Kumabe A, Fukada J, Kota R, Koike N, Shiraishi Y, Seki S, Yoshida K, Kitagawa Y, Shigematsu N
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.
Dis Esophagus. 2018 Apr 1;31(4). doi: 10.1093/dote/dox138.
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.
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。