Moderately Hypofractionated Conformal Radiation Treatment of Thoracic Esophageal Carcinoma

Aims: To prospectively assess the efficacy and safety of moderately hypofractionated conformal radiotherapyin patients with thoracic esophageal cancer. Methods and Materials: From Sept. 2002 to Oct. 2005, 150 eligiblepatients with T2-4N0-1M0 stage thoracic esophageal squamous cell cancers were enrolled to receive eitherconventional fractionated radiation (CFR) or moderately hypofractionated radiation (MHR) with a threedimensionalconformal radiation technique. Of the total, 74 received moderately hypofractionated radiation withtotal dose of 54-60Gy/18-20fractions for 3.5-4 weeks in the MHR arm, and 76 received conventional radiation withtotal dose of 60Gy/30 fractions for 6 weeks in the CFR arm. Concurrent chemotherapy comprised of paclitaxel andcisplatin. Safety was evaluated, and local control and overall survival rates were calculated.
Results: Statisticallysignificant differences between the CFR versus MHR arms were observed in local/regional failure rate (47.3%v 27.0%, P=0.034) and the percentage of patients with persistent local disease (26.3% v 10.8%, P=0.012). But 3and 5-year overall survival rates (43.2%, 38.8% v 38.2%, 28.0%, respectively) were not different between thetwo arms (P=0.268). There were no significant differences in the incidences of grade 3 or higher acute toxicities(66.3% v 50.0%) and late complications rates (27.0% v 22.4%) between the MHR and CFR arms.
Conclusions:Moderately hypofractionated, three-dimensional radiation treatment could improve the local control rate ofesophageal cancer and potentially increase patients’ survival.