40 cases of esophageal cancer intensity modulated synchronization docetaxel + cisplatin chemotherapy and radiotherapy efficacy analysis

[Abstract] Objective To investigate the intensity-modulated radiotherapy synchronous multi-docetaxel + cisplatin efficacy and side effects of the treatment of esophageal cancer. Methods A retrospective analysis of 40 patients with intensity modulated synchronization docetaxel + cisplatin chemotherapy and radiotherapy patients with esophageal cancer. SPSS 17 statistical analysis of the short-term effect of this group of patients, the local control rate, survival rate and toxicity results that were lesions effective rate of nearly 95% of 1,2-year survival rate of 80%, 64.5%, 1,2-year local control rate of 89.5%, 77.5%, mildly radioactive reaction: 95% esophagitis, respiratory reaction 82.5%, leukocytes 97.5% the esophagogram length (c2 = 5.909, P = 0.015 survival rate impact factors Conclusion intensity modulated radiation therapy synchronization Dorsey + cisplatin-week program, his race better treatment of esophageal term efficacy and local control rates, although increased toxicity but tolerated.

[Keywords] esophageal cancer intensity modulated radiotherapy same period chemoradiotherapy Dorsey race

[Abstract] Purpose To investigate the curative effect and the toxic side effect of intensity-modulated radiotherapy concurrent with docetaxel plus cisplatin chemoradiotherapy.Methods Retrospective analysis treatment of 40 patients with esophageal cancer who accepted intensity-modulated radiotherapy concurrent with docetaxel plus cisplatin chemoradiotherapy. Analyzed the short-term effect, the local control rate, the survival rate and toxicity of these 40 patients with SPSS 17. Results The effective rate of short-term effect of the 40 cases is 95%, the local control rate for one-year and two-years is 89.5% and 77.5%, the survival rate for one-year and two-years is 80% and 64.5%. Mildly radioactive reaction: Esophagitis 95%, respiratory reaction 82.5%, leukocytes 97.5%, length of esophagography (c2 = 5.909, P = 0.015 was the influencing factors of survival rate. Conclusions For patients with esophageal cancer, intensity-modulated radiotherapy concurrent with docetaxel plus cisplatin chemoradiotherapy lead to better short-term effect and higher local control rate, although increase toxicity but can be tolerated.

[Key word] esophageal cancer IMRT concurrent chemoradiotherapy Duoxitasai

For esophageal high incidence countries, ranking first in the world to lose the majority of patients diagnosed radical resection. Treatment of unresectable esophageal received increasing attention. Concurrent chemotherapy is the standard treatment of unresectable esophageal programs. IMRT (intensity modulated radiation therapy, IMRT is Bjarngard, Kijewski equal to the late 1970s early 1980s, the current radiotherapy technology has shown a survival benefit in head and neck tumors. docetaxel, paclitaxel class anticancer drugs, its complex treatment of breast cancer, non-small cell lung cancer and ovarian cancer have better efficacy and side effects than paclitaxel. now review our hospital 40 patients with esophageal cancer intensity modulated synchronization docetaxel + cisplatin treatment, reported below.

1 Materials and Methods

1.1 General Information

Our hospital from January 2010 to June 2010 to accept intensity-modulated radiotherapy synchronization Dorsey his race + cisplatin chemotherapy in 40 patients including 26 males and 14 females, the male to female ratio of 1.8: l age 46-62 years old, median age of 58 years old. lesions: the cervical two cases, the upper thoracic 10 cases, 28 cases of middle thoracic esophageal imaging Length: 17 cases <5cm, 23 patients> = 5cm clinical stage: Ⅲ 36 cases, Ⅱ of four cases degree of differentiation: grade Ⅰ 1 cases, 22 cases of grade Ⅱ, Ⅲ 17 cases. pathology: squamous cell carcinoma 40 cases of radiation dose 54-63Gy, median dose 59.4Gy. weeks :2-6 weeks of chemotherapy, the median weeks Number of 6 weeks.

