Simultaneous Integrated Boost Intensity-modulated Radiation Therapy (SIB-IMRT) Concurrent With Tegafur,Gimeracil And Oteracil Porassium Capsules For Unresectable Locally Advanced Esophageal Carcinoma

Objective:We retrospectively analyzed the prognosis of Simultaneous Integrated Boost Intensity-Modulated Radiation Therapy(SIB-IMRT)concurrent with Single-Agent tegafur,gimeracil and oteracil porassium capsules for unresectable locally advanced esophageal carcinoma,to explore whether the strategy can be an option of chemoradiotherapy for esophageal cancer.Methods:This retrospective study enrolled 42 patients with locally advanced esophageal cancer who were treated at our department from January2015 to October 2019.Patients received SIB-IMRT technique with involved-nodal irradiation(IFI).50.4-54.0Gy(1.8Gy per fraction)and60-63Gy(2.0-2.15Gy per fraction)were given to 95%PTV and 95%PGTV respectively in 28-30 fraction one fraction a day,5 days a week.On the first day of radiotherapy,tegafur,gimeracil and oteracil porassium capsules were administered orally d1-14 and d22-36.The prescription dose was as followed:40mg when body surface area was<1.25m~2;50mg,2 times a day when 1.25～<1.5 m~2;60mg≥1.5m~2.The 1,2,3-year overall survival(OS),progression-free survival and local control rate(LC)were analyzed and the tumor response,acute toxicities and patterns of failure were summarized.Results:The median age was 70 years(54.8%patients≥70 years).At the deadline of follow-up on January,2021,the 1-,2-and 3-year OS of all patients were 75.2%,52.7%and 46.5%,respectively.The median OS was 25months.The 1-,2-and 3-year PFS were 63.8%,42.2%and 42.2%respectively.The median PFS was 18 months.And the 1-,2-and 3-year LC were 68.1%,51.8%and 51.8%respectively.The univariate analysis showed that the patients with tumor location in the cervical and upper third of thoracic esophagus had favorable prognosis than those with tumor location in the middle and lower third of thoracic esophagus.And the prognosis of patients with stage T2 was better than that of patients with stage T3/4.But the multivariate analysis found no independent prognostic factors.There were 6patients with complete response and the overall response rate was 95.2%(40/42).All patients completed radiotherapy as planned.32 patients(76.2%)received two cycles of chemotherapy and 10 patients(23.8%)only received one cycle of chemotherapy.The acute radiation esophagitis of≥grade 3 was 3patients(7.1%).Only one patient(2.4%)had grade 3 myelosuppression.Conclusions:For patients with unresectable locally advanced esophageal cancer,the prognosis of SIB-IMRT concurrent with tegafur,gimeracil and oteracil porassium capsules was acceptable.The strategy was well tolerated.It may be a good option for elderly patients...