Noronha V, Patil V, Bhosale B, Joshi A, Purandare N, Prabhash K
Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India.
Indian J Cancer. 2013 Apr-Jun;50(2):128-34. doi: 10.4103/0019-509X.117020.
Advanced esophageal cancer is aggressive with an expected median survival of 6-7 months. Combination chemotherapy regimens provide effective palliation, but result in substantial toxicity.
Retrospective analysis of prospectively collected data of patients with advanced esophageal cancer, not amenable to definitive intent therapy who were treated with intravenous weekly paclitaxel.
Between October 2010 and August 2011, 51 patients were included. Median age was 56 years, with a male: female ratio of 2.9:1. 29% were mid esophageal and 55% were lower third and gastroesophageal junction tumors. 65% of the tumors had squamous histology. Performance status was > 2 in 45%. 61% patients had received prior therapy, either definitive or palliative. 51% patients were platinum-pre-treated and 29% had received prior 3 weekly paclitaxel. 76% patients had distant metastases. Median number of cycles of weekly paclitaxel delivered was 11. 71% of patients had improvement in dysphagia, with a median time to symptom improvement of 9 days. In 72% patients, the feeding nasogastric tube could be removed. Overall response rate was 49% (complete remission: 4%, partial remission: 45%, stable disease: 13%). Median progression free survival was 4.7 months (confidence interval [95% CI: 3.7-5.7 months]) and median overall survival was 7.5 months (95% CI: 3.1-11.8 months). Histopathology, performance status and pre-treatment albumin significantly affected survival. The most common grade 3/4 toxicities included hyponatremia (14%), fatigue (16%), diarrhea (12%), anemia (31%), neutropenia (10%) and febrile neutropenia (4%).
Metronomic weekly paclitaxel chemotherapy may provide palliative benefit in advanced unresectable metastatic esophageal cancer with minimal toxicity.
晚期食管癌侵袭性强，预期中位生存期为6至7个月。联合化疗方案可有效缓解症状，但毒性较大。
对前瞻性收集的晚期食管癌患者数据进行回顾性分析，这些患者不适合进行根治性治疗，接受了静脉注射每周一次的紫杉醇治疗。
2010年10月至2011年8月期间，共纳入51例患者。中位年龄为56岁，男女比例为2.9:1。29%为食管中段肿瘤，55%为食管下段和胃食管交界部肿瘤。65%的肿瘤为鳞状组织学类型。45%的患者体能状态>2。61%的患者曾接受过确定性或姑息性治疗。51%的患者曾接受过铂类预处理，29%的患者曾接受过每三周一次的紫杉醇治疗。76%的患者有远处转移。每周一次紫杉醇的中位给药周期数为11个。71%的患者吞咽困难有所改善，症状改善的中位时间为9天。72%的患者可拔除鼻饲管。总缓解率为49%（完全缓解：4%，部分缓解：45%，病情稳定：13%）。中位无进展生存期为4.7个月（置信区间[95%CI：3.7 - 5.7个月]），中位总生存期为7.5个月（95%CI：3.1 - 11.8个月）。组织病理学、体能状态和治疗前白蛋白水平对生存期有显著影响。最常见的3/4级毒性反应包括低钠血症（14%）、疲劳（16%）、腹泻（12%）、贫血（31%）、中性粒细胞减少（10%）和发热性中性粒细胞减少（4%）。
小剂量每周一次紫杉醇化疗可为晚期不可切除转移性食管癌提供姑息性益处，且毒性最小。
