术前使用紫杉醇、顺铂、5-氟尿嘧啶并联合放疗的强化综合治疗方案用于可切除食管癌的生存情况：一项I期报告
Survival following intensive preoperative combined modality therapy with paclitaxel, cisplatin, 5-fluorouracil, and radiation in resectable esophageal carcinoma: a phase I report.
作者信息
Goldberg Melvyn, Farma Jeffrey, Lampert Craig, Colarusso Patrick, Coia Lawrence, Frucht Harold, Goosenberg Eric, Beard Mary, Weiner Louis M
机构信息
Fox Chase Cancer Center, Division of Thoracic Surgical Oncology, 7701 Burholme Ave, Philadelphia, PA 19111, USA.
出版信息
J Thorac Cardiovasc Surg. 2003 Oct;126(4):1168-73. doi: 10.1016/s0022-5223(03)00977-2.
PURPOSE
To assess the benefits of aggressive chemoradiation therapy followed by surgery in resectable esophageal carcinoma.
METHOD
Twenty-nine patients with resectable carcinoma were treated with 60 Gy of radiation (2 Gy daily for 6 weeks) and concurrent chemotherapy consisting of continuous infusion of 5-fluorouracil (200-225 mg/m(2)/d), paclitaxel (25, 40, 50, or 60 mg/m(2)) weekly over 1 hour, and cisplatin (25 mg/m(2)) weekly immediately following paclitaxel throughout radiation. Patients received either 4 cycles of postoperative paclitaxel 175 mg/m(2) over 3 hours and cisplatin 75 mg/m(2) every 3 weeks or paclitaxel 175 mg/m(2) over 3 hours and cisplatin 75 mg/m(2) every 3 weeks prior to the initiation of chemoradiation. After induction therapy and restaging, esophagectomy was performed 4 to 6 weeks later.
RESULTS
Twenty-seven patients were eligible for study (26 men, 23 with adenocarcinoma). Median age was 58 years (range 30-73). The maximum tolerated dose combination was paclitaxel 50 mg/m(2) over 1 hour weekly, cisplatin 25 mg/m(2) over 1 hour weekly, 5-fluorouracil 200 mg/m(2)/d by continuous infusion throughout radiotherapy and radiation to 60 Gy. Twenty-two patients completed therapy and underwent surgical resection. Four patients had complete pathological responses and 18 had partial responses with no mortality. The commonest dose-limiting toxicity was mucositis and esophagitis (n = 7). Median follow-up of 27 patients was 150 weeks (range 7-303). At 2-year follow-up 16/27 (59%) were alive and 15/27 (56%) were free of disease. At 4-year follow-up 12/27 (44%) were alive and free of disease. Median follow-up of 22 patients undergoing esophagectomy was 205 weeks (range 26-303). At 4-year follow-up 10/22 (45%) were alive and free of disease. For the 18 patients treated at or above the maximum tolerated dose, median follow-up was 151 weeks (range 35-206) and at 3-year follow-up 9/18 (50%) were alive and free of disease.
CONCLUSION
Aggressive combined modality therapy of esophageal carcinoma was associated with excellent long-term survival in this phase I trial.
目的
评估在可切除食管癌中先行积极放化疗再行手术的益处。
方法
29例可切除癌患者接受60 Gy放疗（每日2 Gy，共6周），同时进行化疗，包括持续输注5-氟尿嘧啶（200 - 225 mg/m²/d）、每周1小时静脉滴注紫杉醇（25、40、50或60 mg/m²）以及在整个放疗期间紫杉醇滴注后立即每周静脉滴注顺铂（25 mg/m²）。患者在术后接受4个周期的紫杉醇175 mg/m²静脉滴注3小时和顺铂75 mg/m²每3周一次，或者在放化疗开始前接受紫杉醇175 mg/m²静脉滴注3小时和顺铂75 mg/m²每3周一次。诱导治疗及重新分期后，4至6周后进行食管切除术。
结果
27例患者符合研究条件（26例男性，23例腺癌）。中位年龄为58岁（范围30 - 73岁）。最大耐受剂量组合为每周1小时静脉滴注紫杉醇50 mg/m²、每周1小时静脉滴注顺铂25 mg/m²、放疗期间持续输注5-氟尿嘧啶200 mg/m²/d以及放疗至60 Gy。22例患者完成治疗并接受手术切除。4例患者达到完全病理缓解，18例部分缓解，无死亡病例。最常见的剂量限制性毒性为黏膜炎和食管炎（n = 7）。27例患者的中位随访时间为150周（范围7 - 303周）。在2年随访时，27例中有16例（59%）存活，27例中有15例（56%）无疾病。在4年随访时，27例中有12例（44%）存活且无疾病。22例行食管切除术患者的中位随访时间为205周（范围26 - 303周）。在4年随访时，22例中有10例（45%）存活且无疾病。对于18例接受最大耐受剂量或以上治疗的患者，中位随访时间为151周（范围35 - 206周），在3年随访时，18例中有9例（50%）存活且无疾病。
结论
在这项I期试验中，食管癌积极联合治疗模式与良好的长期生存相关。
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