Radiation Therapy Of Esophageal Cancer

Purpose: To investigate long-term outcome of esophageal squamous cell carcinoma (SCC) treated by irradiation with or without concurrent chemotherapy.Methods and Materials: A prospective clinical trial was carried out from1998to2000. One hundred and eleven patients were randomly enrolled to receive either late course accelerated hyperfractionated irradiation (LCAF) or LCAF with concurrent chemotherapy (LCAF+CT). For LCAF,41.4Gy in23fractions was firstly delivered with5fractions per week, followed by27Gy in18fractions with two1.5Gy fractions a day. Concurrent chemotherapy of cis-platinum and5-fluorouracil was administered for4cycles. Overall survival (OS), locoregional recurrence and distant metastasis were observed. Late toxicity was scored by RTOG criteria, and quality of life (QOL) was also evaluated.Results:The median follow-up time was24months for all patients, and138months for the17patients alive. Median survival time was25months in LCAF and32months in LCAF+CT (p=0.653), respectively. For entire group of patients, overall survivals were34%,27%and22%; locoregional recurrence rates,30%,36%and41%; and distant metastasis rates,26%,28%and29%, respectively at5-yr,8-yr and10-yr. Incidences of≥Grade3late toxicity were29%at10-yr. There were no statistically significant differences between LCAF and LCAF+CT with respect to the parameters mentioned above. Cumulative incidence of late toxicities of≥Grade3increased sharply after the attained age of70years. Eighty-eight percent of patients lived with good KPS (≥90), and94%could eat regular or soft diet.Conclusion:The long-term outcome of esophageal SCC patients who received LCAF or LCAF+CT was good. Although the locoregional and distant failures occurred more often in the first3years after treatment, they could continuously occur up to over10years. The late toxicity was acceptable. Late toxicities of≥Grade3were more likely to occur in elderly patients. QOL was good in the patients alive. Objective: To evaluate the efficacy of three-dimensional conformal radiation therapy (3DCRT) for esophageal cancer and identify prognostic factors in the enrolled patients. To analyze failure patterns after treatment and radiation-related toxicity.Methods and Materials: From Jan,2004to Dec,2006,208patients with esophageal cancer were treated by3DCRT in our hospital. We analyzed their clinical materials to evaluate their survival condition, prognostic factors, failure patterns and treatment related complications. Relationship between DVH and efficacy was also assessed.Results: Median survival time for all the208patients was20months. Their three-year and five-year overall survival rates were36.5%and29.3%. M staging and primary tumor site were the prognostic factors. Larger field irradiation (no less than3cm margin in the SI (superior and inferior) direction from GTV to PTV) resulted in a tendency towards better efficacy and decreased metastasis of out-field lymph nodes, but more radiation-induced injury. MLD was significantly associated with grade≥3radiation induced injury.Conclusions:3DCRT was not bad for esophageal cancer. For upper esophageal cancer, involved field radiation was feasible. Three cm margin in SI direction from GTV to PTV was recommended. MLD was significantly associated with grade≥3radiation induced injury.