Comparison between late-course accelerated hyperfractionation radiotherapy and concurrent chemoradiotherapy in patients with esophageal carcinoma

This study aimed to compare the efficacy of late--course accelerated hyperfractionation radiotherapy (LAFR) and concurrent chemoradiotherapy (CRT) in patients with esophageal carcinoma and to evaluate the side effects of the two treatments. A total of 22 patients with primary esophageal squamous cell carcinoma were prospectively treated with LAFR, while 25 patients, during the same period, served as the control group and received CRT. The 22 patients in the LAFR group received conventional fractionated radiotherapy of 30 Gy over a 3-week period (5 daily fractions of 2.0 Gy per week), followed by accelerated hyperfractionated radiotherapy of 30 Gy for 2 weeks (twice daily, 1.5 Gy per fraction, with a minimal interval of 6 h between fractions, 10 fractions per week). The 25 patients in the CRT group received conventional fractionated radiotherapy of 50 Gy for 5 weeks, with 5 daily fractions of 2.0 Gy per week. Chemotherapy was started on the first day of irradiation (cisplatin 52.5 mg/m² on Day 1 and 5-fluorouracil 700 mg/m² on Days 1-5, repeated four times every 28 days). The median survival time in the LAFR and CRT groups were noted to be 17 and 21 months, respectively. The 1-- and 2--year overall survival rates were 63.6 and 31.6% in the LAFR group and 76 and 57.4% in the CRT group (χ²=1.670; P=0.196). The median local control in the LAFR group was 17 months, while that in the CRT group was not determined. The 1- and 2-year local control rates were 54.5 and 39% in the LAFR group while those in the CRT group were 82.2 and 66.1% (χ²=3.527; P=0.060). The overall survival and local control rates of the LAFR group were lower than those of the CRT group, although the difference was not significant. The metastasis rates of the two groups were also not significantly different (χ²=0.030; P=0.862). Both acute and late adverse events in the two groups were tolerated. The side effects, including hematological toxicities, severe nausea and vomiting, and severe anorexia were significantly less in the LAFR group than those in the CRT group (P<0.05). In this small--sample exploratory study, the overall survival and local control rates were lower with LAFR than with CRT, but the difference was not significant. Moreover, LAFR was found to have fewer side effects and be more cost--effective compared to CRT. The long--term effects on LAFR survival should be evaluated in a phase III clinical trial.