CROSS 试验中单手术治疗与术前放化疗加手术治疗后的复发模式。

Patterns of recurrence after surgery alone versus preoperative chemoradiotherapy and surgery in the CROSS trials.

机构信息

Vera Oppedijk, Rob van Os, Dick J. Richel, Mark I. van Berge Henegouwen, and Maarten C.C.M. Hulshof, Academic Medical Center, Amsterdam; Patty H. Spruit, Vrije Universiteit Medical Center, Amsterdam; Ate van der Gaast, Jan J.B. van Lanschot, Pieter van Hagen, and Caroline M. van Rij, Erasmus Medical Center, Rotterdam; Maurice J. van der Sangen, Catharina Hospital, Eindhoven; Jannet C. Beukema, University Medical Center, Groningen; Heidi Rütten, Radboud University Medical Center, Nijmegen; and Janny G. Reinders, Arnhems Radiotherapeutisch Instituut, Arnhem, the Netherlands.

出版信息

J Clin Oncol. 2014 Feb 10;32(5):385-91. doi: 10.1200/JCO.2013.51.2186. Epub 2014 Jan 13.

DOI:10.1200/JCO.2013.51.2186

PMID:24419108

Abstract

PURPOSE

To analyze recurrence patterns in patients with cancer of the esophagus or gastroesophageal junction treated with either preoperative chemoradiotherapy (CRT) plus surgery or surgery alone.

PATIENTS AND METHODS

Recurrence pattern was analyzed in patients from the previously published CROSS I and II trials in relation to radiation target volumes. CRT consisted of five weekly courses of paclitaxel and carboplatin combined with a concurrent radiation dose of 41.4 Gy in 1.8-Gy fractions to the tumor and pathologic lymph nodes with margin.

RESULTS

Of the 422 patients included from 2001 to 2008, 418 were available for analysis. Histology was mostly adenocarcinoma (75%). Of the 374 patients who underwent resection, 86% were allocated to surgery and 92% to CRT plus surgery. On January 1, 2011, after a minimum follow-up of 24 months (median, 45 months), the overall recurrence rate in the surgery arm was 58% versus 35% in the CRT plus surgery arm. Preoperative CRT reduced locoregional recurrence (LRR) from 34% to 14% (P < .001) and peritoneal carcinomatosis from 14% to 4% (P < .001). There was a small but significant effect on hematogenous dissemination in favor of the CRT group (35% v 29%; P = .025). LRR occurred in 5% within the target volume, in 2% in the margins, and in 6% outside the radiation target volume. In 1%, the exact site in relation to the target volume was unclear. Only 1% had an isolated infield recurrence after CRT plus surgery.

CONCLUSION

Preoperative CRT in patients with esophageal cancer reduced LRR and peritoneal carcinomatosis. Recurrence within the radiation target volume occurred in only 5%, mostly combined with outfield failures.

摘要

目的

分析接受术前放化疗（CRT）加手术或单纯手术治疗的食管癌或胃食管交界癌患者的复发模式。

方法

根据放射靶区分析先前发表的 CROSS I 和 II 试验中的患者复发模式。CRT 包括每周 5 个疗程的紫杉醇和顺铂联合 41.4Gy 同步放疗，1.8Gy 分剂量照射肿瘤和病理淋巴结。

结果

2001 年至 2008 年共纳入 422 例患者，其中 418 例可进行分析。组织学主要为腺癌（75%）。在 374 例接受手术的患者中，86%的患者被分配到手术组，92%的患者被分配到 CRT 加手术组。2011 年 1 月 1 日，在至少 24 个月（中位 45 个月）的随访后，手术组的总复发率为 58%，CRT 加手术组为 35%。术前 CRT 降低了局部区域复发率（LRR）（从 34%降至 14%，P <.001）和腹膜种植（从 14%降至 4%，P <.001）。血液播散也有一定程度的改善，有利于 CRT 组（35%比 29%，P =.025）。LRR 发生在靶区内 5%，靶区边缘 2%，靶区外 6%。1%的患者在靶区内的位置不明确。只有 1%的患者在 CRT 加手术后出现单纯的场内复发。