1.2 Treatment

Patients were treated with a fixed membrane thickness scan, 64 slice spiral CT5mm positioning image spread Varian plan system using intensity-modulated radiotherapy lays GTV, extroverted 5mm for PGTV References sketched CTV [1], extroverted 5mm PTV. first plan for PTV irradiation DT 50.4 Gy, 5 times / week, 1 times / day, 1.8Gy / times. second plan for PGTV irradiation DT9-12.6Gy, 5 times / week, once / day , 1.8Gy / twice a plan to produce complete, Varian planning system integration, come to a total course of tumor and normal organ radiation dose. plans after assessment by CT verification, the doctor anyway, and began to perform a radiation treatment planning, radiation therapy for the first time to plan the implementation of the completion of sequential second radiation treatment planning, unchanged during treatment centers. program evaluation parameters: lung V20 <27%, V30 <20%, the average dose <13Gy, heart V40 <50%, spinal cord 45Gy more than the amount of volume of less than 1%, and the case features appropriate adjustments. program evaluation methods: two radiotherapy plan fusion group, target area surrounding the conformal degree evaluation first and second respective radiotherapy plan contours and the DVH Figure, the DVH Figure normal organ dose the evaluation twice radiotherapy plan fusion. chemotherapy: cisplatin 40mg / times / week, Dorsey docetaxel 40mg / times / week. radiotherapy began at the same time.

1.3 Evaluation Criteria

Evaluation of tumor foci flinch term evaluation. Complete remission (CR): tumor dissipated to maintain more than four weeks, no new lesions; partial remission (PR): tumor regression in 50% maintained for at least four weeks, no new lesions; without change (NC): tumor regression <50% or increase <25%; disease progression (PD): tumor increases> 25% or new lesions CR plus PR total efficiency. radiation injury graded according to the RTOG acute radiation injury The grading criteria to determine the toxicity was recorded according to the U.S. National Cancer Institute NCI CTC 2.0 version of the anti-cancer drug in acute and subacute toxicity manifestations and grading standards,
Statistical package of 1.4 was used for statistical SPSS17. 0. Survival rate, local control rate was estimated using the life table method, the survival rates compare with the Kaplan Meier method and Logrank test, the survival rate impact factor analysis using COX regression. P <0.05 was considered statistical significance.

1.5 follow-up back to check the use of electronic medical records system, combined with telephone follow-up of patients every 6 months follow-up. Return visit rate of 90%.

2 Results

2.1 The short-term effect

40 patient, the CR8 cases, PR30 cases, SD2 cases, PD0 cases, the total efficiency of RR was 95% (38/40).

2.2 The long-term efficacy

And 2-year survival rate was 80%, 64.5%, the 1,2 year local control rate was 89.5%, 77.5% .2 The median survival time was 34 months. Survival curves shown in Figure 1

2.3 adverse reactions were no obvious hepatic, renal dysfunction, no termination of treatment due to toxicity mild radioactivity reactions: 95% of esophagitis, respiratory reaction 82.5%, leukocytes 97.5% (see Table 2)
Table 240 patients with intensity-modulated radiotherapy same period docetaxel + cisplatin chemotherapy side effects


2.4 prognostic factors

Cox method multivariate analysis show the the esophagogram length (c2 = 5.909, P = 0.015 for survival rate factors. Gender, degree of differentiation, stage, the number of cycles of chemotherapy does not affect the survival rate in Table 3
Table 340 patients with intensity-modulated radiotherapy same period docetaxel + cisplatin chemotherapy side effects

