Shimoyama S, Aoki F, Kojima J, Kaminishi M
Third Department of Surgery, Faculty of Medicine, University of Tokyo, Japan.
Hepatogastroenterology. 1999 Jul-Aug;46(28):2409-13.
BACKGROUND/AIMS: A combination of chemotherapy and radiotherapy (chemoradiation therapy) has recently been developed for the treatment of non-operable esophageal cancer patients. Chemoradiation therapy is based on the concept of biochemical modulation effects and radiosensitizing effects of chemotherapeutic agents. However, the optimal choice of chemotherapeutic agents and their doses, as well as chemotherapy and radiotherapy regimens have not been precisely established.
Based on our recent experience of an effective chemoradiation therapy protocol which consisted of 5-fluorouracil (5-FU) combined with daily concurrent cisplatin and radiation, in addition to the recent knowledge on the biochemical modulation between 5-FU and cisplatin or between leucovorin and 5-FU, we have developed a complete daily concurrent chemoradiation therapy for non-operated esophageal cancer as a treatment modality with curative intent.
We report here a novel intensive concurrent chemoradiation protocol by which complete response could be achieved. A low dose of 5-FU (250 mg/body/day) was continuously infused over 24 hours followed by leucovorin (30 mg/body), and a low dose of daily cisplatin (5 mg/body) was administered 1 hour before radiotherapy (2 Gy/day). The administration schedule was 5 consecutive days, followed by a 2-day withdrawal, and then repeated weekly for 4 weeks.
Our completely daily concurrent chemoradiation therapy is rational, effective, and safe, because an endoscopically and pathologically complete response without severe side effects was able to be achieved and this has continued for at least 6 months after chemoradiation therapy. Therefore, we believe that our completely daily concurrent chemoradiation therapy can be recommended for non-operated esophageal cancer patients.
背景/目的：化疗与放疗联合（放化疗）最近已被用于不可手术切除的食管癌患者的治疗。放化疗基于化疗药物的生化调节作用和放射增敏作用的概念。然而，化疗药物的最佳选择及其剂量，以及化疗和放疗方案尚未精确确定。
基于我们近期采用5-氟尿嘧啶（5-FU）联合每日顺铂同步放疗的有效放化疗方案的经验，以及近期关于5-FU与顺铂之间或亚叶酸与5-FU之间生化调节的知识，我们开发了一种针对未手术食管癌的每日全程同步放化疗方案，作为一种具有治愈意图的治疗方式。
我们在此报告一种新型的强化同步放化疗方案，通过该方案可实现完全缓解。低剂量的5-FU（250mg/体/天）在24小时内持续输注，随后给予亚叶酸（30mg/体），低剂量的每日顺铂（5mg/体）在放疗前1小时（2Gy/天）给药。给药方案为连续5天，随后停药2天，然后每周重复，共4周。
我们的每日全程同步放化疗是合理、有效且安全的，因为能够实现内镜及病理完全缓解且无严重副作用，并且在放化疗后至少持续了6个月。因此，我们认为我们的每日全程同步放化疗可推荐用于未手术的食管癌患者。
