Stuschke M, Stahl M, Wilke H, Walz M, Oldenburg A, Stüben G, Seeber S, Sack H
Department of Radiotherapy, University of Essen, Germany.
Am J Clin Oncol. 2000 Jun;23(3):233-8. doi: 10.1097/00000421-200006000-00004.
The purpose of this study was to evaluate the efficacy and toxicity of an induction chemotherapy schedule followed by high-dose radiotherapy and concurrent chemotherapy for locally advanced squamous cell carcinomas of the upper and midthoracic esophagus. Patients were treated with three courses of fluorouracil, leucovorin, etoposide, and cisplatin-containing induction chemotherapy followed by high-dose external beam radiotherapy to 65 Gy in 6 weeks for T4 and obstructing T3 tumors. Transversable T3 tumors received 60 Gy in 6 weeks by external radiotherapy, followed by two high-dose-rate esophageal brachytherapy fractions of 4 Gy in 5-mm tissue depth. Concurrent to radiotherapy, cisplatin and etoposide were given. Long-term survival of 22 patients was 41% and 31% at 2 and 3 years, respectively, with a median follow-up of 39 months. The probability of locoregional tumor recurrence was 60% at 3 years for all patients and 30% for those with a partial or complete response to induction chemotherapy. Acute toxicity of this schedule was moderate. Long-term survivors had a good swallowing function. This schedule offers a considerable chance of long-term survival for patients with locally advanced squamous cell carcinomas of the upper and midthoracic esophagus. Local in-field recurrences are the main risk after definitive radiochemotherapy. Dose escalation of radiotherapy is possible because of the observed low late toxicity.
本研究的目的是评估诱导化疗方案联合大剂量放疗及同步化疗用于治疗胸上段和胸中段局部晚期食管鳞状细胞癌的疗效和毒性。患者接受三个疗程含氟尿嘧啶、亚叶酸钙、依托泊苷和顺铂的诱导化疗，随后对于T4及梗阻性T3肿瘤给予6周内65 Gy的大剂量外照射放疗。可切除的T3肿瘤通过外照射放疗在6周内给予60 Gy，随后给予两剂组织深度5 mm、剂量率为4 Gy的高剂量率食管近距离放疗。放疗同步给予顺铂和依托泊苷。22例患者的2年和3年长期生存率分别为41%和31%，中位随访时间为39个月。所有患者3年时局部区域肿瘤复发概率为60%，诱导化疗部分或完全缓解的患者为30%。该方案的急性毒性为中度。长期生存者吞咽功能良好。该方案为胸上段和胸中段局部晚期食管鳞状细胞癌患者提供了相当大的长期生存机会。根治性放化疗后主要风险是局部野内复发。鉴于观察到的低晚期毒性，放疗剂量递增是可行的。