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3 to discuss the current mainstay of treatment for treatment of esophageal cancer is surgical resection and radiation therapy. Concurrent chemoradiotherapy is locally advanced or neck, esophagus patients treatment surrounding normal means local control or the main reason for the failure of the recurrence radiation therapy Intensity Modulated Radiation Therapy (IMRT is one of the world's most advanced radiotherapy technology, high doses of radiation can be given target organ dose is lower, so you can irradiated tumor dose reduction in patients with complications of radiotherapy and intensity modulated radiation therapy in the clinical applications of esophageal reported less review of the literature [2-4] reported esophageal cancer intensity modulated radiotherapy tumor response rate of 90% or more , the group of patients with tumor response rate was 95% recently but the findings related side effects in the treatment of patients increased significantly, but patients could tolerate from the literature [5-6] Road esophageal cancer intensity modulated plans with three-dimensional conformal shaped plan comparison can be seen IMRT irradiated tumor uniformity is poor, the target memory too much high prescription dose region, but the protection of normal organs was significantly better than the three-dimensional conformal radiotherapy. so ICRU83 Document re define the the prescription dose distribution of the target area. This can be explained by the tone observed strong treatment of patients with clinical radiation esophagitis and tracheal injury is significantly higher than the S & P put or three-dimensional conformal radiotherapy patients.

Fewer esophageal intensity-modulated radiotherapy and three-dimensional conformal radiotherapy controlled clinical studies, intensity-modulated radiotherapy in esophageal cancer treatment can bring the survival benefit opinions are not uniform. Qiu Rong, Wang Yuxiang [7-8] of the tone clinical efficacy of radiation therapy and three-dimensional conformal radiotherapy, that: IMRT and 3D-CRT treatment T4 esophageal cancer ,1-3-year local recurrence-free survival advantage is not obvious, there are authors believe [9] intensity modulated radiation therapy can significantly improve esophageal cancer 1-3 year local control rate and survival rate of patients with better protection of normal tissue in this group and 2-year survival rate was 80%, 64.5%, 1,2-year local control rate was 89.5%, similar to the 77.5 percent reported current literature IMRT treatment for esophageal cancer, esophageal tumor length prognostic factors, clinical observation to longer tumor to recur. intensity-modulated radiotherapy carry units of esophageal cancer, longer time of the follow-up, may be able to see clinical benefit. esophagus is a hollow serial organ restricted high-dose irradiation of the tumor, is also not as powerful in the treatment of head and neck tumors displaying IMRT. addition esophageal cancer cause of death about half FarEasTone transfer only more effective drug treatment is essential.

Non-surgical patients with esophageal cancer, concurrent chemotherapy is currently the standard treatment [10] DDP + 5-FU is still considered the standard chemotherapy [11]. Treatment of esophageal cancer drugs in recent years is the most widely used in clinical applications purple shirt class of drugs. paclitaxel is a cycle specific broad-spectrum anti-cancer drugs, and radiosensitizer role. generally believed that paclitaxel radiosensitization concentration of 10 ~ 100 nmol / L, paclitaxel tumor cells 12 ~ 24 h after the delay radiation therapy increased sensitization relatively large, therefore the extension of low concentrations of paclitaxel the continuing role of time, can achieve therapeutic purposes and reduce treatment related toxic Vice reaction. Wu Ling-British [12] study of paclitaxel weekly therapy program in the treatment of ovarian cancer than advantage of monthly therapy slightly lower toxicity of strength. pharmacological effects of docetaxel than paclitaxel, and anti-tumor activity of paclitaxel 1.3 to 12 times, cardiovascular toxicity than paclitaxel [13] The study found that the intensity modulated radiation therapy be weekly dose of docetaxel plus cisplatin chemotherapy in gastrointestinal reactions gastrointestinal reactions decreased significantly over the past month program of paclitaxel and cisplatin, effective and reliable.

Intensity modulated radiation therapy synchronization docetaxel + cisplatin weeks in the treatment of esophageal cancer-term efficacy and better local control rate, but compared with three-dimensional conformal radiotherapy did not improve the local control, although the increase in toxicity but can tolerate, treatment plan evaluation application of the ICRU 83 document as soon as possible, the control target dose homogeneity in the region, to reduce IMRT acute injury. concurrent chemotherapy for adjuvant chemotherapy should continue to reduce the far turn, may improve the survival rate of esophageal cancer treatment.

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