A Study Of Concurrent Chemoradiotherapy For Esophageal Cancer

Objective: To observe the acute side effects, local control rates andsurvival rates of concurrent chemoradiotherapy and radiotherapy alone forpatients with esophageal carcinoma.Methods: From Sep.2003to Dec.2010,795patients of esophagealcancer were retrospected.241were treated by concurrent chemoradiotherapyand554patients were treated by radiotherapy alone.The total dose ofconcurrent chemoradiotherapy was50Gy~68Gy while it was50Gy~70Gy inradiotherapy alone, the median dose was60Gy, all deliverd in1.8~2Gy perfraction per day,5fractions per week.Chemotherapy was started from thebeginning of radiotherapy by LFP (DDP25mg/m2d1-3,5-Fu450-500mg/m2d1-5, CF200mg d1-5) at the1st and5th week.1~2cycles of chemotherapywere consolidated after radiation according to the patient’s generalcondition.The acute side effects, local control rates and survival rates wereobserved and cause of death analysis were performed. Also sub-groupanalysis was conducted to find benifited patients.Results:(1) There were8patients interrupted radiotherapy due to severemyelosuppression and3due to severe esophagitis in concurrentchemoradiotherapy group while there were4patients interrupted radiotherapydue to severe myelosuppression and1due to severe esophagitis inradiotherapy alone group.What’s more,1patient failed to complete the entireradithotherapy for severe myelosuppression and gastrointestinal tract reactionwith a dose of52Gy in the concurrent group. Other patients completed theradiotherapy on schedule.135patients (56.0%) received2cycles of concurrentchemotherapy and122patients (50.6%) received consolidation chemotherapy.(2) In concurrent chemoradiotherapy group and radiotherapy alone group, bone marrow suppression occurred in75.1%and48.72%respectively (χ2=59.397, P=0.000),mainly for leucocytopenia,aglobulia and thrombocytopenia.1patient died for the septic shock caused by leucocytopenia. The incidence of≥2grade radiation esophagitis were53.1%(128/241) and33.0%(183/554) forthe two groups (χ2=28.431, P=0.000).The incidence of≥2grade radiationpneumonitis for the two groups were14.5%(35/241) and8.7%(48/554),respectively (χ2=6.165, P=0.013).1patient in concurrent group died for5grade pneumonitis combined with pleural effusion3months after radiotherapy.3patients in radiotherapy alone group also developed to5gradepneumonitis.The common characteristics of these4patients were high dosevolumes of lung and elder patients. The incidence of gastrointestinal reactionwas also significantly higher in concurrent group (χ2=105.656, P=0.000).(3) The effect was evaluated after the treatment, the total efftive rate was98.8%(238/241) and97.8%(542/554) respectively in the two groups.Thecomplete remisson rate was56.4%(136/241) and48%(266/554)(χ2=4.760,P=0.029).(4)The overall1-year,3-year and5-year survival rates were78%,45.2%and32.8%in concurrent chemoradiotherapy group, as they were68.4%,38.8%and25.2%in radiotherapy alone respectively. And there weresignificant differcence between two groups (χ2=4.989, P=0.026). The1-year,3-year and5-year local control rates were80.3%,62.9%,56.9%and75.3%,55.3%,50.8%respectively (χ2=3.620, P=0.057).(5) In concurrent chemoradiotherapy group, patients who received2cycles of concurrent chemotherapy had a trend to increace1-year,3-year and5-year survival rates and local control rates, especially for the latter (P=0.057).Addition of consolidation chemotherapy after concurrent chemoradiotherapycould not lead to significant survival prolongation, nor could it increase thelocal control rates.(6) Cox regression analysis revealed an independent prognostic impactfor the lesion, barium meal length, T-stage, GTV volume and concurrentchemotherapy. By further study, sub-group analysis were studied including the lesions, barium meal lengths, T-stages, N-stages, GTV volumes. Logrank-testrevealed the subgroup of barium meal lengths of>5cm, lesions of lowersegment, GTV volumes>40cm3, patients of stage T3and N1-2had a significantsurvival profit from the concurrent chemoradiotherapy.(7) Local control failure was still the main cause of death, the ratio of itwas36.6%(56/153) and45.9%(183/399) in concurrent chemoradiotherapygroup and radiotherapy alone group respectively (χ2=3.865, P=0.049).Metastasis was the second cause of death, but the patients died of distantmetastases didn’t reduce in concurrent chemoradiotherapy group.Conclusions:(1)Three dimensional conformal radiotherapy combining withconcurrent chemotherapy can be considered effective with tolerated sideeffects of most patients.Acute toxicities such as myelosuppression, acuteradiation esophagitis, radiation pneumonitis and gastrointestinal tract reactionmight be increased compared with radiotherapy alone, but the majority ofpatients could be tolerated.(2) The overall survival rates were significantly higher in concurrentchemoradiotherapy group.There was a trend to improve the local control rates.(3) Patients who received2cycles of concurrent chemotherapy had atrend to increace survival rates and local control rates, especially for the latter.Addition of consolidation chemotherapy could not lead to significant survivalprolongation, nor could it increase the local control rates.(4) Subsets analysis by Logrank-test revealed the subgroup of bariummeal lengths of>5cm, lesions of lower segment, GTV volumes>40cm3andpatients of stage T3had a significant survival profit from the concurrentchemoradiotherapy.(5) The distant metastasis rates were not decreased in concurrentchemoradiotherapy group.