Makino Isamu, Ninomiya Itasu, Okamoto Koichi, Kinoshita Jun, Hayashi Hironori, Nakamura Keishi, Oyama Katsunobu, Nakagawara Hisatoshi, Fujita Hideto, Tajima Hidehiro, Takamura Hiroyuki, Kitagawa Hirohisa, Fushida Sachio, Tani Takashi, Fujimura Takashi, Ohta Tetsuo, Takanaka Tsuyoshi
Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, Japan.
Department of Radiology, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, Japan.
World J Oncol. 2011 Oct;2(5):252-258. doi: 10.4021/wjon407w. Epub 2011 Oct 28.
Patients with unresectable or inoperable esophageal carcinoma are usually treated with definitive chemoradiotherapy. The present standard regimen is radiation with concurrent chemotherapy with cisplatin and fluorouracil. However, significant toxicities have been observed. The efficacy and safety of concurrent chemoradiotherapy with weekly docetaxel for head-and-neck squamous cell carcinoma and non-small cell lung cancer have already been recognized. We conducted a pilot study of definitive chemoradiotherapy with weekly docetaxel for advanced esophageal carcinoma.
Nine patients with advanced thoracic esophageal squamous cell carcinoma having a T4 tumor and/or distant lymph node metastasis (M1 LYM) were enrolled. Docetaxel was administered concurrently with 60 Gy of radiation by drip infusion at a dose of 10 mg/m for an hour once per week and 6 times in total.
All 9 patients completed the treatment schedule without any suspension. Grade 3 or higher hematological and biochemical toxicities did not occur. Two patients achieved complete response, and 4 achieved partial response. The response rate was 67%. The median survival time was 16.2 months and the 2-year survival rate was 38.9%.
Concurrent chemoradiotherapy with weekly low dose docetaxel is a safe and effective treatment regimen for esophageal squamous cell carcinoma. We expect that this protocol of chemoradiotherapy may be one of the choices of treatment substituting the regimen with cisplatin and fluorouracil, particularly for the patients for whom chemotherapy with cisplatin and fluorouracil is considered inappropriate because of concomitant renal dysfunction or prior failure of systemic chemotherapy with cisplatin and fluorouracil.
无法切除或无法手术的食管癌患者通常接受根治性放化疗。目前的标准方案是放疗联合顺铂和氟尿嘧啶同步化疗。然而，已观察到明显的毒性。每周一次多西他赛同步放化疗对头颈部鳞状细胞癌和非小细胞肺癌的疗效和安全性已得到认可。我们开展了一项关于每周一次多西他赛根治性放化疗治疗晚期食管癌的初步研究。
纳入9例患有T4期肿瘤和/或远处淋巴结转移（M1 LYM）的晚期胸段食管鳞状细胞癌患者。多西他赛在放疗60 Gy的同时通过静脉滴注给药，剂量为10 mg/m²，持续1小时，每周1次，共6次。
所有9例患者均完成了治疗计划，无任何中断。未发生3级或更高等级的血液学和生化毒性。2例患者达到完全缓解，4例达到部分缓解。缓解率为67%。中位生存时间为16.2个月，2年生存率为38.9%。
每周一次低剂量多西他赛同步放化疗是食管鳞状细胞癌的一种安全有效的治疗方案。我们期望这种放化疗方案可能成为替代顺铂和氟尿嘧啶方案的治疗选择之一，特别是对于因合并肾功能不全或既往顺铂和氟尿嘧啶全身化疗失败而被认为不适合使用顺铂和氟尿嘧啶化疗的患者。
