Fakhrian Khashayar, Ordu Arif Deniz, Nieder Carsten, Lordick Florian, Kup Philipp Günther, Theisen Jörg, Combs Stephanie E, Geinitz Hans
2 Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Munich - Germany.
Tumori. 2015 May-Jun;101(3):263-7. doi: 10.5301/tj.5000266. Epub 2015 Apr 16.
The primary objective was to assess the different reasons for refusal of surgical resection (SR) in patients with esophageal squamous cell cancer (ESCC), who were initially planned for neoadjuvant radiochemotherapy (N-RCT) + SR, but SR was not performed after N-RCT.
From 1988 to 2011, 311 patients with ESCC were treated with N-RCT in a tertiary referral center for esophageal diseases. Fifty-three patients were analyzed who received RCT with 40-45 Gy and concomitant chemotherapy in neoadjuvant intention, but in whom the treatment was stopped or switched to definitive RCT due to progression, patient decision, or new findings.
The reasons for refusal of SR for these 53 patients were as follows: (1) patients' or physicians' preference for the planned treatment was changed during the N-RCT, such that RCT was continued to a curative dose without a break (group 1, n = 23, 44%); (2) patients were restaged after 4 weeks, and the tumor board decided to continue RCT because R0 resection was unlikely and/or patients were medically unfit (group 2, n = 15, 28%); (3) patients refused continuation of any treatment (group 3, n = 15, 28%). Refusal of SR was significantly more likely in patients with longitudinal tumor dimension >8 cm and those with an Eastern Cooperative Oncology Group performance status score of 2. Median follow-up time from the start of N-RCT was 57 months (range 1-137 months). The survival rates at 2 and 5 years were 36 ± 7% and 27 ± 7%, respectively. Group 1 had significantly longer survival.
The planned N-RCT+SR could not be completed in a considerable number of patients in a tertiary referral center. More strict selection criteria for multimodality treatment including SR could spare some of these patients an incomplete treatment and probably lead to increased utilization of definitive RCT.
主要目的是评估食管鳞状细胞癌（ESCC）患者拒绝手术切除（SR）的不同原因，这些患者最初计划接受新辅助放化疗（N-RCT）+SR，但在N-RCT后未进行SR。
1988年至2011年，311例ESCC患者在一家三级食管疾病转诊中心接受N-RCT治疗。分析了53例患者，他们接受了新辅助治疗意向下40-45 Gy的放疗及同步化疗，但因疾病进展、患者决定或新发现而停止治疗或改为根治性RCT。
这53例患者拒绝SR的原因如下：（1）在N-RCT期间患者或医生对计划治疗的偏好发生改变，从而持续进行RCT至根治剂量且无中断（第1组，n = 23，44%）；（2）4周后对患者重新分期，肿瘤委员会决定继续RCT，因为R0切除不太可能且/或患者身体状况不适合手术（第2组，n = 15，28%）；（3）患者拒绝继续任何治疗（第3组，n = 15，28%）。肿瘤纵向径线>8 cm的患者以及东部肿瘤协作组体能状态评分为2的患者拒绝SR的可能性显著更高。从N-RCT开始的中位随访时间为57个月（范围1-137个月）。2年和5年生存率分别为36±7%和27±7%。第1组的生存期明显更长。
在一家三级转诊中心，相当数量的患者无法完成计划的N-RCT+SR。更严格的包括SR在内的多模式治疗选择标准可以使其中一些患者避免接受不完整的治疗，并可能提高根治性RCT的利用率。
