Objective: To analyse the result of late course accelerated hyper-fractionated radiotherapy (LCAHFR) of upper and middle thoracic segment esophageal T2N0M0 carcinoma.
Methods: Fifty-three patients with squamous cell esophageal T2N0M0 carcinoma in the upper and middle segment were treated by LCAHFR from August 1994 to January 2000. The design of the radiation fields were based on CT and barium examination. All patients were treated with the conventional fractionated radiotherapy during the first two-thirds of the treatment to a dose about 41.4 Gy/23 F/4 to 5 weeks. This was followed by accelerated hyper-fractionated irradiation using reduced fields, twice daily at 1.5 Gy per fraction to a dose about 27 Gy/18 d. Thus, the total dose was 67-70 Gy/40-43 F/40-49 d.
Results: The 1-, 2- and 5-year actuarial survival rates were 89.9%, 66.8% and 51.2%, respectively. The 1-, 2- and 5-year local control rates were 92.1%, 87.1% and 87.1%. Of the 17 patients who died, 5 died of local failure (29.4%), 9 (52.9%) of distant metastasis, 5 (29.4%) of lymph metastasis and 1 (5.9%) of bleeding from the esophagus. The Cox multivariate model showed that the site of lesion was the only prognostic factor, with upper better than the middle segment.
Conclusion: Late course accelerated hyper fractionated radiotherapy is one of the best radiation treatment regimen for early esophageal carcinoma in the upper and middle thoracic segment.