Conventional fractionated versus late course accelerated hyperfractionated three-dimensional conformal radiotherapy for esophageal cancer: a randomized controlled trial

AIM: To compare the efficacy and safety of conventional fractionated (CF) versus late course accelerated hyperfractionated (LCAF) three-dimensional conformal radiotherapy (3D-CRT) for esophageal cancer.

METHODS: Ninety-eight patients with esophageal carcinoma were divided into two groups: 55 treated by CF-3D-CRT (a total dose of 60-68 Gy, 2 Gy/F, 5 fractions a week) and 48 by LCAF-3D-CRT (a total dose of 61-67 Gy, first by CF-3D-CRT to a dose of 40 Gy, followed by LCAF-3D-CRT: 1.5 Gy/F, 2 fractions a day, 21-27 Gy).

RESULTS: The 1-, 2-, and 3-year survival rates were 79.2%, 56.3% and 43.8% in the LCAF group, and 74%, 54% and 36% in the CF group, respectively. The 1-, 2-, and 3-year local control rates were 81.3%, 62.5% and 50% in the LCAF group, and 78%, 58% and 42% in the CF group, respectively. The incidence of radiation-induced esophagitis was significantly lower in the CF group than in the LCAF group (72% vs 93.8%, P = 0.008). However, the rate of radiation-induced pneumonitis showed no significant difference between the two groups (10% vs 6.25%, P = 0.498).

CONCLUSION: The 1-, 2- and 3-year local control rates and survival rates of patients with esophageal carcinoma treated by LCAF-3D-CRT are superior to those treated by CF-3D-CRT though the incidence of radiation-induced esophagitis is higher in the LCAF group than in the CF group.