High Dose And Low Dose Image-guided Intensity Modulated Radiotherapy For Advanced Esophageal Cancer Analysis Of Safety And Efficacy Of Dosage

Objective:To investigate the efficacy and toxicity of different radiotherapy doses for advanced esophageal cancer,and to provide the basis of radiotherapy dose for clinical treatment of esophageal cancer and prognosis evaluation.Methods:Patients with locally advanced esophageal cancer who received IGRT intensitymodulated radiotherapy in the Department of Radiotherapy and Chemotherapy of the First Affiliated Hospital of Jiamusi University from January 2017 to December 2020 were selected.All patients had complete clinical data and were diagnosed by histopathology or puncture cytology.50 eligible patients receiving low-dose radiotherapy were collected,from which 24 patients were randomly selected as group A(50.4Gy low-dose group)and 60 patients receiving high-dose radiotherapy,from which 26 patients were randomly selected as group B(60-66 Gy high-dose group).There was no significant difference in gender,age,KPS score,tumor location,lesion length,pathological type and clinical stage between the two groups(P>0.05).VARIAN IX intensity-modulated radiotherapy system was used for target volume delineation,portal design and implementation of radiotherapy plan in both groups.After the treatment,the patients were reexamined every 1 to 3 months,and blood routine,liver and kidney function were examined each time,and other imaging examinations were performed according to the clinical sign and symptom of the patients.The efficacy and toxicity were evaluated by interrogation,physical examination,regular blood routine examination and chest CT,and the toxicity was evaluated according to the World Health Organization(WHO)classification of anticancer drug toxicity and the American Cancer Radiation Therapy Group(RTOG)classification of acute radiation injury.The short-term efficacy and toxicity of the two groups were compared.Result: The 1-year and 2-year survival rates were 76% and 56%,respectively.The shortterm remission rates were 45.8% and 76.9% in group A and group B,respectively,with significant difference(P < 0.05).The 1-year and 2-year survival rates were 62.5% and 41.7%in group A and group B,respectively,with significant difference(P < 0.05).The incidence of mild radiation esophagitis in group B was significantly higher than that in group a(P < 0.05),but no severe radiation esophagitis was found.There was no significant difference in the incidence of hematological toxicity and other radiation injuries between the two groups(P >0.05).Conclusion:When patients with advanced esophageal cancer received radical radiotherapy,the high-dose group had better short-term efficacy and overall survival rate than the low-dose group,and did not significantly increase the side effects after radiotherapy.If the patients could tolerate,increasing the local radiotherapy dose for esophageal cancer could improve the local control rate and overall survival rate.