Late Course Accelerated Hyperfractionated Radiotherapy For Esophageal Cancer:a Meta-analysis And Clinical Research

Objective:Meta-analysis to evaluate the clinical efficacy and safety of the late course accelerated hyperfractionated radiotherapy (LCAH) versus conventional fraction radiotherapy for esophageal squamous cell carcinoma. The clinical research for the treatment of late course accelerated hyperfractionated radiotherapy for esophageal cancer.Methods:The methods of Mate analysis:PubMed, Cochrane Library, Chinese Scientific Journals full-text database, the Chinese periodical full-text databases, full-text database of digitized journals, and biomedical literature database were fully searched for relevant original published in any date, also including manual searching and other search engines such as Baidu. We also track back to the reference to collect trails. The deadline was October 2013. We Included the randomized controlled trials of LCAH versus CR for esophageal squamous cell carcinoma. Two reviewers assessed the quality of included trials and extracted data independently. The RevMan 5.1 software was used for statistical analysis.The methods of Clinical Research:Collecting the patients which with pathologically diagnosed as esophageal cancer in September 2012-December 2014 treated in Gansu Provincial Tumor Hospital radiotherapy center. Using computer randomly divided into two groups, LCAH group of 40 patients, the conventional fraction radiotherapy group of 40 patients. Simulating at CT, scan range from the mandible to the adrenal level, continuous scanning with 3mm thickness. simultaneous injection of contrast agent ioversol 200ml, then outlined gross tumor volume (GTV) and clinical target volume (CTV) in planning system, and the adjacent normal organs, such as the spinal cord, heart and bilateral lung. The LCAH group was divided into two phases, in the early course the DT of GTV was 46Gy/23f, the single dose was 2.0Gy, the end of the process was late course accelerated hyperfractionated irradiation, GTV was DT 14.4Gy/12f, the single dose 1.2Gy,2f/day. The total dose of IMRT was 60Gy-70Gy/6w. Using SPSS 16.0 statistical software to analysis.Results:12 studies involving 1458 patients were included for meta-analysis, the results showed that between LCAH and CR, there were significant difference in 1-year survival (OR= 2.13,95% CI:1.70-2.66, P<0.00001),3-year survival rate (OR=2.28,95% CI,:1.82-2.84, P<0.00001) and 5-year survival (OR=2.28,95% CI:1.79-2.91, P<0.00001); there were also significant difference in 1-year local control rate (OR=2.38,95% CI:1.88-3.01, P<0.00001), 3-year local control rate (OR=2.83,95% CI,:2.26-3.53.P<0.00001) and 5-year local control rate (OR=2.83,95% CI:2.26-3.53, P<0.00001); but in aspect of acute radiation side effect, acute radiation bronchitis (OR=1.43,95% CI:1.08-1.89, P=0.01), acute radiation esophagitis incidence (OR=1.65,95% CI:1.27-2.15, P=0.0002), LCAH was higher than CR. In recurrence, LCAH compared CR (OR=0.49,95%CI:0.38-0.63,P<0.00001), there was statistically significant, LCAH was lower than CR; but in treatment failure rate, LCAH was comparable with CR(OR=0.93,95% CI:0.65-1.31, P= 0.66).The clinical studies showed that there were no significant difference in LCAH of GTV, CTV and PTV, lung volume, lung MLD, lung V5 (%), lung V10 (%),Lung V20 (%), lung V25 (%). After treatment, x-ray results are shown in the picture 6, LCAH groups:grade I was accounted for 44%, grade Ⅱ(46.3%), grade Ⅲ (5.8%), grade Ⅳ accounted 2.6%. CR group:grade I was accounted for 46%, grade Ⅱ(42.9%), grade Ⅲ (6.2%), grade Ⅳ accounted 2.5%, there was no significant difference (x2=0.597, p> 0.05) between the two group in short-term effect. There was significant difference in the efficacy of two group in 1-year survival(χ2=13.09,P<0.01). But the LCAH group was superior to the CR group. For the Acute side effects, the LCAH group was more obvious than CR group.Conclusion:LCAH could improve 1-,3- and 5-year survival rates and local control rates, reduce local recurrence, but increase the incidence of acute radiation bronchitis and esophagitis compared with CR, but could not reduce the incidence of distance metastasis. But in view of the poor quality of included studies, the result was needed to more confirm.The clinical studies showed that there were no significant difference in LCAH of GTV, CTV and PTV, lung volume, lung MLD, lung V5 (%), lung V10 (%),Lung V20 (%), lung V25 (%).There was significant difference in the efficacy of two group in 1-year survival(x2=13.09,P< 0.01). But the LCAH group was superior to the CR group. For the Acute side effects, the LCAH group was more obvious than CR group.