Cancer Chemotherapy Center, Osaka Medical College Hospital, Osaka Medical College, 2-7 Daigaku machi, Takatsuki, Osaka, 569-8686, Japan.
Second Department of Internal Medicine, Osaka Medical College, 2-7 Daigaku machi, Takatsuki, Osaka, 569-8686, Japan.
Int J Clin Oncol. 2018 Aug;23(4):652-658. doi: 10.1007/s10147-018-1258-7. Epub 2018 Mar 8.
While the standard treatment for stage II-III (non-T4) esophageal squamous cell carcinoma (ESCC) is neoadjuvant therapy followed by esophagectomy, definitive chemoradiation therapy (dCRT) is an option to treat ESCC patients who reject or may not tolerate surgical treatment. Second primary malignancy (SPM) is a problem for long-term survivors after achieving complete response (CR) by dCRT.
The source of the subjects in this study was the patients with stage II/III (excluding T4 disease) ESCC (UICC6th) who underwent dCRT from 2000 to 2011 at the National Cancer Center Hospital, Japan. SPM, defined as malignancy newly detected at different site from the initial disease, was checked in patients who achieved CR by the initial dCRT.
Among the 285 patients with stage II/III (excluding T4 disease) ESCC who underwent dCRT, 185 patients achieved CR. SPM was detected in 49 patients (median time to developing SPM, 41.5 months), accounting for 19.3% (95% CI 0.137-0.257) as the 5-year cumulative risk of SPM. SPMs were head and neck cancer (n = 12), gastric cancer (n = 12), esophageal cancer (n = 7), lung cancer (n = 5), colon cancer (n = 4), diffuse large B-cell lymphoma (n = 3), bladder cancer (n = 2), small intestinal cancer (n = 1), cholangiocarcinoma (n = 1), malignant melanoma (n = 1), and breast cancer (n = 1). There were no significant differences in baseline characteristics between the patients who developed SPM (n = 49) and others (n = 136).
Because second primary malignancy developed often after achieving CR by dCRT for ESCC, it should be followed carefully.
对于 II-III 期（非 T4）食管鳞癌（ESCC）患者，标准治疗方法是新辅助治疗后行食管切除术，但对于拒绝或不能耐受手术治疗的 ESCC 患者，根治性放化疗（dCRT）也是一种选择。对于通过 dCRT 达到完全缓解（CR）的患者，第二原发恶性肿瘤（SPM）是长期生存者面临的一个问题。
本研究的对象来源于日本国家癌症中心医院 2000 年至 2011 年间接受 dCRT 治疗的 II/III 期（不包括 T4 期疾病）ESCC（UICC6 期）患者。在初始 dCRT 达到 CR 的患者中，检查是否存在新的与初始疾病不同部位的恶性肿瘤，定义为 SPM。
在 285 例接受 dCRT 的 II/III 期（不包括 T4 期疾病）ESCC 患者中，有 185 例达到 CR。49 例患者（发生 SPM 的中位时间为 41.5 个月）检测到 SPM，占 SPM 5 年累积风险的 19.3%（95%CI 0.137-0.257）。SPM 为头颈部癌（n=12）、胃癌（n=12）、食管癌（n=7）、肺癌（n=5）、结肠癌（n=4）、弥漫性大 B 细胞淋巴瘤（n=3）、膀胱癌（n=2）、小肠癌（n=1）、胆管癌（n=1）、恶性黑色素瘤（n=1）和乳腺癌（n=1）。发生 SPM（n=49）与未发生 SPM（n=136）患者的基线特征无显著差异。
由于 ESCC 患者通过 dCRT 达到 CR 后 SPM 常发生，因此应密切随访。
