van Ruler M A P, Peters F P, Slingerland M, Fiocco M, Grootenboers D A R H, Vulink A J E, Marijnen C A M, Neelis K J
Leiden University Medical Centre, Department of Radiation Oncology, Leiden, the Netherlands.
Leiden University Medical Centre, Department of Medical Oncology, Leiden, the Netherlands.
Dis Esophagus. 2017 Apr 1;30(4):1-9. doi: 10.1093/dote/dow033.
Patients with nonmetastatic esophageal cancer not suitable for surgery can be treated with definitive chemoradiotherapy with curative intent. The purpose of this retrospective study is to evaluate the clinical outcomes of definitive chemoradiotherapy using carboplatin and paclitaxel. Medical records were reviewed of patients treated for nonmetastatic squamous cell or adenocarcinoma of the esophagus between January 2009 and December 2013 in two collaborating institutes. Treatment consisted of external beam radiotherapy (28 fractions of 1.8 Gy) and 6 weekly courses of carboplatin (AUC = 2) and paclitaxel (50 mg/m2). Data on survival, progression, toxicity, and effect on dysphagia were recorded. Sixty-six patients were included. Median overall survival (OS) was 13.1 months (95% CI 4.7-21.5 months) and a 2-year OS was 30% (95% CI 18%-42%). At 2 years, 26% of patients developed local progression (95% CI 15%-37%) and 49% developed distant metastases (95% CI 36%-64%). Acute toxicity grade ≥3 was observed in 47% of patients. Late adverse events grade ≥3 were seen in 20%, mostly esophageal stenoses. Of patients with available data 3 months after treatment, 70% had relief of dysphagia. Definitive chemoradiotherapy led to a median OS of 13 months. Toxicity was common, mostly due to hematological toxicity. Given the relatively short median survival, an adequate selection of patients for this intensive treatment is required.
不适合手术的非转移性食管癌患者可接受根治性放化疗。本回顾性研究旨在评估使用卡铂和紫杉醇进行根治性放化疗的临床疗效。回顾了2009年1月至2013年12月期间在两个合作机构接受非转移性食管鳞状细胞癌或腺癌治疗的患者的病历。治疗包括外照射放疗（28次，每次1.8 Gy）以及卡铂（AUC = 2）和紫杉醇（50 mg/m²）的6周疗程。记录了生存、进展、毒性以及对吞咽困难的影响等数据。纳入了66例患者。中位总生存期（OS）为13.1个月（95%CI 4.7 - 21.5个月），2年总生存率为30%（95%CI 18% - 42%）。2年时，26%的患者出现局部进展（95%CI 15% - 37%），49%的患者出现远处转移（95%CI 36% - 64%）。47%的患者观察到急性毒性≥3级。20%的患者出现晚期不良事件≥3级，主要是食管狭窄。在治疗后3个月有可用数据的患者中，70%的患者吞咽困难得到缓解。根治性放化疗导致中位总生存期为13个月。毒性常见，主要是血液学毒性。鉴于中位生存期相对较短，需要对接受这种强化治疗的患者进行充分选择。
