| Objective: To evaluate the efficacy and safety of preoperative fractionation radiotherapy and conventional fractionation radiotherapy in the treatment of locally advanced esophageal squamous cell carcinoma(ESCC).Methods: From October 2002 to April 2011 in Sichuan Province Tumor hospital admitted patients with esophageal carcinoma,86 cases with this research into the condition of locally advanced esophageal squamous cell carcinoma patients,the preoperative radiotherapy group(A group)41 cases,30Gy/10 /2 week,conventional radiotherapy group(B group)45 cases,40Gy/20 /4 week the use of 5-fluorouracil chemotherapy plan,intravenous infusion of 300mg/m2 D1-3,cisplatin 30mg/m2 D1-3 intravenous drip,21 to 28 days for 1 cycle,completed a total of two cycles of chemotherapy,simultaneously,surgery was performed 3-4 weeks after the end of radiotherapy and chemotherapy.Operation method: for upper thoracic esophageal carcinoma routine from the neck,right chest and upper abdominal incision,esophageal and gastric and cervical anastomosis,and lymph node dissection of the second field army.For thoracic esophageal cancer from the distal right chest and abdominal incision,for thoracic esophageal and gastric anastomosis at the top of the second field army,lymph node dissection.Two groups of clinical data using chi 2 test,survival analysis of the comparison,using kaplan-Meier method,Cox regression model for multivariate analysis.All statistical tests were two-sided test,the efficacy of 0.8,P<0.05,the difference was statistically significant.The primary end point was the patient's stage of descent,R0 resection rate,pCR rate,and survival rate.The secondary end point was treatment-related adverse events.Results: The decrease rate of A group and B group was 68.3% and 55.6%(P=0.03),and the R0 resection rate was 95.1 and 88.9%(P=0.02),respectively,and the pCR rate was 31.7% and 24.4%(P=0.027),respectively.The difference was statistically significant.Hypofractionated radiotherapy group and conventional radiotherapy group 1,2,3,4 and 5 OS were 78.1% and 68.9%,56.1% and 48.9%,43.9% and 44.4%,31.7% and 35.6%,19.5% and 15.6%,there was no significant difference(P > 0.05).There was no significant difference in radiation esophagitis,radiation pneumonitis,leukocyte depletion,anastomotic fistula and delayed healing rate between the two groups(P > 0.05).The rate of reduction,the rate of R0 resection and the rate of pCR in the preoperative fractionation and radiotherapy were superior to those of conventional fractionation chemotherapy and radiotherapy(P<0.05),and there was no significant difference in the overall survival rate and the incidence of side effects in the two groups.Single factor analysis showed that preoperative staging,physical status score,tumor length,post radiotherapy period,and post radiation remission were the prognostic factors for survival.Multivariate analysis showed that preoperative staging,physical status score,post-radiotherapy period,and post-radiotherapy pathology were independent prognostic factors.Conclusion: Compared with conventional radiotherapy,preoperative fractionation radiotherapy had better reduction rate,R0 resection rate and pCR rate,but there was no difference in survival rate between the two groups.Preoperative radiotherapy did not increase the radiation esophagitis and associated radioactive pneumonia,leukopenia,anastomotic fistula and delayed healing of wound treatment and the incidence of patients,the treatment cycle is short,and can shorten the hospitalization time,save the cost of hospitalization,easier for patients to accept.The prognosis is better before radiotherapy,early stage,after radiotherapy and after radiotherapy.Preoperative fractionation radiotherapy and conventional fractionation radiotherapy can be used as the fractionation mode for preoperative radiotherapy of locally advanced esophageal cancer.Clinical treatment should be individualized according to the patient's condition. |
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