Eleven patients (55%) died, 9 patients (45%) are alive. The 5 years overall survival rate was 38.1%. Figure 2 Overall survival of the 20 patients enrolled in the study Discussion In patients
with esophageal cancer, radiation dose and dose-intensity of radiotherapy can be increased using hyperfractionated accelerated RT, without prolonging the duration of neoadjuvant chemoradiotherapy following two courses of induction chemotherapy. Table 4 shows previous neoadjuvant radiotherapy plus concurrent chemotherapy studies. Our results indicate that in this patient group, it is possible to achieve encouraging local control and survival rates with appropriate Inhibitors,research,lifescience,medical chemotherapy and hyperfractionated accelerated radiotherapy. Accelerated fractions previously used generally include those dose schedules that consisted of hyperfractionated accelerated RT (HART),
continuous hyperfractionated accelerated Inhibitors,research,lifescience,medical RT (CHART), concomitant boost RT, and late course accelerated fractionated RT (LCAF). In 1993, Kikuchi (6) reported his results with HART for the treatment of esophageal cancer with 6200-6400 cGy in 40 fractions that were given in 4.5 weeks. The 5-year local control and survival rates were superior compared to the control group (57.2% vs. 31.5%, P˂0.05). Powel et al. (7) used short-term Inhibitors,research,lifescience,medical intensive accelerated fractions in 24 subjects, MEK inhibitor followed by 3 daily fractions (150 cGy per fraction) given with 6-hour Inhibitors,research,lifescience,medical intervals for a total of 12 days to achieve a total dose of 5400 cGy. On average, dysphagia emerged after 7.8 months (0-41.4 months) in the CHART group, as compared to 5.5 months (0-48 months) in the controls. The mean duration of survival was 12 months (0.5-112 months) in the CHART group and 15 months (3.6-56 months) among the controls. The 3-year cause-specific survival rates were 40%, 22%, and 6% in T1, T2, and Inhibitors,research,lifescience,medical T3 patients, respectively. Table 4 Neoadjuvant radiotherapy plus concurrent chemotherapy studies Table 5 shows a comparison of several Phase II and III studies in terms of the radiation dose applied, biological effective doses, chemotherapy schedules according to pathological complete response (pCR), operational mortality, median survival,
and 3-year survival rates (8-17). Despite significant differences in patient cohorts and tumor- and patient-related parameters, the studies were examined with regard to BED and pCR ratios. If pCR is regarded as a meaningful marker of radiation dose after neoadjuvant CRT, then the pCR ratio increases along with the increase in the corrected-dose based Bumetanide on BED calculation (α/β ratio is 10, and α is 0.3 for the time-dependent tumor proliferation). Examination of the RT in these studies reveals a pCR ratio of 10% with 1850 cGy (2000 cGy/10 fr/2wk) of BED, while the corresponding figure is 26% with a BED of 3900 cGy (4400 cGy/22 fr/4.4 wk) and 28% with a BED of 4600 cGy (4500 cGy/30 fr/3 wk). Table 5 The relation between radiation dose and pathological complete response In the study by Choi et al.
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