Akutsu Yasunori, Matsubara Hisahiro, Shuto Kiyohiko, Uesato Masaya, Mori Mikito, Hoshino Isamu, Shiratori Toru, Miyazawa Yukimasa, Ito Hisao, Uno Takashi
Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.
World J Surg. 2009 May;33(5):1002-9. doi: 10.1007/s00268-008-9899-8.
Chemoradiation therapy (CRT) has the strongest antitumor effect against local tumors of esophageal cancer; however, no standard strategy has yet been established to achieve a clinical complete response (CR) after CRT. The aim of this study was to clarify when a decision can be made to perform further treatment for a clinical CR.
We evaluated 78 patients that underwent an esophagectomy after neoadjuvant CRT in our department between 1998 and 2007. The study investigated the clinical and pathologic results of neoadjuvant CRT.
Of the 78 cases, 19 (24.3%) were a pathologic CR (Grade 3). Pathologic CR could be estimated in only 3 of 8 clinical CR cases (37.5%). On the other hand, 12 (20.7%) of the 58 clinical partial response (PR) cases achieved pathologic CR. Likewise, 4 cases (36.4%) achieved pathologic CR among the clinical no change/progressive disease (NC/PD) patients.
The clinical evaluation for CRT does not reflect the pathologic effectiveness and, even if clinical CR was achieved, viable cancer cells were still present at the primary site in the majority of the population.
放化疗（CRT）对食管癌局部肿瘤具有最强的抗肿瘤作用；然而，尚未建立标准策略以在CRT后实现临床完全缓解（CR）。本研究的目的是阐明何时可决定对临床CR进行进一步治疗。
我们评估了1998年至2007年间在我科接受新辅助CRT后行食管切除术的78例患者。该研究调查了新辅助CRT的临床和病理结果。
78例病例中，19例（24.3%）为病理CR（3级）。在8例临床CR病例中，仅3例（37.5%）可估计为病理CR。另一方面，58例临床部分缓解（PR）病例中有12例（20.7%）达到病理CR。同样，在临床无变化/疾病进展（NC/PD）患者中，4例（36.4%）达到病理CR。
CRT的临床评估不能反映病理疗效，即使实现了临床CR，大多数患者的原发部位仍存在存活的癌细胞。
