ABSTRACT
Objective@#To investigate the efficiency and safety of hypofractionated radiotherapy (HFR) combined with chemotherapy using paclitaxel for the treatment of esophageal cancer (EC) patients with post-operative tracheoesophageal groove lymph node (TGLN) metastasis.@*Methods@#A total of fifty-three post-operative EC patients with TGLN metastasis were randomly divided into HFR group (n=25), receiving a radiation of 60 Gy/20 fractions, and conventional fractionated radiotherapy (CFR) group (n=28), receiving a radiation of 60 Gy/30 fractions combined with chemotherapy using paclitaxel with a dosage of 50 mg once per week through tossing a coin. the adverse events and the prognosis between two groups were compared.@*Results@#The incidence of radiation esophagitis and pneumonitis (grade 3-4) between the HFR group and CFR group showed no statistically significant difference (44.0%, 25.0%, P>0.05; 16.0%, 7.1%, P>0.05). No statistical difference was noticed in the efficiency between the HFR group and the CFR group (P>0.05). The efficiency in patients with lymph node metastasis at diameters ≤2 cm was significantly higher than that with lymph node metastasis at diameters >2 cm (P<0.05). The median overall survival (OS) of the HFR group showed a significant increase compared with that of the CRF group [24.2 months (95%CI 16.2-32.1 months) vs. 11.8 months (95%CI 9.2-14.4 months)] (χ2=5.063, P<0.05). Both univariate and multivariate analysis indicated that TGLN diameter (P<0.05) and fractioned types (P<0.05) were factors that affected the prognosis.@*Conclusions@#The combination of HFR and chemotherapy contributed to the improvement of prognosis in EC patients with TGLN metastasis and there was no obvious increase in the adverse events.@*Trial registration@#Chinese clinical trial registry, ChiCTR1800016848
ABSTRACT
Objective: To observe the efficacy and adverse events of high-dose hypofractioned radiotherapy with referencing PET to delineate target areas for patients with pancreatic cancer. Methods: The patients with pathologically-diagnosed stage III primary pancreatic cancer were recruited in this study. All patients underwent PET/CT examination before treatment. PET image was merged to CT image to delineate target areas. The dose mode was 50 Gy for planning target volume (PTV) and 65-70 Gy for gross tumor volume (GTV) in 15-25 fractions with tomotherapy system (TOMO). The efficacy and toxicity of the treatment were observed during follow-up. The survival analysis was conducted. Results: Of 31 patients with pancreatic cancer, 19 were males, and 12 were females; the median age was 60 years; the median volume of tumor was 51.66 cm3. The short-term local control rate was 87.1%, and the rate of cancer pain relief was 92.3%. Grade 3 acute hematologic toxicity was observed in one case (3.2%) and grade 3 digestive tract side reaction was observed in one case (3.2%). Grade 3 later digestive tract side reaction was observed in 3 cases (9.7%). The median follow-up time was 24 months. The median survival time was 15 months, and one-year survival rate was 52.4%. Survival analysis showed that age, KPS score and concurrent chemoradiotherapy were independent prognostic factors (all P < 0.05). Conclusion: Delineating target areas based on PET image may be beneficial to improve the prognosis of patients with pancreatic cancer receiving high-dose hypofractioned radiotherapy.