Caro M, Font A, Comas S, Viciano M, Remon J, Céliz P, Robles J, Musulén E, Sendrós M J, Mesalles E, Jiménez J A, Boix J, Arellano A, Fernández-Llamazares J
Radiation Oncology Service, Institut Català d´Oncologia, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, 08916, Badalona, Barcelona, Spain.
Medical Oncology Service, Institut Català d´Oncologia, Hospital Germans Trias i Pujol, Crta del Canyet, s/n, 08916, Badalona, Barcelona, Spain.
Clin Transl Oncol. 2016 Nov;18(11):1106-1113. doi: 10.1007/s12094-016-1488-y. Epub 2016 Feb 8.
The optimal regimen of preoperative chemoradiotherapy for resectable esophageal cancer has not been established. We evaluated accelerated hyperfractionated radiotherapy (RT) concurrent to low-dose weekly cisplatin and continuous infusion fluorouracil (LDCI-FU) followed by esophagectomy in patients with locally advanced squamous cell carcinoma (SCC) of the esophagus.
Patients with clinical stage II or III SCC of the esophagus received cisplatin 30 mg/m/week (days 1, 8, 15), LDCI-FU 300 mg/m/day (days 1-21), and concomitant RT to a dose of 45 Gy (150 cGy/fraction, 2 fractions/day) on tumor and affected lymph nodes, followed by radical esophagectomy.
From 1997 to 2012, 64 patients were treated with this regimen. Twenty-four patients (37 %) had grade 3 esophagitis, 18 (28 %) of whom required hospitalization. The risk of hospitalization was reduced by placement of a jejunostomy tube before starting induction chemoradiotherapy. Six patients (9 %) had grade 3-4 neutropenia. Fifty-three patients (83 %) underwent esophageal resection and complete resection was achieved in 45 (70 %). The overall median survival was 28 months (95 % CI: 20.4-35.6) and 5-year survival was 38 %. In the 18 patients attaining a pathological complete response, median survival was 132 months and 5-year survival was 72 %. Positron emission tomography standardized uptake values (PET SUVmax) post-chemoradiotherapy were associated with pathological response (p = 0.03) and survival (p = 0.04).
Intensive preoperative hyperfractionated RT concomitant to low-dose cisplatin and LDCI-FU is effective in patients with locally advanced SCC of the esophagus, with good pathological response and survival and manageable toxicities. Post-chemoradiotherapy PET SUVmax shows promise as a potential prognostic factor.
可切除食管癌的术前放化疗最佳方案尚未确定。我们评估了加速超分割放疗（RT）联合低剂量顺铂每周一次及氟尿嘧啶持续输注（LDCI-FU），随后对局部晚期食管鳞状细胞癌（SCC）患者进行食管切除术的疗效。
临床分期为II期或III期的食管SCC患者接受顺铂30mg/m²/周（第1、8、15天），LDCI-FU 300mg/m²/天（第1 - 21天），并对肿瘤及受累淋巴结进行同步放疗，剂量为45Gy（150cGy/分次，每天2次），随后进行根治性食管切除术。
1997年至2012年，64例患者接受了该方案治疗。24例患者（37%）发生3级食管炎，其中18例（28%）需要住院治疗。在开始诱导放化疗前放置空肠造口管可降低住院风险。6例患者（9%）发生3 - 4级中性粒细胞减少。53例患者（83%）接受了食管切除术，45例（70%）实现了完全切除。总体中位生存期为28个月（95%CI：20.4 - 35.6），5年生存率为38%。在18例达到病理完全缓解的患者中，中位生存期为132个月，5年生存率为72%。放化疗后正电子发射断层扫描标准化摄取值（PET SUVmax）与病理反应（p = 0.03）和生存（p = 0.04）相关。
强化术前超分割放疗联合低剂量顺铂和LDCI-FU对局部晚期食管SCC患者有效，具有良好的病理反应、生存率及可控的毒性。放化疗后PET SUVmax有望成为潜在的预后因素。
