Observation Of Short-term Efficacy With Conformal Radiotherapy Plus FP Regiment Chemotherapy For Esophageal Carcinoma

The esophagus is a longitudinal tubular organ, which connects pharynxand stomach. The length of esophagus is average 25 cm, it can be divided intofour sections normally: neck, upper, middle and lower. Esophageal carcinoma is primarily malignant tumor on mucousmembrane, it is one of common malignant tumors in China, it mainlyencroachments region. The etiopathogenisis of esophageal carcinoma is not clear.Patients often appear between 50 and 69, which account 60 percent, 68.5%～90.6% of pathology is squamous cell carcinoma.The death rate of esophageal carcinoma accounts 21.8% on overall deathrate of malignant tumor in China, it is lower than gastric cancer and locates thesecond place, the half new patients of esophageal carcinoma in the world areChinese every year, most of them dwell on poor area, so they can not bediagnosed and treated early.There are not special symptoms on primary esophageal carcinoma, theyappear occasionally, most of patients ignore them, once found, it has beenadvanced stage (Ⅲ,Ⅳa), only 20% of patients can receive radical cure, but theexcision rate is low very much, only 10%～30%, the rest 80% depend onradiotherapy or radiotherapy plus other treatment way, so radiotherapy is a maintreatment way for esophageal carcinoma.But 5-year survival rate of esophageal carcinoma is only 10% byconventional radiotherapy, the main causes are local recurrence and uncontrolledprimary disease, then metastasis. Three dimensional conformal radiotherapy andcurrent radiochemotherapy might provide new means for treating esophagealcarcinoma. But they were carried out for a short time, so it need to accumulatepatients and make more study.Some adverse reaction might appear during the course of radiotherapy,such as: acute radiation esophagitis;acute radiation tracheitis, bone marrowinhibition etc, which not only bring difficulties of treatment, but also aggravatepatients burden, some patients even refuse cure. Therefore, on the one hand wewill raise treatment effect, we can not neglect adverse reaction on the otherhand.The objective of my study is to compare the recent treatment effects andtoxicity of conventional radiotherapy, conformal radiotherapy and radiotherapyplus concurrent chemotherapy on esophageal carcinoma, which providesmaterial to enact good treatment plan.Between January 2005 and February 2006, 34 patients who were fit forconditions were divided into three groups randomly——conventionalradiotherapy(CF),conformal radiotherapy(CRT)and radiotherapy plusconcurrent chemotherapy(RCT).Patients of CF group were 11 , who weretreated in conventional radiotherapy , patients of CRT group were 13, patients ofRCT group were 10, two groups were treated in conformal radiotherapy. Threegroups were irradiated in conventional fractionation,1.8～2.0Gy/f, 5 times aweek, the total dose is 66～70 Gy, patients of RCT group were treated with FP(5-FU 500 mg/m2, d1～5, DDP 20mg d1～5)together with radiotherapy, 28day was a period , two periods were over.All the patients completed their treatment plan. The overall remissionrates of RCT group were better than the other two groups, but there was notstatistical difference (P>0.05).The incidences of acute radiation esophagitis in CF group and RCT groupwere all 100% by grade standard of RTOG about acute radiation esophagitis, theincidence in CRT group was 76.9%, they were only Ⅰand Ⅱgrade, no Ⅲor Ⅳgrade. they happened under higher doses, therefore, conformal radiotherapycould relief radiation damage, there was statistical difference (P<0.05) onincidence of acute radiation esophagitis in three groups. Kuwahata's score andRTOG score came to same conclusion on acute radiation esophagitis.The main appearance of bone narrow inhibition was WBC decreasing,there was no statistical difference (P>0.05) in three groups. But Ⅳ gradeappeared in RCT group, it was clear that bone narrow inhibition was seriousvery much, thus, when using radiotherapy together with chemotherapy, we mustobserve blood routine intimately, once the number of WBC was less than4.0×109/L, we must use GSF or blood transfusion, otherwise it might lead todiscontinuance of treatment plan and infection.Acute radiation tracheitis was also common radiation adverse reaction,when dose was 30～40Gy, it could appear, the main clinical symptoms werecough, chest distress, gasping etc. In my study, the incidence of acute radiationtracheitis was 53.8% in CRT group, all of them were Ⅰor Ⅱgrade, it wasobvious that conformal radiation technique was better and reduced the incidenceof it.My study only evaluated the recent treatment effect and acute toxicities ofthree kinds of ways on esophageal carcinoma. remote treatment effect and lateadverse reaction need further follow-up, my later study is how to raise localcontrol rate, decrease metastasis and reduce toxicities.