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每日低剂量持续输注5-氟尿嘧啶和顺铂同步放化疗(LDFP)治疗I-II期食管癌的长期疗效

Long-term results of concurrent chemoradiotherapy with daily-low-dose continuous infusion of 5-fluorouracil and cisplatin (LDFP) for Stage I-II esophageal carcinoma.

作者信息

Kumabe A, Fukada J, Kota R, Koike N, Shiraishi Y, Seki S, Yoshida K, Kitagawa Y, Shigematsu N

机构信息

Department of Radiology and Department of Surgery, Keio University School of Medicine, Tokyo, Japan.

Department of Radiation Oncology, Saitama Medical University Hospital, Saitama, Tokyo, Japan.

出版信息

Dis Esophagus. 2018 Apr 1;31(4). doi: 10.1093/dote/dox138.

Abstract

We investigated long-term treatment outcomes and the feasibility of chemoradiotherapy consisting of daily-low-dose 5-fluorouracil and cisplatin (LDFP) chemotherapy plus radiotherapy for Stage I-II squamous cell esophageal cancer. Treatment records from the 2000 through 2008 period were reviewed retrospectively. Fractionated radiotherapy was performed with a total dose of 60 Gy delivered in 2 Gy per fraction. LDFP chemotherapy, as continuous infusion of 200 mg/m2 5-fluorouracil combined with one hour infusion of 4 mg/m2 cisplatin, was administered on the same days as radiotherapy. Survival was calculated by the Kaplan-Meier method. Survival, responses, failure patterns, and toxicities were evaluated. Seventy-six (47 stage I and 29 stage II) patients were analyzed with a median follow-up of 93.6 months. The 8-year overall survival (OS), progression-free survival (PFS) and cause-specific survival (CSS) rates were 63.4%, 49.8%, and 76.7%, respectively. The 8-year OS, PFS, and CSS for stage I and stage II patients were 71.0%/56.1%/82.9% and 45.2%/40.2%/66.6%, respectively. Sixty-eight patients (89.5%) completed the treatment regimen. A complete response (CR) was achieved in 68 patients (89.5%). Twenty-five patients (36.8%) experienced recurrence after CR. The failure patterns were (overlap included): local failure (n = 12), nodal metastasis (n = 12), distant metastasis (n = 3), details unknown (n = 2). Salvage therapy was performed for local failure; endoscopic therapy (n = 7) or surgery (n = 2). Six patients remain alive without relapse after salvage endoscopic therapy. Major Grade 3 or higher acute adverse events were leukopenia (22%), anorexia (17%), and esophagitis (11%). Major late toxicities (Grade 3 or 4) involved pericardial effusion (12%), pleural effusion (4%), and esophageal stenosis (3%). Chemoradiotherapy with LDFP provided favorable long-term survival with acceptable toxicity for Stage I-II squamous cell esophageal cancer. The tumor response was excellent, but close endoscopic follow-up is essential for detecting and treating local recurrence.

摘要

我们研究了低剂量每日5-氟尿嘧啶和顺铂(LDFP)化疗联合放疗用于I-II期食管鳞状细胞癌的长期治疗效果及可行性。回顾性分析了2000年至2008年期间的治疗记录。采用分割放疗,总剂量60 Gy,每次2 Gy。LDFP化疗在放疗当天进行,持续输注200 mg/m² 5-氟尿嘧啶并1小时输注4 mg/m²顺铂。采用Kaplan-Meier法计算生存率,并对生存情况、反应、失败模式和毒性进行评估。分析了76例患者(I期47例,II期29例),中位随访时间为93.6个月。8年总生存率(OS)、无进展生存率(PFS)和病因特异性生存率(CSS)分别为63.4%、49.8%和76.7%。I期和II期患者的8年OS、PFS和CSS分别为71.0%/56.1%/82.9%和45.2%/40.2%/66.6%。68例患者(89.5%)完成了治疗方案。68例患者(89.5%)达到完全缓解(CR)。25例患者(36.8%)在CR后出现复发。失败模式包括(包括重叠情况):局部失败(n = 12)、淋巴结转移(n = 12)、远处转移(n = 3)、细节不明(n = 2)。对局部失败进行了挽救治疗;内镜治疗(n = 7)或手术(n = 2)。6例患者在挽救性内镜治疗后仍存活且无复发。主要的3级或更高等级急性不良事件为白细胞减少(22%)、厌食(17%)和食管炎(11%)。主要的晚期毒性(3级或4级)包括心包积液(12%)、胸腔积液(4%)和食管狭窄(3%)。LDFP化疗放疗对I-II期食管鳞状细胞癌提供了良好的长期生存且毒性可接受。肿瘤反应良好,但密切的内镜随访对于检测和治疗局部复发至关重要。

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