Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Cancer. 2010 Apr 1;116(7):1656-63. doi: 10.1002/cncr.24935.
: The use of platinum-based chemoradiation for esophageal cancer is routine, but it is unclear which class of cytotoxic are optimum. It was hypothesized that chemoradiotherapy with fluoropyrimidine, taxane, and camptothecin would have preserved or improved efficacy with no compromise in safety.
: Patients with histologically confirmed, resectable esophageal carcinoma were eligible. In addition to other tests, a baseline endoscopic ultrasonography (EUS) was obtained. Patients were medically fit and had near-normal organ functions. Patients received docetaxel and irinotecan, plus 5-fluorouracil as induction therapy and then the same cytotoxics with 50.4 grays of radiotherapy followed by an attempted surgery. Pathologic complete response (pathCR) at a rate of > or =20% was the primary endpoint. The pathCR and R0 resection were correlated with overall survival (OS). Safety was documented.
: Fifty-five patients were enrolled. Seven were women, and the median age was 56 years. Fifty-three (96%) patients had EUST3, and 41 (75%) had EUSN1 disease. Forty-three (78%) patients underwent surgery, 20% achieved a pathCR, and 76.4% underwent an R0 resection. The median survival (n = 55 patients) was 43.3 months (range, 19-75 months). Baseline clinical parameters were not found to be predictive of OS; however, patients with a pathCR (P = .005) and who underwent R0 resection (P < or = .0001) had an improved OS. There was 1 treatment-related postsurgical death reported. Grade 3 or 4 toxicity (graded according to the National Cancer Institute Common Toxicity Criteria [version 2.0]) was observed in 62% of patients.
: The results of the current study documented that this 3-drug, noncisplatin-based chemoradiotherapy was feasible, safe, and active but not better than the published cisplatin-based chemoradiotherapy. A fluoropyrimidine and another cytotoxic (from any class) may be adequate to establish a baseline chemoradiotherapy regimen to combine biologics. Cancer 2010. (c) 2010 American Cancer Society.
铂类化疗联合放疗是治疗食管癌的常规手段，但目前尚不清楚哪种细胞毒药物疗效最佳。本研究假设氟尿嘧啶类、紫杉烷类和喜树碱类化疗联合放疗在不降低安全性的前提下可提高疗效。
经组织学证实、可切除的食管癌患者符合入组条件。患者除接受其他检查外，还需进行基线内镜超声检查（EUS）。患者身体状况良好，重要器官功能接近正常。患者接受多西紫杉醇和伊立替康联合氟尿嘧啶诱导化疗，随后接受 50.4 戈瑞放疗及相同的细胞毒药物化疗，然后尝试进行手术。病理完全缓解（pathCR）率>或=20%为主要研究终点。pathCR 和 R0 切除与总生存（OS）相关。记录安全性。
共入组 55 例患者，其中 7 例为女性，中位年龄为 56 岁。53 例（96%）患者的 EUS 分期为 T3，41 例（75%）为 N1。43 例（78%）患者接受了手术治疗，20%的患者达到 pathCR，76.4%的患者达到 R0 切除。55 例患者的中位生存时间为 43.3 个月（19-75 个月）。基线临床参数与 OS 无相关性；然而，pathCR（P=0.005）和 R0 切除（P<或=0.0001）的患者 OS 明显改善。术后仅 1 例患者因治疗相关死亡。根据美国国立癌症研究所常见毒性标准（版本 2.0），62%的患者出现 3 级或 4 级毒性。
本研究表明，该三药非顺铂方案化疗联合放疗安全可行且有一定活性，但并不优于已发表的顺铂方案化疗联合放疗。氟尿嘧啶类药物和其他（任意种类）细胞毒药物可能足以建立标准的化疗联合放疗方案，联合应用生物制剂。癌症 2010。
