| ObjectiveTo observe the efficacy and safety of esophageal squamous cell carcinoma(ESCC)after radical radiotherapy in patients with local recurrence of re-course intensity modulated radiation therapy(re-IMRT)concurrent with low-dose Capecitabine(Cap),and to evaluate the feasibility and clinical value of concurrent chemoradiotherapy after radical radiotherapy for esophageal squamous cell carcinoma and to provide a basis for the treatment of recurrent esophageal cancer.MethodsSixty-eight patients with recurrent esophageal squamous cell carcinoma(ESCC)after radical radiotherapy admitted to Tai-an cancer control hospital since 2012.04-2016.07 were randomly divided into control group(n=33)and experimental group(n=35).The control group received simple intensity-modulated radiation therapy(IMRT),the experimental group was treated with intensity-modulated radiation therapy simultaneously with low-dose capecitabine chemotherapy.All patients were treated with three-dimensional intensity modulated radiation therapy.The machine was Sweden Elekta medical linear accelerator,and the 6-MV X-ray was selected for ray irradiation,1.8Gy/time,once a day,5times per week,and the total dose was 50.4Gy/1.8Gy/28F.Capecitabine dose is500mg/m~2/time,2times/d,taken orally from the beginning of radiotherapy until the end of radiotherapy.The short-term curative effect,total effective rate,survival rate and incidence of adverse reactions were compared between the two groups after treatment.SPSS 21.0software was used for statistical analysis of statistical results,chi-square test or Fisher's exact test was used for count data,the t test was used for measurement data,the non-parametric test(rank sum test)was used for grade data,the survival curve was plotted using Kaplan-Meier method.Log-rank test was used to test whether there was a significant difference in survival rate,?=0.05,and all test statistics had statistical difference when set to p<0.05.ResultsThe efficacy could be evaluated in all patients.In the experimental group CR was 5(14.3%)and PR was 18(51.4%).The total effective rate was 65.7%(23/35).In the control group,CR was 3(9.1%)and PR was 10(30.3%).The efficiency was 39.4%(13/33).The effective rate was significantly higher in the experimental group than in the control group.The difference was statistically significant(?~2=4.723,p=0.030).The median survival time of the experimental group was 10.8 months,the 6-month survival rate was 57.1%(20/35),1 year survival rate was 42.9%(15/35),the median survival time in the control group was5.6 months,and the 6-month survival rate was 42.4%(14/33).The one-year survival rate was 18.2%(6/33);the 6-month survival rate in the experimental group was not statistically different from that in the control group,?~2=1.472,p=0.225;the one-year survival rate in the experimental group was statistically different from that in the control group,?~2=4.845,p=0.028;log-rank test of survival curve was?~2=5.002,p=0.025;incidence of grade 1,2,and 3 of acute radiation esophagitis in experimental group was 57.1%(20/35),31.4%(11/35),11.4%(4/35)respectively,and the control group were 57.6%(19/33),30.3%(10/33),and 12.1%(4/33);there was no significant difference between the two groups,z=-0.007,p=0.994;the acute radiation pneumonitis incidences of grade 1,grade 2,grade 3in experimental group were 48.6%(17/35),37.1%(13/35),5.7%(2/35)respectively,while the control group were 51.5%(17/33),36.4%(12/33),3.0%(1/33)respectively,there was no statistically significant difference comparing the two groups,z=0.345,p=0.730;in the experimental group,the incidence of grade 1 bone marrow suppression was 51.4%(18/35),grade 2 was 34.3%(12/35)and grade 3 was 14.3%(5/35),and there was no grade4 bone marrow suppression,in the control group,grade 1 bone marrow inhibition rate was51.5%(17/33),grade 2 was 36.4%(12/33),grade 3 was 12.1%(4/33),grade 4 bone marrow inhibition was not occurred,grade 2 or higher bone marrow inhibition rate in the experimental group was 48.6%(17/35),while the control group was 48.5%(16/33),there was no statistically significant difference comparing the two groups,z=0.088,p=0.930;ConclusionThe treatment of re-course intensity modulated radiation therapy concurrent with low-dose Capecitabine in patients with local recurrent esophageal cancer after radical radiotherapy has a good short-term curative effect,it has no obvious increase of adverse reaction,patient compliance is high,and it can be used as an effective treatment for patients with locally recurrent esophageal cancer after radiotherapy. |
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