Abstract
To prospectively assess the efficacy and safety of moderately hypofractionated conformal radiotherapy in patients with thoracic esophageal cancer. From Sept. 2002 to Oct. 2005, 150 eligible patients with T2-4N0-1M0 stage thoracic esophageal squamous cell cancers were enrolled to receive either conventional fractionated radiation (CFR) or moderately hypofractionated radiation (MHR) with a three- dimensional conformal radiation technique. Of the total, 74 received moderately hypofractionated radiation with total dose of 54-60 Gy/18-20 fractions for 3.5-4 weeks in the MHR arm, and 76 received conventional radiation with total dose of 60 Gy/30 fractions for 6 weeks in the CFR arm. Concurrent chemotherapy comprised of paclitaxel and cisplatin. Safety was evaluated, and local control and overall survival rates were calculated. Statistically significant differences between the CFR versus MHR arms were observed in local/regional failure rate (47.3% v 27.0%, P=0.034) and the percentage of patients with persistent local disease (26.3% v 10.8%, P=0.012). But 3 and 5-year overall survival rates (43.2%, 38.8% v 38.2%, 28.0%, respectively) were not different between the two arms (P=0.268). There were no significant differences in the incidences of grade 3 or higher acute toxicities (66.3% v 50.0%) and late complications rates (27.0% v 22.4%) between the MHR and CFR arms. Moderately hypofractionated, three-dimensional radiation treatment could improve the local control rate of esophageal cancer and potentially increase patient survival.
Highlights
Radiation or chemoradiation therapy was one of optional treatments for esophageal cancer with the average 5-year overall survival rate of 25% (Cooper et al, 1999)
RTOG9207 trial concluded with the same results (Gaspar et al, 2000). These findings indicated that conventional fraction scheme produced radiobiologically less tumoricidal effects for radio-resistant esophageal cancer (Halperin et al, 2008)
Our previous phase I/II study of fraction dose escalation indicated that daily dose of ≤5 Gy was appropriate in hypofractionated radiation for the treatment of esophageal carcinoma (Song, et al, 2011)
Summary
Radiation or chemoradiation therapy was one of optional treatments for esophageal cancer with the average 5-year overall survival rate of 25% (Cooper et al, 1999). Tumor regional persistence is the major cause of local failure for the standard chemoradiation therapy of esophageal cancer. RTOG9207 trial concluded with the same results (Gaspar et al, 2000) These findings indicated that conventional fraction scheme produced radiobiologically less tumoricidal effects for radio-resistant esophageal cancer (Halperin et al, 2008). Sykes AJ reported the result of hypofractionated radiation for the treatment of esophageal carcinoma (Sykes et al, 1998), in which 5-year survival rate was 42% with diagnostic CT scanning, but only 13% without diagnostic CT scanning. Our previous phase I/II study of fraction dose escalation indicated that hypofractionated radiation improved the local control of esophageal carcinoma (Song et al, 2011). We conducted this study to investigate the results of hypofractionated conformal radiation for the treatment of thoracic esophageal carcinoma
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