Safety Evaluation And Short-term Efficacy Of Low-dose Apatinib Combined With Concurrent Chemoradiotherapy In The Treatment Of Elderly Patients With Esophageal Cancer

Objective: To explore the safety and short-term efficacy of low-dose apatinib combined with concurrent chemoradiotherapy in the treatment of elderly patients with esophageal cancer.Methods: Eleven elderly patients with stage II-IVA esophageal cancer who were newly treated in our hospital from August 2019 to July 2021 were selected.The treatment plan was low-dose apatinib（250 mg po qd during radiotherapy）combined with concurrent chemoradiotherapy.The chemotherapy regimen was raltitrexed 3mg/m2 d1+nedaplatin 75 mg/m2 d2,and the radiotherapy method was intensity-modulated radiotherapy（95% PGTV 60Gy/30f/6w）.Observe the adverse reactions of patients during treatment and evaluate the short-term effects.Results: In terms of adverse reactions,it was observed that during the treatment of 11patients,1 patient discontinued treatment due to radiation pneumonitis with pulmonary infection.The 10 patients who have completed the treatment were evaluated for their adverse reactions according to CTCAE 5.0 and RTOG grading.Among them,the side effects of blood system included leukopenia in 7 cases（70%）,neutropenia in 5 cases（50%）,hemoglobin decrease in 3 cases（30%）;non-hematological toxicity included hypertension in 1 case（10%）,Transaminases increased in 1 case（10%）,bilirubin increased in 1 case（10%）,rash in 1 case（10%）,radiation esophagitis in 7 cases（70%）,and radiation pneumonitis in 1 case（10%）.Only 1 patient had grade 3 adverse reaction,manifested as leukopenia,and the rest of the adverse reactions were grade 1-2,and all the adverse reactions were tolerated by the patients and improved after symptomatic treatment,no grade 4 adverse reactions,and no drug-related die.Three months after the end of treatment,the short-term efficacy was evaluated according to RECIST1.1criteria.Among the 10 patients,3（30%）had complete remission（CR）,6（60%）had partial remission（PR）,and 1（10%）had complete remission（PR）.Stable disease（SD）with objective response rate（ORR）of 90% and disease control rate（DCR）of 100%.Conclusion: Low-dose apatinib combined with concurrent chemoradiotherapy shows high safety and good short-term efficacy in the treatment of elderly esophageal cancer,so it is worth expanding the sample size and follow-up for a longer time for further research.