根治性放化疗在非转移性食管癌患者中的作用。

The role of definitive chemoradiation in patients with non-metastatic oesophageal cancer.

机构信息

Amsterdam University Medical Centers, Cancer Center Amsterdam, Location Academic Medical Center, Department of Radiation Oncology, Meibergdreef 9; B0-107, 1105 AZ, Amsterdam, Netherlands.

Amsterdam University Medical Centers, Cancer Center Amsterdam, Location Academic Medical Center, Department of Medical Oncology, Meibergdreef 9; F4-224, 1105 AZ, Amsterdam, Netherlands.

出版信息

Best Pract Res Clin Gastroenterol. 2018 Oct-Dec;36-37:53-59. doi: 10.1016/j.bpg.2018.11.011. Epub 2018 Nov 21.

DOI:10.1016/j.bpg.2018.11.011

PMID:30551857

Abstract

Definitive chemoradiation (dCRT) is a curative treatment option for patients with oesophageal cancer. It is effective in both adenocarcinoma and squamous cell carcinoma. However, locoregional control is less after dCRT compared to preoperative CRT (pCRT) followed by surgery. Also, overall survival is lower compared to pCRT followed by surgery, which can only partly be explained by a negative selection of patients. The optimal dose of radiotherapy remains to be determined, but dose escalation above 50.4Gy might be beneficial. Cisplatinum/5-FU is the most applied concurrent chemotherapy, but carboplatin/paclitaxel seems equally effective with less toxicity. The addition of 5-FU to a taxane and platinum seems promising. Accelerated fractionation and addition of cetuximab did not improve results. dCRT is a successful treatment for regional lymph node recurrences, but less so for recurrences at the anastomotic site. Re-irradiation after prior curative radiotherapy yields poor results. dCRT can be safely used in carefully selected elderly.

摘要

根治性放化疗（dCRT）是食管癌患者的一种有治愈可能的治疗选择。它对腺癌和鳞癌均有效。然而，与术前放化疗（pCRT）加手术相比，dCRT 后的局部区域控制效果较差。此外，与 pCRT 加手术相比，总生存率较低，这部分可以通过患者的负面选择来解释。放射治疗的最佳剂量仍有待确定，但超过 50.4Gy 的剂量升级可能有益。顺铂/5-FU 是最常用的同期化疗药物，但卡铂/紫杉醇的疗效相当，毒性较小。在紫杉烷和铂类药物中加入 5-FU 似乎很有前景。加速分割和西妥昔单抗的加入并没有改善结果。dCRT 是治疗区域淋巴结复发的有效方法，但对于吻合口部位的复发效果较差。在先前的根治性放疗后再次放疗效果不佳。dCRT 可以安全地用于精心选择的老年患者。