Department of Surgery, Oncology Center, Affiliated Nanjing First Hospital of Nanjing Medical University and Oncology Center of Nanjing Medical University, Nanjing 210006, Jiangsu Province, China.
World J Gastroenterol. 2010 Apr 7;16(13):1649-54. doi: 10.3748/wjg.v16.i13.1649.
To investigate the role of perioperative chemoradiotherapy (CRT) in the treatment of locally advanced thoracic esophageal squamous cell carcinoma (ESCC).
Using preoperative computed tomography (CT)-based staging criteria, 238 patients with ESCC (stage II-III) were enrolled in this prospective study between January 1997 and June 2004. With informed consent, patients were randomized into 3 groups: preoperative CRT (80 cases), postoperative CRT (78 cases) and surgery alone (S) (80 cases). The 1-, 3-, 5- and 10-year survival were followed up. Progression-free survival (PFS) was chosen as the primary endpoint by treatment arm measured from study entry until documented progression of disease or death from any cause. The secondary endpoint was overall survival (OS) determined as the time (in months) between the date of therapy and the date of death. Other objectives were surgical and adjuvant therapy complications.
With median follow-up of 45 mo for all the enrolled patients, significant differences in the 1-, 3-, 5-, 10-year OS (91.3%, 63.5%, 43.5%, 24.5% vs 91%, 62.8%, 42.3%, 24.4% vs 87.5%, 51.3%, 33.8%, 12.5%, P = 0.0176) and PFS (89.3%, 61.3%, 37.5%, 18.1% vs 89.1%, 61.1%, 37.2%, 17.8% vs 84.5%, 49.3%, 25.9%, 6.2%, P = 0.0151) were detected among the 3 arms. There were no significant differences in OS and PFS between the preoperative CRT and postoperative CRT arm (P > 0.05). For the patients who had radical resection, significant differences in median PFS (48 mo vs 61 mo vs 39.5 mo, P = 0.0331) and median OS (56.5 mo vs 72 mo vs 41.5 mo, P = 0.0153) were detected among the 3 arms, but there were no significant differences in OS and PFS between the preoperative CRT and postoperative CRT arm (P > 0.05). The local recurrence rates in the preoperative CRT, postoperative CRT group and S group were 11.3%, 14.1% and 35%, respectively (P < 0.05). No significant differences were detected among the 3 groups when comparing complications but tended to be in favor of the postoperative CRT and S groups (P > 0.05). Toxicities of CRT in the preoperative or postoperative CRT arms were mostly moderate, and could be quickly alleviated by adequate therapy.
Rational application of preoperative or postoperative CRT can provide a benefit in PFS and OS in patients with locally advanced ESCC.
探讨围手术期放化疗（CRT）在局部晚期胸段食管鳞癌（ESCC）治疗中的作用。
1997 年 1 月至 2004 年 6 月期间，采用术前 CT 分期标准，前瞻性纳入 238 例 ESCC（Ⅱ-Ⅲ期）患者。征得患者同意后，将其随机分为术前 CRT 组（80 例）、术后 CRT 组（78 例）和单纯手术组（S 组，80 例）。随访患者 1、3、5 和 10 年的生存率。以治疗臂为单位，从研究入组开始到疾病进展或任何原因死亡为止，无进展生存期（PFS）作为主要终点进行评估。总生存期（OS）为从治疗日期到死亡日期的时间（以月为单位），作为次要终点。其他观察指标包括手术和辅助治疗的并发症。
所有入组患者中位随访时间为 45 个月，术前 CRT 组、术后 CRT 组和 S 组的 1、3、5、10 年 OS（91.3%、63.5%、43.5%、24.5%比 91%、62.8%、42.3%、24.4%比 87.5%、51.3%、33.8%、12.5%，P = 0.0176）和 PFS（89.3%、61.3%、37.5%、18.1%比 89.1%、61.1%、37.2%、17.8%比 84.5%、49.3%、25.9%、6.2%，P = 0.0151）差异均有统计学意义。术前 CRT 组和术后 CRT 组 OS 和 PFS 差异无统计学意义（P > 0.05）。对于行根治性切除术的患者，术前 CRT 组、术后 CRT 组和 S 组的中位 PFS（48 mo 比 61 mo 比 39.5 mo，P = 0.0331）和中位 OS（56.5 mo 比 72 mo 比 41.5 mo，P = 0.0153）差异均有统计学意义，但术前 CRT 组和术后 CRT 组 OS 和 PFS 差异无统计学意义（P > 0.05）。术前 CRT 组、术后 CRT 组和 S 组的局部复发率分别为 11.3%、14.1%和 35%（P < 0.05）。3 组间并发症发生率差异无统计学意义，但术后 CRT 组和 S 组并发症发生率有向低风险趋势（P > 0.05）。术前或术后 CRT 的放化疗毒性大多为中度，经充分治疗后可迅速缓解。
合理应用术前或术后 CRT 可提高局部晚期 ESCC 患者的 PFS 和 OS。
