Long-term result and prognostic analysis of accelerated hyperfractionated radi o therapy for esophageal carcinoma

Objective To evaluate the long-term treatment result and prognostic f actors of whole-course continual accelerated hyperfractionated (CAHF) and late -c ourse accelerated hyperfractionated (LCAF) radiotherapy for esophageal carcinoma . Methods From August 1995 to March 1998, a prospectively randomized trial was c arried out on 101 patients with squamous cell carcinoma of the esophagus which were randomized into two groups: 49 in the CAHF group and 52 in the LCAF group. Patients in the CAHF group received radiation at 1.5?Gy/fx , twice a day (in terva l of 6 hrs), 5 days per week , to a total dose of 66?Gy/44f/4.3 wks. Patients i n the LCAF group received conventional fractionation radiotherapy of 1.8 ?Gy per fr action to a dose of 41.4?Gy/23 f/4.6 wks , followed by accelerated fraction ation irradiation using reduced fields, twice daily at 1.5?Gy per fraction with a mini mum interval of 6 hours between fractions to a the total dose was 68.4?Gy/41 fx/ 6.4 wks . Results The local control rates at 1, 2, 3, 4 and 5 years were 85.9%, 83.1%, 72.6%, 72.6% and 72.6% in the CAHF group and 81.3%, 69.6%, 67.1%, 67.1% and 67.1% in the LCAF group ( P=0.37 ). The median relapse time was 10.0 months in CAHF group and 7.5 months in LCAF group. The 1-, 2- , 3-,4- and 5-year survival rates were 77.6%, 55.1%, 42.9% , 37.5% and 37.5% inthe CAHF group and 82.4% , 58.8%, 49.0%, 49.0% and 39.2% in the LCAF group (P=0.46 ). The 5-year tumor-fr ee survival rates were 64.8%, 51.4%, 35.8% , 35.8% and 35.8% in CAHF group and 66 .0%, 53.9%, 51.8%, 51.8% and 41.5% in LCAF group,with the difference insignific ant (P=0.34). The main common late reactions were lung fibrosis and esophageal stricture. In the CAHF arm, 16 of 29 patients died of distant metastasis; In the LCAF arm, 15 of 28 died of distant metastasis. Circumferential involvement and tumor response at the completion of radiotherapy were demonstrated to be indepen dent prognostic variables influencing the control rate by Cox regression model. And circumferential involvement, tumor response, T classification and age had in dependent prognostic value on long survival. Conclusions Continual accelerated hyperfractionated (CAHF) and late-course accelerated hyperfractionated (LCAF) r a diotherapy possess similar long-term result and late reaction. Circumferential i nvolvement and tumor response at the completion of radiotherapy are independent prognostic variables influencing the control rate by Cox regression model. And c ircumferential involvement, tumor response, T classification and age possess ind ependent prognostic value on the remote survival.