| Objective: To observe the curative effects and side effects of three dimensional conformal radiotherapy(3D-CRT) combined with chemotherapy for mediate and advanced stage esophageal cancer, discussing the effect of treatment plan and correlative factors to short term results and survival rate.Methods: From Sep.2006 to Oct.2007, 36 patients of esophageal carcinoma who fulfilled the criteria were treated. They were immobilized and scanned by CT simulator in the treatment position . The images were transferred through local network to the treatment planning system (ADAC Pinnacle 7.6c) and reconstructed by TPS. The gross tumor volume (GTV),clinical target volume (CTV), planning target volume (PTV) and organs at risk (OAR) were outlined basing on the findings of esophagogram, esophagoscopy and CT images. Three dimensional conformal radiotherapy plan was degisned by physicists for each patient, the most excellent dose distribution for GTV, CTV, PTV and normal tissues around was achieved by three dimensional TPS.The 3D-CRT was carried out by conventional fractionation, to a total dose of 5600cGy~6400cGy /30-33Fr/6.0-6.5W. Three courses of Concurrent chemotherapy(5-Fu 600mg/m2d1-5,DDP 12 mg/m2d1-5,CF 100mgd1-5) was given from the beginning of 3D-CRT at 4-week intervals.Results:⑴The average length of lesion was 5.04 cm shown on esophageal barium meal, 4.77 cm on esophagoscopy and 7.19 cm on CT scan . The greatest diameter of tumor were 4.43cm (right-left) shown on CT scan, the average volume of GTV was 52.75 cm3(8.20 cm3~195.20cm3).⑵The mean dose of GTV was 6407.50 cGy,The doses of 100% GTV volume and of 95% GTV volume were 6028.72cGy, 6258.17 cGy from CRT, respectively . The doses of 100% CTV volume and of 95% CTV volume were 5464.62cGy,6125.81cGy from CRT, respectively . The doses of 100% PTV volume and of 95% PTV volume were 4700.36cGy,5932.83cGy from CRT, respectively. The lungs V20 was 22.97%.⑶All patients completed the radiotherapy on schedule. 47.22%(17/36) patients received 3 cycles of chemotherapy, 36.11%(13/36) patients received 2 cycles of chemotherapy while 16.67%(6/36) patients only received 1 cycle. Curative effect was evaluated after the treatment, the complete response rate was 61.11% and the partial response rate was 30.56% ,the overall response rate was up to 91.67%.Grade 1～2 radiation-induced esophagitis developed in 69.44% (25/36) and grade 3 in 19.44%(7/36) patients. Grade 1～2 acute radiation bronchitis occurred in 50.00% (18/36), no one suffered from grade 3; Grade 1 acute radiation phneumonitis developed in 25.00%(9/36), grade 2 in 38.89%(14/36), and grade 3 in 2.78%(1/36) patients. Leucopenia occurred in 75% (27/36) patients, Grade 1～2 developed in 63.89% (23/36) and grade 3 in 11.10%(4/36) patients. Till the end of the follow up period, 3 cases suffered from distant metastasis and 4 cases died. Among them,3 cases died of local failure and recurrence and 1 died of esophagorrhagia.⑷The overall 1-year survival rate was 82.76%. The 1-year survival rate was 84.21% and 67.69% for patients of tumors≤7cm and >7cm (P=0.3086). For GTV volumes≤35cm3 group and >35cm3 group , the 1-year survival rate was 91.67% and 75.99%,P=0.3898. The 1-year survival rate for patients of tumors invading aortic was 78.12%, and 90.00% for the others.(P=0.5849) . All the differences were not significant.Conclusions: The 3D-CRT combined with chemotherapy can be considered effective and developed a relatively high 1-year survival for mediate and advanced stage esophageal cancer. The clinical T staging of tumor and the number of cycles have no notable relations with 1-year survival. Complications were slight and could be accepted by patients . The long-term effect and late side effect need further clinical follow-up. |
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