,P =0.076). By the last follow up, 19 patients in group A and 21 in group B died.Among them, 10 in group A and 15 in group B died of local failure, while 7 in group A and5 in group B died of metastasis. Conclusions When com-pared with conventionalfractionation 3DCRT, late course accelerated 3DCRT for esophageal carcinoma can achievebetter results in clinical response, though not in long-term local control or survival.The incidence of acute radiation esophagitis and pneumonitis is clinically acceptable. Key words: Esophageal neoplasms/radiotherapy; Radiotherapy,three-dimensional conformal; Radiotherapy,late course accelerated; Prognosis