Department of Oncology, Division of Cancer Medicine and Radiotherapy, Norwegian Radium Hospital, Oslo University Hospital, Montebello, Oslo, Norway.
Acta Oncol. 2010;49(2):209-18. doi: 10.3109/02841860903246573.
Over a 10-year period from 1990, 445 patients with carcinoma of the oesophagus were admitted to the Norwegian Radium Hospital and 184 of these patients received treatment with curative intent. Even though surgery is the treatment of choice for these patients, many of them suffer from medical conditions that increase the risk for postoperative mortality and morbidity. In a retrospective study, the effect of the curative treatment offered to patients was explored with a particular focus on patients unfit for surgery.
Medical data of the 184 patients treated with curative intent were reviewed and additional clinical information was retrieved from local hospitals and general practitioners. Preoperative radiotherapy followed by surgery was the standard curative treatment for operable patients. Medically inoperable patients were offered radical split-course hyperfractionated radiotherapy followed by a brachytherapy boost.
More than 50% (103/184) received non-surgical treatment only. Patients who received radical surgery (n = 81) were younger, had better performance status, less weight loss and dysphagia compared to patients treated with radical radiotherapy (n = 102). One patient received only photodynamic therapy. The 3-year survival was 29% for patients treated with radical surgery, and 8% for patients who received radical radiotherapy. The overall median crude survival for the two groups of patients were 20 months and seven months respectively.
The hyperfractionated radiotherapy provided symptom relief without extensive toxicity and with a possibility for cure for patients with oesophageal cancer who are unfit for surgery and chemoradiotherapy. The literature supports the curative potential of high dose accelerated hyperfractionated radiotherapy even though the optimal radiotherapy regimen still needs to be explored.
1990 年以来的 10 年间，共有 445 例食管癌患者在挪威镭医院就诊，其中 184 例患者接受了以治愈为目的的治疗。尽管手术是这些患者的首选治疗方法，但其中许多患者患有增加术后死亡率和发病率风险的疾病。在一项回顾性研究中，特别关注不适合手术的患者，探讨了为患者提供的治愈性治疗的效果。
对 184 例接受治愈性治疗的患者的医疗数据进行了回顾，并从当地医院和全科医生处获取了额外的临床信息。手术可切除患者的标准治愈性治疗是术前放疗加手术。不能手术的患者接受根治性分割超分割高剂量率放疗加近距离放疗。
超过 50%（103/184）的患者仅接受非手术治疗。接受根治性手术（n=81）的患者比接受根治性放疗（n=102）的患者年龄更小，功能状态更好，体重减轻和吞咽困难更少。一名患者仅接受光动力疗法。接受根治性手术的患者 3 年生存率为 29%，接受根治性放疗的患者为 8%。两组患者的总体中位粗生存率分别为 20 个月和 7 个月。
对于不适合手术和放化疗的食管癌患者，超分割放疗可缓解症状，毒性不广泛，并有治愈的可能。即使需要探索最佳放疗方案，文献也支持高剂量加速超分割放疗的治愈潜力。
