Concurrent Radiotherapy And Chemotherapy Plus Endostar In Esophageal Squamous Cell Carcinoma Clinical Research

Background:Esophageal squamous cell carcinoma is the most common gastrointestinal cancer, surgery, radiotherapy, chemotherapy are reliable treatments. Resectable esophageal cancer surgery is the gold standard, but after 5-year survival rate of 20%, 50% local recurrence rate was less and there is early diagnosis, the difficult problem of local excision。Radiotherapy is another important treatment of esophageal cancer, radiotherapy alone, the median survival time was 6-12 months, 0-20% 5-year survival is difficult and there is precise biological target volume outlined the shortcomings of simple effective than chemotherapy poor complete remission rate of <5% and there are multi-drug resistanceand the dose limit。Comprehensive treatment of esophageal cancer become the focus of research. Non-surgical treatment of esophageal cancer in RTOG8501 study, the use of 5-Fu + cisplatin + radiotherapy (50.4Gy) VS radiotherapy alone (64Gy), both median survival time, 5-year survival rate was significantly better than the radiotherapy group, local failure rate of distant metastasis were lower than radiotherapy, concurrent chemoradiotherapy has become the standard treatment for locally advanced esophageal cancer. In recent years it becomes a hot research targeted therapy, recombinant human endostatin for angiostatin class of biological products, its mechanism is inhibiting the migration of endothelial cells and going to inhibit tumor angiogenesis, thus choking off the tumor supply of nutrients to inhibit tumor proliferation or metastasis of the purpose, with concurrent radiotherapy and chemotherapy can further improve the overall survival of patients is not clear。Objective: The degree of concurrent chemoradiotherapy combined short-term effect and 1-year survival rate, clinical evaluation of Endostar the safety and tolerability.Methods: 39 casesⅡ-Ⅲesophageal cancer were randomly divided into two groups, 19 patients included in the concurrent chemoradiotherapy group, 20 patients included in the concurrent chemoradiotherapy + Endostar group. Concurrent chemoradiotherapy group, male 10 cases, 9 females, average age 55.6 years (range 37 to 69 years), the lesion, the upper 4 cases, the middle 8 cases, lower in 7 cases, lesion length 5.14±1. 75cm; Concurrent chemoradiotherapy + Endostar group, male 11 cases and 9 females, average age 56.3 years (range 40 to 72 years), the lesion, with 6 cases, middle in 9 cases, lower in 5 cases, lesion length 5. 46±1. 26cm. TP week regimen with chemotherapy, PTX, 45mg/m~2, intravenous infusion of W1-W7, with the first day of week, DPP 25mg/m~2, intravenous infusion of W1-W7, with the first day of a week, with a course of 7 weeks. Endostar 7.5 mg/m~2 qd for 2 weeks, rest for a week, a total of 2 cycles. Radiotherapy methods were: 6MV X ray 3DCRT, 1.8Gy×33, 5 times / week, the tumor dose of 59.4Gy.Results: The concurrent chemoradiotherapy group of the group 2 patients, CR9 cases (52.9%), PR7 cases (41.1%), SD1 patient (6%), PD0 patient (0%), the total effective rate of 16 cases CR + PR (94% ), clinical benefit rate of 17 cases of CP + PR + SD (100%); Concurrent chemoradiotherapy + Endostar group, 1 patient out of group to evaluate 19 patients, CR12 cases (63.1%), PR7 cases (36.9%), SD0 patient (0%), PD0 patient (0%), the total effective rate in 19 patients (100%), clinical benefit rate (100%). The difference was statistically significant. 1 year survival rate two groups were 46.8% and 61.3%, the survival rate between the two groups by log-rank test showed that there are differences. Toxicity of the two groups mainly neutropenia, gastrointestinal symptoms, esophagitis, radiation pharyngeal inflammation mainly gradeⅠ-Ⅱ, but the patient can accept, no significant difference.Conclusion: Concurrent chemotherapy combined with Endostar can increase the degree of locally advanced squamous cell carcinoma of the esophagus recent remission rate and better safety and tolerability, and to extend the 1-year survival, but long-term effect remains to be seen.