Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
Department of Palliative Medicine, Iwate Medical University School of Medicine, Morioka, Iwate, Japan.
World J Surg Oncol. 2018 Jul 2;16(1):122. doi: 10.1186/s12957-018-1420-8.
Docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy can cause severe adverse events, including neutropenia and febrile neutropenia. The feasibility of DCF therapy is a concern, particularly for elderly patients, patients with moderate organ disorders, and patients suffering from malnutrition caused by dysphagia or insufficient oral intake. We introduced a biweekly DCF therapy (bDCF) for the purpose of reducing severe adverse events for these fragile patients. This study investigated the feasibility and outcome of an esophagectomy after bDCF therapy for patients with advanced esophageal squamous cell carcinoma.
Fifty-nine patients with esophageal carcinoma underwent an esophagectomy after DCF or bDCF therapy as primary chemotherapy. DCF was administered to 37 patients in the DCF group, whereas bDCF was administered to 22 patients in the bDCF group.
Patients in the bDCF group were significantly older than those in the DCF group (p = 0.016). Heart and pulmonary comorbidities were significantly more common in the bDCF than in the DCF group (p < 0.001 and p = 0.039, respectively). Grade 3 or 4 neutropenia was less frequent in the bDCF than in the DCF group (40.9 vs. 81.1%, p = 0.002). Anorexia was more frequent in the DCF group than in the bDCF group (18.9 vs. 0%, p = 0.030). The clinical response rate of the bDCF group was significantly higher than that of the DCF group (86.4 vs. 62.2%, p = 0.047). There was no significant between-group difference in the postoperative morbidity rate (bDCF 45.5% vs. DCF 32.4%) or in the histological therapeutic effect.
The results demonstrate that primary bDCF therapy for high-risk patients with advanced esophageal cancer is feasible and safe in both chemotherapeutic and perioperative periods without a reduction in the efficacy of DCF therapy.
多西他赛、顺铂和 5-氟尿嘧啶（DCF）治疗会引起严重的不良反应，包括中性粒细胞减少症和发热性中性粒细胞减少症。DCF 治疗的可行性是一个关注点，尤其是对于老年患者、中重度器官功能障碍患者以及因吞咽困难或口服摄入不足而营养不良的患者。我们引入了双周 DCF 治疗（bDCF），以降低这些脆弱患者的严重不良反应。本研究旨在探讨接受 bDCF 治疗后的晚期食管鳞状细胞癌患者行食管切除术的可行性和结果。
59 例食管癌患者在接受 DCF 或 bDCF 治疗作为新辅助化疗后行食管切除术。DCF 组 37 例患者接受 DCF 治疗，bDCF 组 22 例患者接受 bDCF 治疗。
bDCF 组患者明显比 DCF 组患者年龄大（p=0.016）。bDCF 组的心脏和肺部合并症明显比 DCF 组更常见（p<0.001 和 p=0.039）。bDCF 组的 3 或 4 级中性粒细胞减少症发生率明显低于 DCF 组（40.9%比 81.1%，p=0.002）。bDCF 组厌食发生率明显高于 DCF 组（18.9%比 0%，p=0.030）。bDCF 组的临床缓解率明显高于 DCF 组（86.4%比 62.2%，p=0.047）。bDCF 组和 DCF 组在术后发病率（bDCF 组 45.5%比 DCF 组 32.4%）或组织学治疗效果方面均无显著差异。
这些结果表明，对于高危、晚期食管癌患者，在化疗和围手术期，采用 bDCF 作为初始治疗是可行和安全的，不会降低 DCF 治疗的疗效。
