Short-term Efficacy of Paclitaxel Plus Concurrent Late-course Accelerated Hyperfractionated Radiotherapy on Elderly Patients with Esophageal Carcinoma

Objective To evaluate the short-term efficacy and clinical toxicity of late-course accelerated hyperfractionated radiotherapy plus concurrent chemotherapy with China-made paclitaxel in treatment of elderly patients with esophageal carcinoma.Methods From Nov.2006 to Nov.2008,88 elder patients with esophageal carcinoma were randomly divided into two groups:44 cases in the LCAF group receiving LCAF alone;another 44 cases in the LCAF+C group with additional paclitaxel 30 mg/m2,once per week before radiotherapy for six weeks with premedication of one hour travenous infusion simultaneously.All patients were beforehand laid immobilized with thermoplastic cast.Six MV X-ray or fifteen MV X-ray was employed.The schedule of LCAF was as following: conventional radiotherapy of 2.0 Gy per day,once per day,five days per week,was treated during the first phase to a total dose of 36 Gy,then followed by LCAF(twice per day,1.4~1.5 Gy per fraction,between two fractions more than six hours,to the total dose of 61.2~66 Gy with 36-38 fractions).The toxicity,response rate,one-year local control rate and one-year overall survival rate were evaluated and compared between the two groups.Results The total response rate(CR+PR) in the LCAF+C group and in the LCAF group was 93.2% and 77.3%,respectively.There was a significant difference(χ2=4.423,0.01P0.05)of the total response rate between the two groups.The one-year local control rates and the one-year survival rates were 86.4%,72.7% and 86.4%,72.7% respectively,whose difference was statistically significant(P0.05).Acute radiation esophagitis grade 1~2 and grade 3~4 for the two groups were 68%,61% and 25.0%,22.7%,respectively.Acute radiation pneumonitis grade 1~2 and grade 3~4 for those of the two groups were 29.5%(13/44),31.8% and 9.1%,4.5%,respectively.No significant diferences in incidences of acute radiation pneumonitis and esophagitis between LCAF+C and LCAF groups were found(P0.05),The rate grade 3-4 myelosuppression in LCAF+C was significantly higher than in LCAF(P0.01).All the toxicities were well tolerated.Conclusion The toxicity of hyperfractionated radiotherapy delivered concurrently with China-made paclitaxel regimen for elder patients with esophageal cancer is tolerable and the improved short-term effect is promising.But the long-term effect is worth further study.