title: Late-course accelerated hyperfractionated radiotherapy for localized esophageal carcinoma.
abstract: OBJECTIVE
  To evaluate the long-term survival results and patterns of failure for localized carcinoma of the esophagus receiving late-course accelerated hyperfractionated (LCAF) radiotherapy (RT).
  
  
  METHODS
  We studied 201 patients with histologically confirmed squamous cell carcinoma of the esophagus who were treated with LCAF RT between August 1994 and January 2000. The design of the radiation fields was based on the diagnosis by computed tomography and barium examination. All patients received conventionally fractionated RT at 1.8 Gy/d, five fractions weekly for the first two-thirds of treatment to a dose of about 41.4 Gy in 23 fractions within 4-5 weeks. This was followed by LCAF RT using reduced fields, 1.5 Gy/fraction twice daily with a 6-h interval between fractions, to a dose of about 27 Gy within 9 days. Thus, the total dose was 68.4 Gy in 41 fractions within 44 days.
  
  
  RESULTS
  The incidence of Grade 3-5 acute radiation-induced bronchitis was 4.0% (8 cases), 3.0% (6 cases), and 0%, respectively. The incidence of Grade 3-5 acute radiation-induced esophagitis was 14.9% (30 cases), 0.5% (1 case), and 0%. Ten patients (5%) died of late complications. The 1-year, 3-year, and 5-year overall survival rate was 73%, 34%, and 26%, respectively. The 1-year, 3-year, and 5-year local control rate was 77%, 58%, and 56%, respectively. The main site of first failure was locoregional failure and distant metastasis (including lymph node metastasis from regional recurrence). Of 201 patients, 77 (38.4%) had local disease alone or with distant metastasis as the first failure, and 70 patients (34.9%) had distant metastasis and/or lymph node metastasis alone or with local failure as the first failure.
  
  
  CONCLUSIONS
  The LCAF regimen offers similar local control and survival to standard chemotherapy plus RT, such as was delivered in the Radiation Therapy Oncology Group studies 85-01 and 94-05.
authors.affiliation: Department of Radiation Oncology, Cancer Hospital, Fudan University, Shanghai 200032, People's Republic of China. kuaile_z@sina.com
authors.forename: Kuai-Le
authors.initials: KL
authors.lastname: Zhao
authors.forename: Xue-Hui
authors.initials: XH
authors.lastname: Shi
authors.forename: Guo-Liang
authors.initials: GL
authors.lastname: Jiang
authors.forename: Yang
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D004938:Esophageal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D017211:Treatment Failure