Department of Surgical Oncology/GI Surgery, University Medical Centre Groningen (UMCG), University of Groningen, Groningen, The Netherlands,
Ann Surg Oncol. 2014 Feb;21(2):605-11. doi: 10.1245/s10434-013-3316-8. Epub 2013 Oct 8.
Neoadjuvant chemoradiotherapy (CRT) improves locoregional control and overall survival in esophageal cancer patients. Although adverse events are relatively low during neoadjuvant CRT, severe postoperative adverse effects may occur, leading to morbidity and even mortality. We investigated the impact of a more frequently used neoadjuvant CRT regimen of 41.4 Gy/5 weeks radiotherapy with concurrent carboplatin and paclitaxel (CROSS schedule) on the postoperative course.
Between 2006 and 2012, a total of 96 esophageal cancer patients (staged cT1N+/T2-4a/N0-3 and M0) were treated according to the above neoadjuvant scheme. To reduce bias in this single-center study, we performed a propensity score-matched analysis with patients who underwent surgery alone (n = 230) from a prospectively maintained database (n = 326).
Baseline characteristics between both groups were equally distributed in the matched cohort. In the neoadjuvant treated group, significantly more patients were diagnosed with pneumonia (27.1 vs. 51.0%; p = 0.001), pleural effusion (12.5 vs. 24.0%; p = 0.040), and arrhythmia (20.4 vs. 34.4%; p = 0.008). In addition, in the multivariate analysis, neoadjuvant CRT was significantly associated with an increased risk of pneumonia (p = 0.001, odds ratio 2.896), pleural effusion (p = 0.041, odds ratio 2.268), and arrhythmia (p = 0.023, odds ratio 2.215). Despite these outcomes, no differences were detected in duration of intensive care unit or hospital stay. Short-term mortality did not differ between both groups.
We observed an increase of cardiopulmonary complications in the neoadjuvant CRT group, without any effect on hospital or intensive care unit stay and mortality. Further research is warranted on the limitation of chemoradiation-induced cardiopulmonary toxicity.
新辅助放化疗（CRT）可改善食管癌患者的局部区域控制和总体生存率。尽管新辅助 CRT 期间的不良事件相对较低，但仍可能发生严重的术后不良影响，导致发病率甚至死亡率。我们研究了更为常用的新辅助 CRT 方案（41.4 Gy/5 周放疗联合卡铂和紫杉醇[CROSS 方案]）对术后过程的影响。
2006 年至 2012 年，共有 96 名食管癌患者（分期 cT1N+/T2-4a/N0-3 和 M0）按上述新辅助方案进行治疗。为了减少这项单中心研究的偏倚，我们从前瞻性维护的数据库中（n = 326）选择接受单纯手术的患者（n = 230）进行倾向评分匹配分析。
匹配队列中两组的基线特征分布均衡。在新辅助治疗组中，更多的患者被诊断为肺炎（27.1% vs. 51.0%；p = 0.001）、胸腔积液（12.5% vs. 24.0%；p = 0.040）和心律失常（20.4% vs. 34.4%；p = 0.008）。此外，在多变量分析中，新辅助 CRT 与肺炎（p = 0.001，优势比 2.896）、胸腔积液（p = 0.041，优势比 2.268）和心律失常（p = 0.023，优势比 2.215）的风险增加显著相关。尽管存在这些结果，但重症监护病房或住院时间无差异。两组的短期死亡率无差异。
我们观察到新辅助 CRT 组心肺并发症增加，但对住院或重症监护病房时间和死亡率无影响。有必要进一步研究限制放化疗引起的心肺毒性。
