Different fractionation schedules of radiotherapy in preoperative concurrent chemoradiotherapy for thoracic esophageal cancer: a clinical study

Objective To investigate the clinical efficacy and safety of preoperative hypofractionated and conventionally-fractionated chemoradiotherapy for thoracic esophageal cancer. Methods A total of 86 patients with thoracic esophageal cancer receiving chemoradiotherpy in Sichuan Cancer Hospital between 2002 and 2011 were enrolled and randomized into the preoperative hypofractionated chemoradiotherapy group (group A, n=41, 30 Gy in 10 fractions for 2 weeks) and conventionally-fractionated chemoradiotherapy group (group B, n=45, 40 Gy in 20 fractions for 4 weeks). Surgery was performed at 2-6 weeks after chemoradiotherapy. The probability of patients’ survival was estimated by Kaplan-Meier method and analyzed by log-rank test. Results In groups A and B, the pathological downstaging rates were 68% and 56%(P=0.270), the R0 resection rates were 95% and 89%(P=0.437) and the pCR rates of 32% and 24%(P=0.480). The 1-, 3-and 5-year overall survival (OS) rates were 78% and 69%, 44% and 44%, 29% and 33%(P=0.114, 0.223, 0.289), and the progression-free survival (PFS) rates were 71% and 62%, 39% and 38%, 24% and 29%(P=0.211, 0.689, 0.331), respectively. The incidence rate of chemoradiothery-and surgery-related adverse events did not differ between two groups (P=0.089-0.872). The average length of hospital stay, radiotherapy cost and preoperative treatment costs in group A were significantly less compared with those in group B (P=0.000, 0.000, 0.000). Conclusions Both preoperative hypofractionated and conventionally-fractionated chemoradiotherapy can be used as the regimen of preoperative chemoradiotherapy in patients with resectable thoracic esophageal carcinoma. Compared with conventionally-fractionated chemoradiotherapy, preoperative hypofractionated chemoradiotherapy has shorter treatment cycle, shorter length of hospital stay and lower radiotherapy cost, which is more easily accepted by patients. Key words: Esophageal neoplasm/preoperative chemoradiotherapy; Hypofractionated; Conventional fractionated; Prognosis