Torrente Sara, Turri Lucia, Deantonio Letizia, Cena Tiziana, Gambaro Giuseppina, Magnani Corrado, Krengli Marco
Radiotherapy, University Hospital "Maggiore della Carità", Novara, Italy.
Biostatistics and Clinical Epidemiology, University of Piemonte Orientale "Amedeo Avogadro", Novara, Italy.
Rep Pract Oncol Radiother. 2012 May 22;17(4):226-32. doi: 10.1016/j.rpor.2012.03.013. eCollection 2012.
BACKGROUND/AIM: To analyse clinical response, overall (OS) and disease free survival (DFS) and toxicity in patients with unresectable oesophageal cancer treated by concomitant chemo-radiotherapy (CRT).
Forty patients with stage IIa-IVa biopsy proven oesophageal carcinoma were treated with CRT. All patients were studied with endoscopy and CT and judged unresectable after multidisciplinary discussion. CRT consisted of 3 cycles of cisplatin 100 mg/m(2) or carboplatin 300 mg/m(2) on day 1 and 5-fluorouracil 1000 mg/m(2) as a continuous infusion of 96 h associated with concurrent 3D-conformal RT. By using 15 MeV X-rays, a total dose of 60-66 Gy was delivered with daily fractions of 1.8-2.0 Gy.
Complete response (CR), partial response (PR) and no response (NR) were observed in 50%, 20% and 20% of cases, respectively. Of the 20 patients with CR, 15 developed loco-regional recurrent disease. OS and DFS rates at 3 and 5 years were 38%, 8%, 49% and 10%, respectively. Total radiation dose ≥60 Gy improved loco-regional control and complete response (CR vs. PR + NR; p = 0.004) influenced both DFS and loco-regional control. Grade 3 gastrointestinal and haematological acute toxicity occurred in 3/40 patients (7.5%). One patient developed grade 4 renal failure. Late toxicity was reported in 2/40 patients (5.0%), consisting of grade 3 radiation pneumonitis.
Concomitant CRT for unresectable oesophageal cancer can result in an acceptable loco-regional control with limited toxicity. Response after treatment and total radiation dose influenced the outcome.
背景/目的：分析同步放化疗（CRT）治疗不可切除食管癌患者的临床反应、总生存期（OS）、无病生存期（DFS）及毒性反应。
40例经活检证实为Ⅱa - Ⅳa期食管癌患者接受同步放化疗。所有患者均行内镜及CT检查，并经多学科讨论判定为不可切除。同步放化疗方案为第1天和第2天给予顺铂100mg/m²或卡铂300mg/m²，共3个周期，同时持续96小时静脉滴注5 - 氟尿嘧啶1000mg/m²，并联合三维适形放疗。采用15MeV X线，总剂量60 - 66Gy，每日分次剂量1.8 - 2.0Gy。
分别有50%、20%和20%的病例观察到完全缓解（CR）、部分缓解（PR）和无缓解（NR）。20例CR患者中，15例出现局部区域复发。3年和5年的OS率分别为38%和8%，DFS率分别为49%和10%。总放疗剂量≥60Gy可改善局部区域控制，完全缓解（CR与PR + NR相比；p = 0.004）对DFS和局部区域控制均有影响。3/40例患者（7.5%）出现3级胃肠道和血液学急性毒性反应。1例患者发生4级肾衰竭。2/40例患者（5.0%）报告有晚期毒性反应，为3级放射性肺炎。
同步放化疗治疗不可切除食管癌可获得可接受的局部区域控制，毒性反应有限。治疗后的反应及总放疗剂量影响治疗结果。
