Chan R, Morrill S, Freeman D, Colman M, Zwischenberger J
Department of Radiation Oncology, University of Texas Medical Branch at Galveston, Galveston, TX 77555-0711, USA.
Dis Esophagus. 2001;14(3-4):202-7. doi: 10.1046/j.1442-2050.2001.00185.x.
The purpose of the study was to investigate the difference in overall survival in patients with localized carcinoma of esophagus treated using chemo-radiation (bi-modality, BM) or chemo-radiation followed by surgery (tri-modality, TM). From 1981 to 1999, 65 patients were identified who had localized carcinoma of the esophagus treated with either concurrent chemo-radiation (BM, n=22) or concurrent chemo-radiation followed by surgery (TM, n=43) at the University of Texas Medical Branch at Galveston. All 65 patients received concurrent chemotherapy and external beam radiation. Radiation was delivered by linear accelerators (greater-than-or-equal 6 MV), except in one patient who had part of his treatment given by a Co-60 machine. Chemotherapy consisted of 5-fluorouracil and cisplatin plus minus vinblastine under different regimens. Median follow-up time was 10 months (range=1-195 months) for all patients. Of the 14 patients still alive, the median follow-up time was 32 months (range=2-192 months). No difference in overall survival was detected between the two treatment groups, BM vs. TM (P=0.394) despite a selection bias favoring the TM group. Five-year survival rates of the BM and TM groups were 17% and 18%, respectively; 10-year survival rates were 17% and 12%, respectively. The presence of significant past medical history (P=0.017) and a complete pathologic response in the TM group (P < 0.001) were significant independent predictors of survival. We did not find any difference in survival between chemo-radiation or chemo-radiation followed by surgery in patients with localized carcinoma of the esophagus. Use of biologic markers and functional imaging should be explored in order to segregate patients with different tumor biology for treatment using different treatment strategies.
本研究的目的是调查接受化疗联合放疗（双模式，BM）或化疗联合放疗后手术（三模式，TM）治疗的局限性食管癌患者的总生存率差异。1981年至1999年期间，在加尔维斯顿的德克萨斯大学医学分校，确定了65例接受同步化疗联合放疗（BM，n = 22）或同步化疗联合放疗后手术（TM，n = 43）治疗的局限性食管癌患者。所有65例患者均接受了同步化疗和外照射放疗。放疗由直线加速器（≥6 MV）进行，除1例患者部分治疗使用钴-60机器外。化疗由5-氟尿嘧啶和顺铂加或不加长春碱组成，采用不同方案。所有患者的中位随访时间为10个月（范围 = 1 - 195个月）。在14例仍存活的患者中，中位随访时间为32个月（范围 = 2 - 192个月）。尽管存在有利于TM组的选择偏倚，但在两个治疗组（BM与TM）之间未检测到总生存率的差异（P = 0.394）。BM组和TM组的5年生存率分别为17%和18%；10年生存率分别为17%和12%。显著的既往病史（P = 0.017）和TM组的完全病理缓解（P < 0.001）是生存的显著独立预测因素。我们未发现局限性食管癌患者接受化疗联合放疗或化疗联合放疗后手术在生存率上存在任何差异。应探索使用生物标志物和功能成像，以便区分具有不同肿瘤生物学特性的患者，采用不同的治疗策略进行治疗。
