Mizrak Kaya Dilsa, Wang Xuemei, Harada Kazuto, Blum Murphy Mariela A, Das Prajnan, Minsky Bruce D, Estrella Jeannelyn S, Lin Quan, Amlashi Fatemeh G, Lee Jeffrey H, Weston Brian, Bhutani Manoop S, Matamoros Aurelio, Sagebiel Tara, Wu Carol C, Rogers Jane E, Thomas Irene, Maru Dipen M, Skinner Heath D, Badgwell Brian D, Hofstetter Wayne L, Ajani Jaffer A
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Oncology. 2017;93(4):243-248. doi: 10.1159/000475550. Epub 2017 Jul 6.
Through a multidisciplinary decision-making process, we developed a strategy of systemic therapy followed by local consolidative therapy (chemoradiation with/without surgery) in selected patients with metastatic gastroesophageal carcinoma (mGEAC). Only after a consensus during multidisciplinary discussions, local therapy was initiated.
We identified 101 patients with mGEAC who had local consolidation. We evaluated the association between various clinical variables (location of the primary, location of metastases, duration of initial chemotherapy, histologic grade, and radiation dose) and overall survival (OS).
Of 101 patients, 71 had a proximal primary (esophageal, Siewert type I or II), and 30 patients had a distal primary (Siewert type III or distal). The median OS was 25.7 months (95% confidence interval [CI] 22.3-32.8). The OS rates at 2 and 5 years were 53.8% (95% CI 44.7-64.8) and 20.7% (95% CI 13.4-31.9), respectively. OS was highly associated with the location of the primary (median of 22.8 months for Siewert I/II vs. 41.5 months for Siewert III or distal, p = 0.03). The duration of initial chemotherapy was highly associated with OS (median of 21.8 months for <3 months vs. 32.5 months for ≥3 months, p = 0.004).
Some mGEAC patients with a favorable clinical course can achieve a ∼20% 5-year survival rate with an approach that uses initial chemotherapy followed by multidisciplinary discussion to proceed with consolidation with local therapy. Patients with distal GEAC and those who receive initial chemotherapy for ≥3 months are the maximum beneficiaries.
通过多学科决策过程，我们为部分转移性胃食管癌（mGEAC）患者制定了一种先进行全身治疗，然后进行局部巩固治疗（有/无手术的放化疗）的策略。只有在多学科讨论达成共识后，才开始进行局部治疗。
我们确定了101例接受局部巩固治疗的mGEAC患者。我们评估了各种临床变量（原发灶位置、转移部位、初始化疗持续时间、组织学分级和放疗剂量）与总生存期（OS）之间的关联。
101例患者中，71例原发灶位于近端（食管，Siewert I型或II型），30例患者原发灶位于远端（Siewert III型或远端）。中位总生存期为25.7个月（95%置信区间[CI] 22.3 - 32.8）。2年和5年的总生存率分别为53.8%（95% CI 44.7 - 64.8）和20.7%（95% CI 13.4 - 31.9）。总生存期与原发灶位置高度相关（Siewert I/II型的中位生存期为22.8个月，而Siewert III型或远端为41.5个月，p = 0.03）。初始化疗持续时间与总生存期高度相关（<3个月的中位生存期为21.8个月，而≥3个月的为32.5个月，p = 0.004）。
一些临床病程良好的mGEAC患者采用先进行初始化疗，然后通过多学科讨论进行局部巩固治疗的方法，可实现约20%的5年生存率。远端胃食管癌患者以及接受初始化疗≥3个月的患者是最大受益者。
