Clinical observation of concurrent chemoradiotherapy and sequential chemoradiotherapy in the treatment of advanced esophageal carcinoma

YANG Yan; LI Jiancheng; WANG Shengqiang; TANG Xianjun

doi:10.3969/j.issn.1009-0460.2018.03.012

Abstract：Objective To compare the efficacy and safety of concurrent chemoradiotherapy and sequential radiotherapy in the treatment of advanced esophageal cancer. Methods Two hundred and forty-eight cases of esophageal cancer were divided into 120 cases with sequential radiotherapy group and 128 cases with synchronous radiotherapy and chemotherapy group according to different treatment schemes. The sequential radiotherapy group received local radiotherapy after 2 cycles of systemic chemotherapy, followed by 2 cycles of systemic chemotherapy after the completion of local radiotherapy. Concurrent chemoradiotherapy group received 2 cycles of concurrent chemotherapy during radiotherapy, followed by 2 cycles of systemic chemotherapy after concurrent chemoradiotherapy. The chemotherapy regimen was paclitaxel 135-175 mg/m2 intravenous d1, nedaplatin 80 mg/m2 intravenous d2, 21 days as a cycle. The dose of radiotherapy was DT:60-66 Gy/30～ 33 f/6.0-6.6W. According to the RECIST1.1 standard, the short-term effect was evaluated, and the NCI-CTC AE3.0 standard was used to evaluate the side effects. The Kaplan-Meier method was used to draw the survival curve. Results In the sequential radiotherapy group, the response rate (RR) was 74.2％, while that in the concurrent chemoradiotherapy group was 86.7％, and the difference was statistically significant (P＜0.05). The l-, 2-, 3-, 4-and 5-year survive rates of the sequential radiotherapy group were 73.1％, 53.1％, 38.6％, 31.6％ and 27.6％, respectively. The l-, 2-, 3-, 4-and 5-year survive rates of the patients with synchronous group were 79.4％, 56.2％, 48.6％, 41.7％ and 33.3％, respectively. There were no statistical difference between the two groups in terms of 1-to 5-year survival rates(P＞0.05). The incidence of side effects, especially myelosuppression and radiation esophagitis in the concurrent chemoradiotherapy group were higher than those in the sequential chemoradiotherapy group (P＜0.05). The incidence of other adverse reactions were similar between the two groups. Conclusion Concurrent chemoradiotherapy with paclitaxel and nedaplatin can improve the short term effect of the patients with advanced esophageal cancer and prolong the long-term survival trend. The acute side-effects were greater than that of sequential chemoradiotherapy, but it can be tolerated.