Tamtai Amorn, Jiarpinitnun Chuleeporn, Hiranyatheb Pitichote, Unwanatham Nattawut, Sirachainun Eakapop, Supsamutchai Chairat, Pattaranutaporn Poompis, Ngamphaiboon Nuttapong
Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchatewi, Bangkok, 10400, Thailand.
Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Med Oncol. 2017 Sep;34(9):157. doi: 10.1007/s12032-017-1017-z. Epub 2017 Aug 7.
Platinum/5-fluorouracil (PF) is commonly used for chemoradiotherapy (CRT) for locally advanced esophageal and esophagogastric junction (EGJ) cancers. Weekly carboplatin and paclitaxel (CP) regimen for preoperative CRT has increased in popularity due to its potentially less toxicity. We retrospectively compared the tolerability and efficacy of these regimens. Patients with esophageal and EGJ squamous cell carcinoma (SCC) or adenocarcinoma who received CRT with curative intent were included. Safety and tolerability during CRT were evaluated using the CTCAE version 4.0. Efficacy was analyzed using pathologic complete response, disease-free survival, and overall survival. One hundred and twenty-four patients were eligible for analysis (CP = 64, PF = 60). Most patients had esophageal cancer (97%) with SCC histology (91%). Preoperative CRT was planned for 43% of patients in the CP group and 34% in the PF group (p = 0.306). The relative dose intensities of cisplatin (67.0%) and 5-fluorouracil (81.4%) were lower than those of carboplatin (86.6%) and paclitaxel (86.2%). No difference in the radiotherapy dose, hospitalization, interruption, or termination was observed between the groups. Dose reduction of chemotherapy was more frequent in the CP group (38 vs. 19%; p = 0.015). Febrile neutropenia was more frequent in the PF group (8 vs. 0%; p = 0.058). All-grade nausea/vomiting was lower in the CP group (20 vs. 38%; p = 0.032). Efficacy was comparable between both regimens. In the multivariate analysis, the CRT regimen was not a significant predictor of survival. The CP regimen had less toxicity than the PF regimen, while efficacy was comparable. A large prospective randomized study is warranted to confirm these results.
顺铂/5-氟尿嘧啶（PF）常用于局部晚期食管癌和食管胃交界（EGJ）癌的放化疗（CRT）。术前CRT采用每周卡铂和紫杉醇（CP）方案因其潜在毒性较小而越来越受欢迎。我们回顾性比较了这些方案的耐受性和疗效。纳入了接受根治性CRT的食管和EGJ鳞状细胞癌（SCC）或腺癌患者。使用CTCAE 4.0版评估CRT期间的安全性和耐受性。通过病理完全缓解、无病生存期和总生存期分析疗效。124例患者符合分析条件（CP组 = 64例，PF组 = 60例）。大多数患者患有食管癌（97%），组织学类型为SCC（91%）。CP组43%的患者和PF组34%的患者计划进行术前CRT（p = 0.306）。顺铂（67.0%）和5-氟尿嘧啶（81.4%）的相对剂量强度低于卡铂（86.6%）和紫杉醇（86.2%）。两组之间在放疗剂量、住院、中断或终止方面未观察到差异。CP组化疗剂量减少更为频繁（38%对19%；p = 0.015）。PF组发热性中性粒细胞减少更为频繁（8%对0%；p = 0.058）。CP组所有级别的恶心/呕吐发生率较低（20%对38%；p = 0.032）。两种方案的疗效相当。在多变量分析中，CRT方案不是生存的显著预测因素。CP方案的毒性低于PF方案，而疗效相当。需要进行一项大型前瞻性随机研究来证实这些结果。
