Wong Simon K H, Chiu Philip W Y, Leung S F, Cheung K Y, Chan Angus C W, Au-Yeung Alex C M, Griffith James F, Chung Sydney S C, Ng Enders K W
Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
Ann Surg Oncol. 2008 Feb;15(2):576-82. doi: 10.1245/s10434-007-9679-y. Epub 2007 Dec 5.
We evaluated the role of chemoradiotherapy (CRT) for patients with inoperable squamous esophageal cancer.
Patients with locally advanced or metastatic squamous esophageal carcinoma who received CRT were recruited. The CRT consists of continuous infusion of 5-fluorouracil at 200 mg/m(2)/day, and cisplatin at 60 mg/m(2) on days 1 and 22, with concurrent radiotherapy for a total of 50 to 60 Gy in 25 to 30 fractions over 6 weeks. Efficacy was assessed by endoscopy and computed tomographic scan before and 8 weeks after completion of the treatment program. Median survival and the need for palliative esophageal stenting were compared with another group of patients who received endoscopic stenting.
From 1996 to 2003, a total of 36 consecutive patients (33 male, mean +/- SD age 63.2 +/- 9.5 years) with T4 disease (81%) with or without cervical nodal metastasis (50%) received CRT, while 36 patients treated with endoscopic stenting alone were recruited as controls. Both groups were comparable in demographics, pretreatment dysphagia score, comorbidities, and tumor characteristics. CRT was completed in 32 patients (89%). There was no treatment-related mortality. Tumor volume was greatly reduced after CRT in 19 patients. Four patients (11%) received salvage esophagectomy 9 to 42 months after CRT. Compared with the stenting group, CRT statistically significantly improved 5-year survival (15% vs. 0%, P = .01), median survival (10.8 months vs. 4.0 months, P < .005), and need for stenting (22% vs. 100%, P = .005).
Palliative CRT can effectively improve the symptoms of dysphagia in patients with inoperable squamous esophageal carcinoma. It results in better survival compared with endoscopic stenting in these patients.
我们评估了放化疗（CRT）对无法手术的鳞状食管癌患者的作用。
招募接受CRT的局部晚期或转移性鳞状食管癌患者。CRT包括持续输注5-氟尿嘧啶，剂量为200mg/m²/天，顺铂在第1天和第22天剂量为60mg/m²，同时进行放疗，在6周内分25至30次给予总量50至60Gy。在治疗方案完成前及完成后8周通过内镜检查和计算机断层扫描评估疗效。将中位生存期和姑息性食管支架置入的需求与另一组接受内镜支架置入的患者进行比较。
1996年至2003年，共有36例连续患者（33例男性，平均±标准差年龄63.2±9.5岁）患有T4期疾病（81%），有或无颈部淋巴结转移（50%）接受了CRT，同时招募36例仅接受内镜支架置入治疗的患者作为对照。两组在人口统计学、治疗前吞咽困难评分、合并症和肿瘤特征方面具有可比性。32例患者（89%）完成了CRT。无治疗相关死亡。19例患者在CRT后肿瘤体积大幅缩小。4例患者（11%）在CRT后9至42个月接受了挽救性食管切除术。与支架置入组相比，CRT在统计学上显著提高了5年生存率（15%对0%，P = 0.01）、中位生存期（10.8个月对4.0个月，P < 0.005）以及支架置入需求（22%对100%，P = 0.005）。
姑息性CRT可有效改善无法手术的鳞状食管癌患者的吞咽困难症状。与内镜支架置入相比，这些患者的生存期更好。
