内镜支架置入术联合放化疗治疗晚期食管癌：一项病例对照研究。
Endoscopic stenting and concurrent chemoradiotherapy for advanced esophageal cancer: a case-control study.
机构信息
Department of Gastroenterology, Qingdao Municipal Hospital affiliated to Qingdao University, Qingdao 266011, Shandong Province, China.
出版信息
World J Gastroenterol. 2012 Mar 28;18(12):1404-9. doi: 10.3748/wjg.v18.i12.1404.
AIM
To evaluate the role of endoscopic stenting with or without concurrent 3-dimensional conformal chemoradiotherapy (3D-CRT) in patients with inoperable esophageal cancer.
METHODS
Advanced esophageal cancer patients indicated for esophagectomy received esophageal stents. A part of patients completed 3D-CRT after stenting. Efficacy was assessed by endoscopy and computed tomographic scan before and 4 wk after completion of the treatment. The median survival, 3D-CRT toxicity and complications were compared between 3D-CRT and control groups.
RESULTS
From 1999 to 2008, 99 consecutive patients with T3/T4 disease and unsuitable for esophagectomy were placed with esophageal stents. Sixty-seven patients received 3D-CRT, while 36 patients treated with endoscopic stents alone were recruited as controls. After 3D-CRT treatment, the median tumor volume of 3D-CRT patients were reduced significantly from 43.7 ± 10.2 cm³ to 28.8 ± 8.5 cm³ (P < 0.05). The complete and partial response rate was 85.1%, and no response was 14.9%. After 3D-CRT, the incidence rate of T2 and T3 disease evident on CT scan increased to 78.4% while T4 decreased from 66.7% to 21.6% (P < 0.05). 3D-CRT Karnofsky Performance Status improved in 3D-CRT patients compared with the control group (P = 0.031). 3D-CRT patients had a longer survival than the control group (251.7 d vs 91.1 d, P < 0.05). And the median half-year survival rate in 3D-CRT group (91%) was higher than in the control group (50%, P < 0.05). The most common toxicity was leukocytopenia in the 3D-CRT group (46.7% vs 18.8%, P = 0.008). The control group had a higher rate of restenosis than the 3D-CRT group (81.3% vs 9.0%, P < 0.05). The rate of nephrotoxicity was increased in 3D-CRT as compared with the control group (31.3% vs 15.6%, P < 0.05).
CONCLUSION
3D-CRT can improve dysphagia in patients with inoperable esophageal carcinoma. 3D-CRT combined with stenting results in better survival as compared with endoscopic stents used alone.
目的
评估内镜支架置入术联合或不联合三维适形放化疗（3D-CRT）在不能手术的食管癌患者中的作用。
方法
对拟行食管癌切除术的晚期食管癌患者进行食管支架置入术。部分患者在支架置入后完成 3D-CRT。通过治疗完成前后的内镜和计算机断层扫描评估疗效。比较 3D-CRT 组和对照组的中位生存期、3D-CRT 毒性和并发症。
结果
1999 年至 2008 年，99 例 T3/T4 期疾病且不适合手术的患者接受了食管支架置入术。67 例患者接受了 3D-CRT 治疗，而 36 例仅接受内镜支架治疗的患者作为对照组。3D-CRT 治疗后，3D-CRT 患者的肿瘤体积中位数从 43.7±10.2cm³显著缩小至 28.8±8.5cm³（P<0.05）。完全缓解和部分缓解率为 85.1%，无反应率为 14.9%。3D-CRT 后，CT 扫描上 T2 和 T3 期疾病的发生率增加到 78.4%，而 T4 期疾病从 66.7%降至 21.6%（P<0.05）。与对照组相比，3D-CRT 患者的 Karnofsky 表现状态（KPS）评分提高（P=0.031）。3D-CRT 患者的生存时间长于对照组（251.7d 比 91.1d，P<0.05）。3D-CRT 组的中位半年生存率（91%）高于对照组（50%，P<0.05）。3D-CRT 组最常见的毒性是白细胞减少症（46.7%比 18.8%，P=0.008）。对照组的再狭窄率高于 3D-CRT 组（81.3%比 9.0%，P<0.05）。与对照组相比，3D-CRT 组的肾毒性发生率增加（31.3%比 15.6%，P<0.05）。
结论
3D-CRT 可改善不能手术的食管癌患者的吞咽困难。与单独使用内镜支架相比，3D-CRT 联合支架置入可获得更好的生存。
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