Imrt Clinical Analysis In Combination With Paclitaxel Andnedaplatin Concurrent Chemotherapy For Esophageal Cancer

Objectives Our institution has treated esophageal cancer with three-dimensional conformal radiation therapy(3D-CRT) combined with chemotherapy for over ten years, and has achieved good clinical effects and gained rich clinical experience. However, the clinical effect of intensity modulated radiation therapy(IMRT) combined with chemotherapy of paclitaxel and nedaplatin treating esophageal cancer has not been reported. Our study selected 80 patients diagnosed with esophageal cancer to compare the short-term efficacy and the tolerance between IMRT and 3D-CRT combined with paclitaxel and nedaplatin treating esophageal cancer.Methods This study collected 80 patients of esophageal cancer in the First Affiliated Hospital of Henan University from September 2012 to December 2014.Eligibility criteria included the following: esophageal squamous cell carcinoma, without radiation and chemotherapy contraindications, incapability or unwillingness of surgery, without symptom of perforation( including niche, carcinelcosis, angular deformity), without abnormity of cardiac, hepatic and renal function, normal bone marrow condition, without major medical disorders, Karnofsky performance status of 70 or greater, the lesion limited to the esophagus, estimated survival no less than 6 months. The patients were randomized to receive IMRT combined with paclitaxel and nedaplatin(the experiment group) versus 3D-CRT combined with paclitaxel and nedaplatin(the control group).There were 40 cases in each group. There was no significant difference on the characteristics between the two groups(P> 0.05).The radiation dose: The patients were treated 5 days per week at 1.8Gy/d. The total dose was 64 Gy with 32 fractions for 6.4 weeks. The prescribed dose was 95 percent of the Planned Targeted Volume. The protection dose for important organs: V20 of the lung less than 30 percent, V30 of the lung less than 20 percent, The maximum dose( Dmax) of the spinal cord was less than 45 Gy. Chemotherapy Nedaplatin 40mg/m^2 was given with 250 ml normal saline(NS) by venous transfusion on day 1 and 8, Paclitaxel 80mg/m^2 was given with 500 ml NS by venous transfusion on day 1 and 8.Dexamethasone 7.5mg was given orally before medication in 12 hours and 6 hours respectively. Diphenhydramine 20 mg by intramuscular injection, ranitidine 100 mg dissolved in 250 ml NS were given before medication in 30 minutes. Radiation therapy began on day 1, concurrent with the beginning of cycle one of chemotherapy. Each cycle of chemotherapy was repeated every 4 weeks. Chemotherapy was given for 3-4 cycles. Hepatic function and renal function were monitored regularly. Liver protectants were given orally or by venous infusion if there was liver damage. Drugs to improve the renal microcirculation were given if there was renal function damage. At the same time, the bone marrow function was monitored intimately. Radiation was conducted concurrent with chemotherapy possibly. Electrocardiomonitor was used regularly.Results 80 patients completed the treatment as planned, 3 patients prolonged the schedule for 1 week due to the degree 2 bone marrow suppression.Efficacy Chest CT and X-ray barium swallow was performed on 1 month after the completion of all therapy to evaluate the curative effect. The evaluation was divided to CR(complete response), PR(partial response), SD(stable disease) and PD(progression disease) according to the WHO tumor curative effect evaluation standard. The response rate was accumulated by CR plus PR. The response rate of the experiment group was 90.0%(36/40), higher than the control group 80.0%(32/40). The difference was not significant(χ2=0.521,P>0.05).Toxicity The radiation toxicity assessment was based on RTOG morbidity scoring criteria, and the chemotherapy toxicity was based on acute and subacute toxicity classification criteria on antitumor drugs by World Health Organization. The toxicity of the both groups was acute radiation esophagitis, leucopenia, thrombocytopenia. Acute radiation esophagitis in both groups was mainly grade 1 or 2 based on RTOG criteria, and there was no significant difference between the two groups(P>0.05). Patients in both groups could tolerate the toxicity caused by radiation or chemotherapy after positive symptomatic therapy and completed the treatment. The chemotherapy drug dose in the experiment was moderate and the toxicity caused by chemotherapy could be tolerated after symptomatic treatment and nutritional support timely, so that the treatment was completed continuously. The lung V20 and V30 in the experiment group was superior to the control group, and the acute radiation esophagitis rate in the experiment group was lower(P<0.05).Conclusions In this study, IMRT was superior in reducing the dose of important organs around the tumor as well as enhancing tumor dose uniformity and increasing the tumor dose. The experiment group demonstrated an advantage in the short-term effects, but whether can improve the 3-year and 5-year survival rate needs the further study. V20 is the independent prognostic factor of acute radiation pneumonitis and is significantly correlated with the severity of radiation pneumonitis and related to the incidence rate of radiation pneumonitis. The data in this study showed that the lung V20 and V30 was superior and the incidence rate of radiation pneumonitis was lower in the experiment group. Chemotherapy combined with radiation enhances the sensitization and prevent the gene expression of antitumor drug resistance. Concurrent treatment can increase the local control rate, eradicate micrometastases and reduce the probability of distant metastasis, thus enhance the antitumor effect.