Kumekawa Yosuke, Kaneko Kazuhiro, Ito Hiroaki, Kurahashi Toshinori, Konishi Kazuo, Katagiri Atsushi, Yamamoto Taikan, Kuwahara Meiko, Kubota Yutaro, Muramoto Takashi, Mizutani Yoshihide, Imawari Michio
Second Department of Internal Medicine, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan.
J Gastroenterol. 2006 May;41(5):425-32. doi: 10.1007/s00535-006-1771-8.
We retrospectively investigated long-term toxicity after concurrent chemoradiotherapy (CRT) for patients with esophageal squamous cell carcinoma (ESCC).
Concurrent chemoradiotherapy was performed in 110 patients with T1 to T4 disease containing M1 lymph node (LYM) disease. Chemotherapy consisted of protracted infusion of 5-fluorouracil 400 mg/m(2) per 24 h on days 1 to 5 and 8 to 12, combined with 2-h infusion of cisplatin 40 mg/m(2) on days 1 and 8. Radiation treatment of the mediastinum at a dose of 30 Gy in 15 fractions was administered concomitantly with chemotherapy. A course schedule with a 3-week treatment and a 2-week break was applied twice, with a total radiation dose of 60 Gy. For the assessment of toxicity, the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer late radiation morbidity scoring schema was adopted.
A total of 81 patients were recruited in patients with stage I to IVA. Of 34 patients with complete response, 1 patient died as a result of acute myocardial infarction. Grade 2, 3, and 4 late toxicities occurred with the following incidences: pericarditis in 3 patients, 1 patient, and 2 patients, respectively; heart failure in 0, 0, and 3 patients; pleural effusion in 2, 3, and 0 patients; and radiation pneumonitis in 0, 0, and 1 patient, respectively.
Definitive chemoradiotherapy for ESCC is effective with substantial toxicities. Further investigation is warranted to minimize the normal tissue toxicities.
我们回顾性研究了食管鳞状细胞癌（ESCC）患者同步放化疗（CRT）后的长期毒性。
对110例患有T1至T4期疾病（包括M1淋巴结（LYM）疾病）的患者进行同步放化疗。化疗方案为在第1至5天和第8至12天持续输注5-氟尿嘧啶400mg/m²，每24小时一次，并在第1天和第8天联合2小时输注顺铂40mg/m²。纵隔放疗剂量为30Gy，分15次进行，与化疗同步进行。采用3周治疗、2周休息的疗程安排，共进行两次，总放疗剂量为60Gy。采用放射治疗肿瘤学组/欧洲癌症研究与治疗组织晚期放射并发症评分方案评估毒性。
共纳入81例I至IVA期患者。在34例完全缓解的患者中，1例因急性心肌梗死死亡。2级、3级和4级晚期毒性的发生率如下：心包炎分别为3例、1例和2例；心力衰竭分别为0例、0例和3例；胸腔积液分别为2例、3例和0例；放射性肺炎分别为0例、0例和1例。
ESCC的根治性同步放化疗有效，但毒性较大。有必要进一步研究以尽量减少正常组织的毒性。
