Department of Radiation Oncology, LMU University Hospital Munich, Marchioninistraße 15, 81377 München, Germany.
Radiat Oncol. 2012 Apr 15;7:60. doi: 10.1186/1748-717X-7-60.
Treatment options for oesophageal cancer have changed considerably over the last decades with the introduction of multimodal treatment concepts dominating the progress in the field. However, it remains unclear in how far the documented scientific progress influenced and changed the daily routine practice. Since most patients with oesophageal cancer generally suffer from reduced overall health conditions it is uncertain how high the proportion of aggressive treatments is and whether outcomes are improved substantially. In order to gain insight into this we performed a retrospective analysis of patients treated at a larger tertiary referral centre over time course of 25 years.
Data of all patients diagnosed with squamous cell carcinoma (SCC) and adenocarcinoma (AC) of the oesophagus, treated between 1983 and 2007 in the department of radiation oncology of the LMU, were obtained. The primary endpoint of the data collection was overall survival (calculated from the date of diagnosis until death or last follow up). Changes in basic clinical characteristics, treatment approach and the effect on survival were analysed after dividing the cohort into five subsequent time periods (I-V) with 5 years each. In a second analysis any pattern of change regarding the use of radio(chemo)therapy (R(C)T) with and without surgery was determined.
In total, 503 patients with SCC (78.5%) and AC (18.9%) of the oesophagus were identified. The average age was 60 years (range 35-91 years). 56.5% of the patients were diagnose with advanced UICC stages III-IV. R(C)T was applied to 353 (70.2%) patients; R(C)T+ surgery was performed in 134 (26.6%) patients, 63.8% of all received chemotherapy (platinum-based 5.8%, 5-fluorouracil (5-FU)12.1%, 42.3% 5-FU and mitomycin C (MMC)). The median follow-up period was 4.3 years. The median overall survival was 21.4 months. Over the time, patients were older, the formal tumour stage was more advanced, the incidence of AC was higher and the intensified treatment had a higher prevalence. However there was only a trend for an improved OS over the years with no difference between RCT with or without surgery (p = 0.09). The use of radiation doses over 54 Gy and the addition of chemotherapy (p = 0.002) were associated with improved OS.
Although more complex treatment protocols were introduced into clinical routine, only a minor progress in OS rates was detectable. Main predictors of outcome in this cohort was the addition of chemotherapy. The addition of surgery to radio-chemotherapy may only be of value for very limited patient groups.
在过去的几十年中，食管癌的治疗选择发生了重大变化，多模式治疗概念的引入主导了该领域的进展。然而，目前尚不清楚记录的科学进展在多大程度上影响和改变了日常实践。由于大多数食管癌患者的整体健康状况普遍较差，因此尚不清楚激进治疗的比例有多高，以及结果是否有实质性改善。为了深入了解这一点，我们对 25 年来在一家大型三级转诊中心接受治疗的患者进行了回顾性分析。
我们获取了 1983 年至 2007 年间在 LMU 放射肿瘤科接受治疗的食管鳞状细胞癌（SCC）和腺癌（AC）患者的所有数据。数据收集的主要终点是总生存期（从诊断之日起计算至死亡或最后一次随访）。通过将队列分为五个后续时间区间（I-V），每个区间为 5 年，分析基本临床特征、治疗方法的变化以及对生存的影响。在第二次分析中，确定了任何关于放疗（化疗）（R（C）T）与手术结合或不结合的使用模式的变化。
共确定了 503 例食管 SCC（78.5%）和 AC（18.9%）患者。平均年龄为 60 岁（范围 35-91 岁）。56.5%的患者被诊断为 UICC 晚期 III-IV 期。353 例患者接受了 R（C）T；134 例患者接受了 R（C）T+手术，所有患者中有 63.8%接受了化疗（铂类 5.8%，5-氟尿嘧啶（5-FU）12.1%，42.3%5-FU 和丝裂霉素 C（MMC））。中位随访时间为 4.3 年。中位总生存期为 21.4 个月。随着时间的推移，患者年龄更大，肿瘤分期更晚，AC 的发病率更高，强化治疗的比例更高。然而，尽管这些年 OS 率呈上升趋势，但与 RCT 加或不加手术之间没有差异（p=0.09）。放射剂量超过 54 Gy 和添加化疗（p=0.002）与 OS 改善相关。
尽管引入了更复杂的治疗方案，但 OS 率的提高并不明显。该队列中，预测结局的主要因素是添加化疗。放射治疗加化疗加手术可能仅对非常有限的患者群体有价值。
