Murakami Yuji, Hamai Yoichi, Emi Manabu, Hihara Jun, Imano Nobuki, Takeuchi Yuki, Takahashi Ippei, Nishibuchi Ikuno, Kimura Tomoki, Okada Morihito, Nagata Yasushi
Department of Radiation Oncology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Japan.
Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Japan.
J Radiat Res. 2018 Sep 1;59(5):616-624. doi: 10.1093/jrr/rry047.
This study retrospectively evaluated the long-term results of neoadjuvant chemoradiotherapy (NCRT) followed by esophagectomy for the patients with resectable, locally advanced esophageal squamous cell carcinoma (ESCC). Altogether, 49 patients treated from 2008 to 2012 were analyzed. Chemotherapy consisted of 5-fluorouracil and cisplatin. Radiotherapy was performed with a total dose of 40 Gy in 20 fractions for primary tumor, metastatic lymph nodes, and elective nodal area. Subsequently, transthoracic esophagectomy with extensive lymphadenectomy was performed. The median follow-up time for the survivors was 86 (range, 55-111) months. Pathological complete response from NCRT was observed in 17 (35%) patients. The 5-year overall survival and relapse-free survival rates were 56% [95% confidence interval (CI): 43-71%] and 55% (95% CI: 41-69%), respectively. The 5-year locoregional control rate was 84% (95% CI: 74-95%). Multivariate analyses revealed body mass index, N-factor, and %ΔSUVmax as significant factors for overall survival. Recurrences and within-irradiation field failure were observed in 16 (31%) and 4 (8%) patients, respectively. Toxicities of NCRT were generally mild. Postoperative Grade IIIb or worse complications were seen in 14% of patients, including one Grade V case (2%). The 5-year incidence rate of late complications of Grade 3 or worse was 22% (95% CI: 7-36%). The cumulative 5-year incidence rate of metachronous malignancies was 13% (95% CI: 1-26%). NCRT followed by esophagectomy for patients with resectable, locally advanced ESCC showed favorable locoregional control and overall survival, with acceptable postoperative complications. Long-term careful follow-up for late complications and metachronous malignancies is needed.
本研究回顾性评估了新辅助放化疗（NCRT）联合食管切除术治疗可切除的局部晚期食管鳞状细胞癌（ESCC）患者的长期疗效。共分析了2008年至2012年期间接受治疗的49例患者。化疗方案为5-氟尿嘧啶和顺铂。对原发肿瘤、转移淋巴结及选择性淋巴结区域进行放疗，总剂量40 Gy，分20次进行。随后行经胸食管切除术及广泛淋巴结清扫术。存活患者的中位随访时间为86（范围55 - 111）个月。17例（35%）患者经NCRT后达到病理完全缓解。5年总生存率和无复发生存率分别为56% [95%置信区间（CI）：43 - 71%]和55%（95% CI：41 - 69%）。5年局部区域控制率为84%（95% CI：74 - 95%）。多因素分析显示，体重指数、N分期及%ΔSUVmax是总生存的显著影响因素。分别有16例（31%）和4例（8%）患者出现复发及放疗野内失败。NCRT的毒性反应一般较轻。14%的患者术后出现Ⅲb级或更严重的并发症，包括1例Ⅴ级病例（2%）。3级或更严重晚期并发症的5年发生率为22%（95% CI：7 - 36%）。异时性恶性肿瘤的累积5年发生率为13%（95% CI：1 - 26%）。NCRT联合食管切除术治疗可切除的局部晚期ESCC患者显示出良好的局部区域控制和总生存，术后并发症可接受。需要对晚期并发症和异时性恶性肿瘤进行长期密切随访。
