Comparison Of Concurrent Radiotherapy With Paclitaxel To 5-Fu Combined With Cisplatin For Esophageal Cancer

BACKGROUND:The mortality rate of esophageal cancer is high in China,and the morbidity and mortality are still rising,compared to other diseases.Because the overall survival rate of esophageal cancer depends on surgery or radiotherapy alone is low.Chemoradiotherapy has become the standard treatment protocol in treatment of esophageal cancer of middle or advanced stage.Most current clinical studies have shown that local control and survival rate for concurrent chemoradiotherapy are better than for radiotherapy alone.The protocol of traditional concurrent chemoradiotherapy is 5-FU combined with cisplatin,However,the side effects of concurrent chemoradiotherapy is obvious,especially the digestive tract symptoms,followed by bone marrow suppression.In order to obtain better curative effect,it is necessary to explore a new and effective concurrent chemoradiotherapy program.Paclitaxel that is an antitumor drug,extracted from the bark of pacific cedar,has unique function of microtubule stabilization.It has been clinically proved that are effective for multiple solid tumors,such as lung cancer,breast cancer,and gastrointestinal tumors,etc.And it is a broad-spectrum anti-cancer drug.However,paclitaxel has a dose limiting toxicity,such as nerve,cardiac toxicity and bone marrow suppression.AIM:1.To study curative effect and adverse reaction of paclitaxel plus cisplatinof synchronous radiation scheme.2.To analyze and compare the clinical efficacy and adverse reactions of concurrent radiotherapy with paclitaxel to 5-Fu combined with cisplatin for esophageal cancer.3.To explore how to optimize esophageal chemoradiation scheme.METHODS:53 patients with esophageal cancer confirmed by histopathological examination were randomly divided into two groups:concurrent radiotherapy of paclitaxel(125 mg/m~2,d 1)plus cisplatin(20 mg/m~2,d 1-3)group(TP group)(25 cases);concurrent radiotherapy of 5-Fu(500 mg/m~2,d 1-5)combined with cisplatin(20 mg/m~2,d 1-4)group(DF group)(28 cases).The treatment regimen of two groups was 28 days as a cycle,the second treatment course was repeated for the fourth week of radiotherapy.Radiotherapy dose was 56-60 Gy,2 Gy/d,5 times/wk.The local control rate,1-year survival rate and adverse reaction rate were compared between the two groups.Survival rate was analyzed by Kaplan-Meier way.RESULTS:1)Local control rate of TP group and DF group was 84%and 89.29%,respectively;1-year survival rates were 76%and 85.71%.There was no significant difference in 1-year survival rates between the two groups(P>0.05).2)There were similar in incidence of vomiting and radiation pneumonitis for two groups(P>0.05).The incidence of radiation esophagitis of TP group(32%)was lower than that of DF group(53.57%),but the difference between the two groups was not statistically significant(P>0.05).The toxic side effects of the two groups were more obvious,and the incidence of TP group(60%)was significantly higher than that in DF group(42.86%).The difference in the incidence of toxic side effects between the two groups was statistically significant(P=0.013<0.05).The incidence of severe bone marrow suppression of TP group was 20%,and that of DF group was 7.14%.CONCLUSION:1.There was comparable short-term efficay for TP group and DF group in treatment of esophageal cancer.Compared of DF group,the incidence of radiation esophagitis was lower in TP group,and the patients in it was better tolerated.2.TP group can be used as an alternative treatment of DF group,but TP group still further optimize the dose application.