Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Kyoto 602-8566 Japan.
Anticancer Res. 2014 Apr;34(4):1989-92.
To examine the outcome of patients with cervical esophageal cancer treated by a multimodal protocol.
We retrospectively analyzed the outcome and prognostic factors for 20 patients with cervical esophageal cancer who received multimodal treatment at the Kurume University Hospital between 2003 and 2009. One case of stage I, seven of stage II and 12 of stage III disease (2 T1, 3 T2, 4 T3, 11 T4 and 14 N1) were included. Radiotherapy was administered at a median dose of 60 Gy (range=30-70 Gy). The median follow-up time was 32 months for surviving patients (14-94 months). Platinum-based neoadjuvant chemotherapy (NAC) was performed in 14 cases and all received chemoradiotherapy.
median survival was 20 months and overall survival rates at 1, 2, and 5-years were 70%, 60% and 30%, respectively. T-Category, length of the primary lesion, N-category, stage, hemoglobin levels and response to induction chemotherapy were statistically significant predisposing factors for overall survival rate. According to NAC response, 10 good responders (complete response or partial response) showed 2-year survival rates of 80% (5 survivors), whereas that for poor responder (stable disease and progressive disease) was 0% (p=0.006), respectively. Response to NAC was the only statistically significant predisposing factor for increased progression-free survival (p=0.03). Severe acute toxicities of grade 3 or more appeared in 5 patients; two grade 5 (esophageal perforations and lung fistula), one grade 4 (bilateral recurrent nerve palsy), and two grade three (pneumonitis and mucositis).
Although severe prognosis was identified for cervical esophageal cancer, good response to NAC indicates a good prognosis with organ preservation even for those with T4 tumor.
研究多模式治疗方案治疗颈段食管癌患者的效果。
我们回顾性分析了 2003 年至 2009 年在久留米大学医院接受多模式治疗的 20 例颈段食管癌患者的疗效和预后因素。1 例Ⅰ期，7 例Ⅱ期，12 例Ⅲ期（2 例 T1，3 例 T2，4 例 T3，11 例 T4，14 例 N1）。放疗中位剂量为 60Gy（范围 30-70Gy）。生存患者的中位随访时间为 32 个月（14-94 个月）。14 例患者接受了铂类新辅助化疗（NAC），所有患者均接受了放化疗。
中位生存期为 20 个月，1、2、5 年总生存率分别为 70%、60%和 30%。T 分期、原发肿瘤长度、N 分期、分期、血红蛋白水平和诱导化疗反应是总生存率的统计学显著预测因素。根据 NAC 反应，10 例完全或部分缓解的良好反应者 2 年生存率为 80%（5 例存活），而反应不佳者（稳定和进展）为 0%（p=0.006）。NAC 反应是无进展生存期延长的唯一统计学显著预测因素（p=0.03）。5 例患者出现 3 级或更严重的急性毒性反应；2 例 5 级（食管穿孔和肺瘘），1 例 4 级（双侧喉返神经麻痹），2 例 3 级（肺炎和粘膜炎）。
尽管颈段食管癌预后严重，但对 NAC 的良好反应表明，即使是 T4 肿瘤患者，也能通过器官保存获得良好的预后。
