Whole-Course Conformal Radiotherapy Combined with Late-Course Accelerated Hyperfractionation Radiotherapy for Esophageal Squamous Cell Carcinoma: A Report of 110 Cases

Abstract Purpose: This retrospective study was designed to analyze the effect and prognostic factors of whole-course conformal radiotherapy and late-course accelerated hyperfractionation radiotherapy (LCAFRT) for esophageal squamous cell carcinoma (ESCC).Methods and materials: A total of 110 patients with ESCC received whole-course conformal radiotherapy and LCAFRT in Chaozhou City People’s hospital between May 2004 and January 2015. All patients received conventional conformal radiotherapy of 2 Gy per day up to 30–40 Gy, followed by accelerated hyperfractionation conformal radiotherapy using reduced fields at 1.5 Gy/fraction twice a day up to 24–39 Gy, with a total dose of 60–69 Gy.Results: Median follow-up was 85 months (2–170 months). The one-, three-, and five-year survival rates were 81.82%, 46.36%, and 41.82%, respectively. The median survival time was 31.8 months. The local control rates for the whole group at 1, 3, and 5 years were 82.73%, 70%, and 68.18%, respectively. There were no significant differences among 1-, 3-, and 5-year survival rates and local control rates between the three-dimensional conformal radiotherapy group and intensity-modulated radiotherapy group. The main reactions to acute radiotherapy were acute radiation tracheitis, esophagitis, and pneumonia. Multivariate analysis showed that the tumor location and TNM stage were independent prognostic factors.Conclusion: The results from this study showed that whole-course conformal radiotherapy and LCAFRT for ESCC can further improve survival and local control with a tolerable acute reaction compared to previous studies. Local recurrence and distant metastasis are the main failure modes of treatment.