A clinical comparison of short-term efficacy, survival and adverse reactions between raltitrexed/cisplatin-based and docetaxel/cisplatin-based concurrent chemoradiotherapy in the treatment of advanced esophageal squamous cell carcinoma

Background: Raltitrexed belongs to the new generation of aqueous soluble thymidylate synthase inhibitor. We carried out this study to compare the efficacy and adverse reactions of raltitrexed/cisplatin-based concurrent chemoradiotherapy with docetaxel/cisplatin-based concurrent chemoradiotherapy in the treatment of advanced esophageal cancer. Methods: One hundred and four patients with locally advanced esophageal squamous cell carcinoma (ESCC) were randomly divided into the raltitrexed group (n=54) and the docetaxel group (n=50). All patients received chest radiotherapy, using Intensity-modulated radiotherapy (IMRT). In both groups, chemotherapy was conducted for 2 cycles, including raltitrexed/cisplatin and docetaxel/cisplatin during the course of radiotherapy. The short-term efficacy and adverse effects were compared between the two groups. Results: The objective response rate (RR) and the disease control rate (DCR) were 85.2%, 94.4% in the raltitrexed group, and 80% and 92% in the docetaxel group, respectively (P=0.485 and 0.708, respectively). The 1-year survival rate was 85.1% in the raltitrexed group and 71.0% in the docetaxel group, with a statistically significant difference (chi(2)= 4.181, P= 0.041). The median progression-free survival and 1-year progression-free survival were not significantly different between the two groups (chi(2)= 2.931, P= 0.087). The 1-year local progression-free survival was better in the raltitrexed group than in the docetaxel group (chi(2)= 4.063, P= 0.044). The main adverse reactions included myelosuppression, gastrointestinal reaction and increased transferase, and were not significantly different between the two groups (P> 0.05). Conclusions: Raltitrexed/cisplatin-based concurrent chemoradiotherapy was able to improve the 1-year survival rate and local progression-free survival rate of patients with locally advanced esophageal carcinoma. The adverse reactions are comparable between the two groups with no identified cardiotoxicity.