Hamai Yoichi, Hihara Jun, Emi Manabu, Murakami Yuji, Kenjo Masahiro, Nagata Yasushi, Okada Morihito
Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
Ann Thorac Surg. 2015 Jun;99(6):1887-93. doi: 10.1016/j.athoracsur.2015.02.042. Epub 2015 Apr 23.
Esophageal cancer is most frequently treated with platinum-based chemoradiotherapy (CRT). We previously described a phase I study of definitive CRT with docetaxel (DOC) and 5-fluorouracil (5FU) in patients with advanced esophageal cancer. This regimen had low toxicity and was effective without platinating agents. The present study aims to determine the antitumor effects of neoadjuvant CRT with DOC and 5FU and surgical outcomes.
We reviewed data from 38 patients with locally advanced cancer of the esophagus or esophagogastric junction who underwent trimodality therapy comprising neoadjuvant CRT with DOC and 5FU followed by esophagectomy between 2003 and 2008.
Esophagitis was the most common toxicity associated with neoadjuvant CRT (grade 3; 26.3%), and hematologic toxicity was mild. Transthoracic esophagectomy and pharyngolaryngoesophagectomy proceeded in 36 (94.7%) and 2 (5.3%) patients, respectively, and 35 (92.1%) underwent R0 resection. Five (13.2%) patients had complete pathologic responses (pCR) of the primary tumor, and 23 (60.5%) had pathologic reductions of over two-thirds of the primary tumor. The T or N status was also down-staged in 26 (68.4%) patients. Overall postoperative morbidity developed in 21 (55.3%) patients, and mortality due to postoperative morbidity was zero. The 5-year recurrence-free and overall survival rates were 39.5% and 44.7%, respectively.
The rates of neoadjuvant CRT toxicity and postoperative complications were acceptable, and the complete resection rate and survival data were favorable. This regimen is promising as neoadjuvant CRT for esophageal cancer and very useful as an alternative regimen for treating patients with esophageal cancer who cannot tolerate cisplatin.
食管癌最常采用铂类化疗联合放疗（CRT）进行治疗。我们之前描述了一项针对晚期食管癌患者的多西他赛（DOC）和5-氟尿嘧啶（5FU）确定性CRT的I期研究。该方案毒性低，且在无铂类药物的情况下有效。本研究旨在确定DOC和5FU新辅助CRT的抗肿瘤效果及手术结果。
我们回顾了2003年至2008年间38例局部晚期食管癌或食管胃交界癌患者的数据，这些患者接受了包括DOC和5FU新辅助CRT随后行食管切除术的三联疗法。
食管炎是与新辅助CRT相关的最常见毒性反应（3级；26.3%），血液学毒性较轻。分别有36例（94.7%）和2例（5.3%）患者进行了经胸食管切除术和咽喉食管切除术，35例（92.1%）患者进行了R0切除。5例（13.2%）患者原发肿瘤出现完全病理缓解（pCR），23例（60.5%）患者原发肿瘤病理缩小超过三分之二。26例（68.4%）患者的T或N分期也有所降低。21例（55.3%）患者出现总体术后并发症，术后并发症导致的死亡率为零。5年无复发生存率和总生存率分别为39.5%和44.7%。
新辅助CRT的毒性发生率和术后并发症是可接受的，完全切除率和生存数据良好。该方案作为食管癌新辅助CRT很有前景，并且作为治疗不能耐受顺铂的食管癌患者的替代方案非常有用。
