| ZHU Wei-guo,ZHOU Ke,TAO Guang-zhou,et al.Efficacy analysis on simplified intensity-modulated radiotherapy with high or conventional dose and concurrent chemotherapy for patients with N1 esophageal carcinoma[J].Chinese Journal of Radiological Medicine and Protection,2011,31(4):460-464 |
| Efficacy analysis on simplified intensity-modulated radiotherapy with high or conventional dose and concurrent chemotherapy for patients with N1 esophageal carcinoma |
| Received:November 26, 2010 |
| DOI：10.3760/cma.j.issn.0254-5098.2011.04.022 |
| KeyWords:Esophageal cancer Simplified intensity-modulated radiotherapy Dose Prognosis |
| FundProject: |
| Author Name | Affiliation | E-mail | | ZHU Wei-guo | Department of Radiation Oncology, First People's Hospital of Huai'an City, Nanjing Medical University, Huai'an 223300,China | | | ZHOU Ke | Department of Radiation Oncology, First People's Hospital of Huai'an City, Nanjing Medical University, Huai'an 223300,China | | | TAO Guang-zhou | Department of Radiation Oncology, First People's Hospital of Huai'an City, Nanjing Medical University, Huai'an 223300,China | | | YU Chang-hua | Department of Radiation Oncology, First People's Hospital of Huai'an City, Nanjing Medical University, Huai'an 223300,China | | | HAN Ji-hua | Department of Radiation Oncology, First People's Hospital of Huai'an City, Nanjing Medical University, Huai'an 223300,China | | | LI Tao | Department of Radiation Oncology, First People's Hospital of Huai'an City, Nanjing Medical University, Huai'an 223300,China | | | CHEN Xiao-fei | Department of Radiation Oncology, First People's Hospital of Huai'an City, Nanjing Medical University, Huai'an 223300,China | jshazwg@126.com |
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| Abstract:: |
| Objective To investigate the feasibility of simplified intensity-modulated radiotherapy (sIMRT) and concurrent chemotherapy against neck and upper thoracic esophageal carcinoma with lymph node metastasis. Methods sIMRT plans were designed for 44 patients of neck and upper thoracic esophageal carcinoma with lymph node metastasis, 20 of which underwent high dose sIMRT (hsIMRT group) and 24 underwent conventional dose sIMRT (csIMRT group). Three target volumes were defined: PGTVnd, target volume of lymph node lesion, irradiated to 68.1 Gy (2.27 Gy×30 fractions) for the hsIMRT group, and 60 Gy (2.0 Gy×30 fractions) the csIMRT group; PTV1, the target volume of primary lesion, to be irradiate to 63.9 Gy (2.13 Gy×30 fractions) for the hsIMRT group and 60 Gy (2.0 Gy×30 fractions) for the csIMRT group; PTV2, the prophylacticly irradiated volume, to be irradiated to 54 Gy (1.8 Gy×30) for both groups. The sIMRT plan included 5 equiangular coplanar beams. All patients received DDP+5-FU regimen concurrently with radiotherapy at 1 -5 d and 29 -33 d, respectively. Chemotherapy was repeated for two cycles 28 days after the radiotherapy was finished. Results The treatment was completed for all patients within 6 weeks. During the treatment only one patient with grade 3 acute bronchitis was observed in the hsIMRT group. The complete response (CR) rate for the lymph node lesion of the hsIMRT group was 75% (15/20), significantly higher than that of the csIMRT group [45.8%(11/24), χ2=3.84,P<0.05]. The 1-, 2-, and 3-year progression-free survival rates of the hsIMRT group were 60%, 40%, and 25%, respectively,all significantly higher than those of the csIMRT group (41.7%, 25%, and 8.3% respectively, χ2=4.11,P﹤0.05). However, there were not significant differences in the total survival rate, and the CR and PR of the esophageal lesion between these 2 groups. The major toxicity observed was grade Ⅰ-Ⅱ leukoctyopenia. Conclusions sIMRT generates desirable dose distribution for neck and upper thoracic esophageal carcinoma. hsIMRT has a better short-term efficacy than csIMRT. High dose radiotherapy toward metastatic lymph nodes helps increase progression-free survival. |
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