Abstract:

Objective To compare the clinical efficacy of helical tomotherapy in the treatment of esophageal cancer， explore its influence on nutrition status， blood routine indexes， inflammatory factors and immune function， and analyze its safety. Methods A total of 124 patients with esophageal cancer treated in Liyang People's Hospital of Jiangsu Province from May 2021 to April 2023 were selected as the study objects， and the patients were divided into the helical tomotherapy group （n=62） and the modulated arc therapy group （n=62） according to random number table method. The clinical efficacy， nutritional status [transferrin （TRF）， prealbumin （PAB）， serum albumin （ALB）]， blood routine indexes [hemoglobin （HGB）， neutrophils count， white blood cells （WBC） count， platelets count]， the inflammatory factors [C-reactive protein （CRP）， interleukin （IL）-6， IL-18， tumor necrosis factor-α （TNF-α）]， immune function indexes [CD3⁺ T cells， CD4⁺ T cells， CD4⁺ T cells /CD8⁺ T cells ratio， natural killer （NK） cells]， and the rate of adverse reactions were statistically analyzed. Results The disease control rate of treatment in the helical tomotherapy group （88.71%， 55/62） was significantly higher than that in the modulated arc therapy group （74.19%， 46/62）， with a statistically significant difference （χ²=4.32， P=0.038）. After treatment， TRF [（178.42±19.24） µg/dl vs. （171.27±18.19） µg/dl， t=2.13， P=0.035]， PAB [（0.37±0.11） g/L vs. （0.31±0.09） g/L， t=3.32， P=0.001]， ALB [（4.25±0.52） g/dl vs. （4.01±0.58） g/dl， t=2.43， P=0.017] in the helical tomotherapy group were higher than those in the modulated arc therapy group， with statistically significant differences. After treatment， HGB [（125.49±13.87） g/dl vs. （112.37±14.49） g/dl， t=5.21， P<0.001] in the helical tomotherapy group were higher than those in the modulated arc therapy group； neutrophils count [（4.91±0.75）×10⁹/L vs. （5.37±0.84）×10⁹/L， t=3.22， P=0.002]， WBC count [（4.96±0.52）×10⁹/L vs. （5.26±0.61）×10⁹/L， t=2.95， P=0.004]， platelets count [（227.15±25.38）×10⁹/L vs. （241.37±26.91）×10⁹/L， t=3.03， P=0.003] in the helical tomotherapy group were lower than those in the modulated arc therapy group， with statistically significant differences. After treatment， CRP [（7.76±0.84） mg/dl vs. （8.11±1.01） mg/dl， t=2.10， P=0.038]， IL-6 [（6.47±0.81） µg/L vs. （7.16±0.93） µg/L， t=4.41， P<0.001]， IL-18 [（191.01±23.14） µg/L vs. （201.62±22.96） µg/L， t=2.56， P=0.012，） and TNF-α [（3.65±0.41） µg/L vs. （3.82±0.43） µg/L， t=2.25， P=0.026] in the helical tomotherapy group were lower than those in the modulated arc therapy group， with statistically significant differences. After treatment， the proportion of CD3⁺ T cells [（41.27±5.45） % vs.（35.48±5.17） %， t=6.07， P<0.001]， the proportion of CD4⁺ T cells [（36.11±4.49） % vs. （29.24±9.52） %， t=9.48， P<0.001]， CD4⁺ T cells /CD8⁺ T cells ratio （1.35±0.19 vs. 1.21±0.13， t=4.79， P<0.001）， the proportion of NK cells [（14.68±2.79） % vs. （12.37±1.86） %， t=5.42， P<0.001] in the helical tomotherapy group were higher than those in the modulated arc therapy group， with statistically significant differences. The rate of adverse reactions in the helical tomotherapy group （80.65%， 50/62） was significantly lower than that in the modulated arc therapy group （93.55%， 58/62）， with a statistically significant difference （χ²=4.59， P=0.032）. Conclusion Helical tomotherapy is more effective than modulated arc therapy in the treatment of esophageal cancer， which can improve nutrition levels， reduce immunity decline， and has high safety.

Key words: Esophageal neoplasms, Radiotherapy， computer-assisted, Treatment outcome