Adams R, Morgan M, Mukherjee S, Brewster A, Maughan T, Morrey D, Havard T, Lewis W, Clark G, Roberts S, Vachtsevanos L, Leong J, Hardwick R, Carey D, Crosby T
Velindre Cancer Centre, Velindre Road, Whitchurch, Cardiff CF14 2TL, UK.
Eur J Surg Oncol. 2007 Apr;33(3):307-13. doi: 10.1016/j.ejso.2006.10.026. Epub 2006 Nov 22.
Combined modality therapy (with chemotherapy+/-radiotherapy) has become a standard treatment for locally advanced oesophageal cancer. However, there appears to be no compelling evidence for one treatment type or combination to suit all and at this time the clinical multi-disciplinary team (MDT) forms an important role in selecting optimal therapies for the individual. This prospective comparison in one cancer network, looks at the outcomes of this decision making process.
Over a five year period 1998-2003, data were prospectively collected on all 330 consecutive patients, referred to a tertiary specialised MDT for whom curative treatment was the planned intent. Patients were managed according to an agreed local protocol and allocated to receive one of 5 treatments: surgery alone (S), pre-operative chemotherapy (C+S), pre-operative chemo-radiotherapy (CRT+S), definitive chemo-radiotherapy (CRT) and radiotherapy alone (RT).
The 2 and 5 year survival for all patients receiving potentially curative treatment were 49% and 26% respectively. With 2 and 5 year survival for S, CRT+S, C+S, CRT and RT being 53,21; 57,40; 37,27; 50,27; 23,0 months respectively. Of the surgical therapies, mortality was highest in the CRT+S group, versus C+S and S; 12.5%, 1.6%, 4.5% respectively (p=0.025). Non-surgical based therapies had more than double the incidence of local relapses compared to surgical based therapies; however the CRT group had an overall survival comparable with S alone. The commonest sites of distant relapse were liver (56%), lung (38%), bone (32%) and non-regional lymph nodes (24%).
The results suggest that in patients who are deemed unfit for surgical intervention, definitive chemoradiotherapy remains a viable alternative; they also lend further support to selected case triple modality therapy. These areas should be further examined in the context of randomised controlled phase III trials.
综合治疗（化疗±放疗）已成为局部晚期食管癌的标准治疗方法。然而，似乎没有令人信服的证据表明有一种治疗类型或组合适用于所有患者，目前临床多学科团队（MDT）在为个体选择最佳治疗方案中发挥着重要作用。本癌症网络中的前瞻性比较研究着眼于这一决策过程的结果。
在1998年至2003年的五年期间，前瞻性收集了连续330例患者的数据，这些患者被转诊至三级专科MDT，计划进行根治性治疗。患者按照商定的当地方案进行管理，并被分配接受以下5种治疗之一：单纯手术（S）、术前化疗（C+S）、术前放化疗（CRT+S）、根治性放化疗（CRT）和单纯放疗（RT）。
所有接受潜在根治性治疗的患者的2年和5年生存率分别为49%和26%。S、CRT+S、C+S、CRT和RT的2年和5年生存率分别为53、21；57、40；37、27；50、27；23、0个月。在手术治疗中，CRT+S组的死亡率最高，与C+S组和S组相比，分别为12.5%、1.6%、4.5%（p=0.025）。与基于手术的治疗相比，非手术治疗的局部复发率高出一倍多；然而，CRT组的总生存率与单纯S组相当。远处复发最常见的部位是肝脏（56%）、肺（38%）、骨（32%）和非区域淋巴结（24%）。
结果表明，对于被认为不适合手术干预的患者，根治性放化疗仍然是一种可行的选择；它们也进一步支持了特定病例的三联疗法。这些领域应在随机对照III期试验的背景下进一步研究。
Zotero 插件