Department of Oncology and Medical Physics, Haukeland University Hospital, N-5021 Bergen, Norway.
Dis Esophagus. 2010 Apr;23(3):244-52. doi: 10.1111/j.1442-2050.2009.00999.x. Epub 2009 Jul 31.
This study is a retrospective analysis of high-dose definitive concomitant chemoradiotherapy in locally advanced esophageal cancer in a single institution. The aim of the study was to identify and quantify the toxicity associated with the high-dose treatment and to analyze the outcome of this treatment. Forty-six patients (41 men and 5 women, median age of 67.5 years) with disease stage IIA-III esophageal cancer were treated with high-dose definitive chemoradiotherapy. Thirty patients had squamous cell carcinomas and 16 had adenocarcinomas. The patients were treated with three courses of chemotherapy. Each chemotherapy course consisted of cisplatin 100 mg/m(2), day 1 and 5-Fluorouracil 1000 mg/m(2)/day, day 1-5. One course was given every 3 weeks. Concurrent radiotherapy (66 Gy/33 fractions) was administered during the last two courses of chemotherapy. Toxicity grades three and four were seen in 47.5% and 40% of the patients, respectively. Treatment related mortality occurred in one patient (2.5%) due to neutropenic septicemia. Follow-up time for surviving patients (2/46) was 45 and 112 months. For the entire study population, the median time to local recurrence in the radiotherapy field was 33 months and the median time to distant metastasis was 8.7 months, whereas median overall survival was 10.8 months and median disease-specific survival 11 months. For responders to chemoradiotherapy, the median time to local recurrence was 76 months, the median time to distant metastasis 16.8 months, the median overall survival and the median disease-specific survival for the responders were both 17 months. The 2, 3 and 5-year survival rates were 22%, 15% and 11% for the entire study population, and 31%, 24% and 17% for the responders to chemoradiotherapy, respectively. By multivariate analysis response to chemoradiotherapy and lower disease stage were positive prognostic factors for survival. The results of our study have shown that concurrent high-dose chemoradiotherapy provides long-term local tumor control in locally advanced esophageal cancer. However, toxicities following this high-dose treatment, while manageable, were significant. Survival rates were not improved by high-dose chemoradiotherapy compared with what is reported in previous studies applying lower doses of definitive chemoradiotherapy.
这项研究是对单家机构中局部晚期食管癌高剂量根治性放化疗的回顾性分析。本研究旨在确定并量化与高剂量治疗相关的毒性，并分析该治疗的结果。46 例（41 名男性和 5 名女性，中位年龄 67.5 岁）疾病分期为 IIA-III 期的食管癌患者接受高剂量根治性放化疗。30 例为鳞状细胞癌，16 例为腺癌。患者接受了三个疗程的化疗。每个化疗疗程包括顺铂 100mg/m²，第 1 天和第 5 天氟尿嘧啶 1000mg/m²/天，第 1-5 天。每 3 周进行一次疗程。在最后两个化疗疗程期间同时给予放疗（66Gy/33 次）。毒性分级为 3 级和 4 级的患者分别占 47.5%和 40%。1 例患者（2.5%）因中性粒细胞减少性败血症导致治疗相关死亡。2/46 例存活患者的随访时间分别为 45 个月和 112 个月。对于整个研究人群，放疗野局部复发的中位时间为 33 个月，远处转移的中位时间为 8.7 个月，中位总生存期为 10.8 个月，中位疾病特异性生存期为 11 个月。对于放化疗反应者，局部复发的中位时间为 76 个月，远处转移的中位时间为 16.8 个月，反应者的中位总生存期和疾病特异性生存期均为 17 个月。整个研究人群的 2 年、3 年和 5 年生存率分别为 22%、15%和 11%，放化疗反应者的 2 年、3 年和 5 年生存率分别为 31%、24%和 17%。多因素分析显示，放化疗反应和较低的疾病分期是生存的有利预后因素。我们的研究结果表明，局部晚期食管癌同步高剂量放化疗可提供长期局部肿瘤控制。然而，这种高剂量治疗后的毒性虽然可以控制，但仍很显著。与应用低剂量根治性放化疗的既往研究相比，高剂量放化疗并未提高生存率。
