The Short-Term Effect and Toxicity of Simutaneous Boost Intensity-Modulated Radiotherapy for 28 Patients with Cervical or Thoracic Upper or Middle Esophageal Sequamous Cell Carcinoma

[Purpose] To assess short-term effect and toxicity of simutaneous boost intensity-modulated radiotherapy(SIB-IMRT) combined with chemotherapy for cervical or thoracic upper or middle esophageal sequamous cell carcinoma.[Mehhods] Twenty-eight cases with stage T1～4N0～1M0 esophageal sequamous cell carcinoma underwent prophylactic subtotal lymphatic irradiation.PGTV including primary tumor and metastatic lymph nodes and PTV including prophylactic subtotal lymphatic irradiated region were treated with SIB-IMRT.The prescribed dose for PTV-GTV with 66Gy/30f and 60Gy/30f for PTV-CTV and 4 courses of PF-or TP-based chemotherapy were administered during and before(or after)radiotherapy.[Results] Twenty-eight patients completed full dose of planned radiotherapy and 21 received more than two courses of chemotherapy,15 received one or two courses of concomitant chemotherapy.Complete response rate was 28.6%(8/28);partial response rate,50%(14/28);and death,5 cases.The median follow-up was 8.5 months(2～17 months).Local persistent disease or recurrence was 35.7%(10/28).Recurrence in radiation region was not found.Distant metastasis rate was 10.7%(3/28).Pericardial lymph node metastasis was found in 1 case.Loss weight more than 5% was found in 7 cases.No toxicity grade 2 for heart,liver and kidney,no toxicity grade 3 for lung,5 cases with grade 3～4 esophagitis,3 cases with grade 3～4 hematologic toxicity and 2 cases with esophageal fistula were found.Treatment-related death was not found.[Conclusions] Simutaneous boost intensity-modulated radiotherapy for cervical or thoracic upper or middle esophageal carcinoma is tolerable and can decrease regional recurrence.Lymphatic metastases out of the field is rarely seen.Local recurrence are still the dominant patterns of failure.