de Manzoni Giovanni, Pedrazzani Corrado, Pasini Felice, Bernini Marco, Minicozzi Anna Maria, Giacopuzzi Simone, Grandinetti Antonio, Cordiano Claudio
First Department of General Surgery, University of Verona, Verona, Italy.
J Surg Oncol. 2007 Mar 1;95(3):261-6. doi: 10.1002/jso.20640.
The role of surgery for esophageal squamous cell carcinoma (SCC) with clinical evidence of adjacent organ invasion (cT4) is a debated issue. This study was aimed at analyzing our experience with chemoradiotherapy (CRT) followed by surgery as treatment for non-metastatic cT4 SCC of the thoracic esophagus.
The results of 51 patients consecutively treated at the First Department of General Surgery, University of Verona, from January 1987 to December 2004 were analyzed.
The most frequently clinically involved structures were the trachea (43.1%), the main left bronchus (17.6%), and the thoracic aorta (15.7%). CRT was completed in all but one of the patients (98.0%) without toxicity-related deaths. After completion of induction treatment 49 patients underwent surgery (96.1%), and resection was possible in 40 patients (78.4%) but R0 surgery was rarely obtained (39.2%). Pathologic downstaging was achieved in 18 cases (35.3%) while a major response (responders) was observed in 10 patients (19.6%) and a complete response (pT0N0) in 7 (13.7%). The overall median survival time was 11.1 months with a 3-year survival rate of 8.8%. A significantly better survival (P < 0.001) was observed after a R0 resection (median: 22.3 months; 3-year survival: 25.4%; P < 0.001) and for responders (median: 33.1 months; 3-year survival: 25.7%; P = 0.019).
Aggressive multi-modal therapy with CRT followed by surgery in cT4 SCC of the thoracic esophagus is feasible. Surgery should be limited to patients with significant response to induction treatment and a high probability of R0 resection.
对于有邻近器官侵犯临床证据（cT4）的食管鳞状细胞癌（SCC），手术的作用是一个存在争议的问题。本研究旨在分析我们采用化疗放疗（CRT）后行手术治疗胸段食管非转移性cT4 SCC的经验。
分析了1987年1月至2004年12月在维罗纳大学第一普通外科连续治疗的51例患者的结果。
临床上最常受累的结构是气管（43.1%）、左主支气管（17.6%）和胸主动脉（15.7%）。除1例患者外，所有患者（98.0%）均完成了CRT，且无毒性相关死亡。诱导治疗完成后，49例患者接受了手术（96.1%），40例患者（78.4%）可行切除，但R0手术很少实现（39.2%）。18例（35.3%）实现了病理降期，10例患者（19.6%）观察到主要缓解（缓解者），7例（13.7%）实现了完全缓解（pT0N0）。总体中位生存时间为11.1个月，3年生存率为8.8%。R0切除术后观察到显著更好的生存率（P < 0.001）（中位值：22.3个月；3年生存率：25.4%；P < 0.001），缓解者的生存率也显著更好（中位值：33.1个月；3年生存率：25.7%；P = 0.019）。
对于胸段食管cT4 SCC，采用CRT后行手术的积极多模式治疗是可行的。手术应限于对诱导治疗有显著反应且R0切除可能性高的患者。
