Late course accelerated hyperfractionation radiotherapy on selective esophageal carcinoma

Background and purpose:Late course accelerated hyperfractionation radiotherapy(LCAF) can improve the local control rate and survival rate,but acute toxic effect was severe.The trial investigated who would get benefit from LCAF.Methods:From May 2000 to Mar 2001,a randomized trial was carried out in our hospital.84 patients were treated by conventional fractionated(CF) radiation of 1.8-2 Gy/FX to a total dose of 40-41.4 Gy in 20-23 fractions over 28-32 days;NR+DR patients received hyperfractionated radiation(LCAF)(no-response group).CR+PR patients whose responses were were randomized to response-CF group and response-LCAF group.The patients in response-CF group received conventional radiation again to a total dose of 60-64 Gy in 30-34 fractions over 42-46 days.In Response-LCAF Group received accelerated fractionation irradiation at 1.5 Gy per fraction,twice a day,to a total dose of 65.4-67 Gy in 38-39 fractions over 39-43 days.Results:The local control rates at 1,2,3 years were 66%,53%,38% in the no-response group,85%,73%,69% in the response-CF group and 89%,77%,69% in the response-LCAF group,respectively.The 1-,2-,3-year survival rates were 56%,31%,25% in the no-response group,73%,42%,35% in the response-CF group and 77%,46%,39% in the response-LCAF group,respectively.There was no significant differentce between two response groups(P0.05).The acute toxicity was more severe in the no-response group and response-LCAF group than in the response-CF group.Conclusion:LCAF did not improve the local control rate and survival rate on grades ⅠⅡ esophageal carcinoma when 40Gy had been given by CF.Grades ⅢⅣ esophageal carcinoma will get benefit from LCAF.