Capecitabine Combined With Late Course Accelerated Hyperfractionated Radiotherapy For Esophageal Cancer

Objective:To investigate the short-term effective rate,local control,survival and toxicity of capecitabine combined with late course accelerated hyperfractionated radiotherapy(LCAHR)for esophageal cancer.To evaluate the advantage and disadvantage of this combined therapy.To estimate the patients' improvement of quality of life after therapy.Materials and Methods:Eighty-two patients with esophageal squamous carcinoma admitted to Oncology department of Shandong Provincial Hospital from Janurary of 2006 to August of 2006 were divided randomly into two groups:41 patients in treatment group received capecitabine combined with LCAHR,while the other 41 patients in control group received LCAHR only.All patients were treated by conventional fractionated radiotherapy during the first two-thirds of the whole course with 40Gy in 20 fractions,followed by LCAHR with 25-30Gy in 17-19 fractions, 1.SGy per fraction,twice a day,with an interval of more than 6 hours between fractions to a total dose of 65-70Gy.The treatment group took capecitabine 1000mg/m~2 twice a day for fourteen days followed by a 7-day rest period from the first day of radiotherapy,every 3 weeks as one cycle to totally 2 cycles.After radiotherapy all patients were treated by four cycles of chemotherapy of cisplatin and fuorouracil.All patients were followed up to August of 2007.By observation,the short-term effective rate,local control rate,1-year survival rate,side effect and quality of life were obtained and compared between the two groups.Results:All patients completed treatment course and the follow-up rate was 94.9%(78/82).The short-term effective rate of the treatment group and the control group was 89.7%(37/41)and 76.9%(26/41)respectively with statistically significant difference.1-year local control rates of treatment group and control group were 73.2% (30/41)and 65.9%(27/41)respectively with statistically significant difference. 1-year survival rates were 80.5%and 73.2%in treatment and control group respectively(P＞0.05).The survival curve showed a trend towards improving the long-term survival.Improvement rates of dysphagia in treatment group and controle group were 58.5%(24/41)and 48.8%(20/41)respectively with statistically significant difference.While there was no statistically difference between the two groups assesed by KPS.Score of depression,sleep and diet in treatment group was higher than control group with statistically significant difference,but score of psychosis was lower.As for others such as physical symptoms,compulsive symptoms,personnel relationship,anxious,hostile,fear,monomania,there was no statistically significant difference between the two groups.As for acute and late radiation side effect,there was no significant difference between the two groups.Conclusion:Capecitabine combined with late course accelerated hyperfractionated radiotherapy for esophageal cancer can improve short-term effective rate and 1-year control rate and had a trend towards improving the long-term survival.This combined therapy could also improve the quality of life including dysphagia,KPS score and psychological status.Its side effects were not statistically different from the LCAHR alone and were tolerable.The value of combined treatment in long-term results needs further study in clinic.