Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama, 700-8558, Japan.
Department of Surgery, Shigei Medical Research Institute, Okayama, Japan.
Esophagus. 2020 Apr;17(2):127-134. doi: 10.1007/s10388-019-00709-5. Epub 2020 Jan 2.
Locally advanced esophageal cancer (EC) invading surrounding organs (T4b) is difficult to treat. In general, definitive chemoradiotherapy (d-CRT) has been chosen as treatment for such cases. However, the outcome has not been good. Recently, the effectiveness of d-CRT with docetaxel, cisplatin, and 5-fluorouracil (DCF-RT) has been reported. Furthermore, surgery after d-CRT has a better prognosis than d-CRT alone in some reports, although it has a high risk of surgical complications. This study investigated the effectiveness and safety of induction DCF-RT.
The subjects were EC patients who underwent induction DCF-RT in Okayama University Hospital between January 2011 and December 2017. Their background characteristics, treatment details, histopathological factors, adverse events during CRT, postoperative complications, and overall survival (OS) were assessed.
A total of 16 cases were performed induction DCF-RT. In 10 cases, death occurred, with 9 cancer-related deaths, and 1 death due to other disease. For all cases, OS was 37.5% at 3 years. 12 cases underwent esophagectomy after DCF-RT. Their OS was 50% at 3 years. 13 patients (81.3%) had Grade 3 febrile neutropenia. In 7 cases (62.5%), fasting for the treatment of diarrhea was needed. Three patients (25%) developed anastomotic leakage. Some recurrent laryngeal nerve paralysis was observed in 6 cases (50%).
Although the rates of adverse events and surgical complications were slightly higher than in past reports, they were acceptable. It is useful to perform induction DCF-RT for T4b EC.
局部晚期食管癌（EC）侵犯周围器官（T4b）的治疗较为困难。一般来说，对于这种病例，选择明确的放化疗（d-CRT）。然而，效果并不理想。最近，多西紫杉醇、顺铂和 5-氟尿嘧啶（DCF-RT）的 d-CRT 有效性已被报道。此外，一些报道表明，d-CRT 后手术比单纯 d-CRT 预后更好，尽管手术并发症风险较高。本研究旨在探讨诱导 DCF-RT 的有效性和安全性。
本研究对象为 2011 年 1 月至 2017 年 12 月期间在冈山大学医院接受诱导 DCF-RT 的 EC 患者。评估了他们的背景特征、治疗细节、组织病理学因素、CRT 期间的不良事件、术后并发症和总生存（OS）。
共进行了 16 例诱导 DCF-RT。10 例死亡，其中 9 例为癌症相关死亡，1 例为其他疾病死亡。所有病例的 3 年 OS 为 37.5%。12 例患者在 DCF-RT 后接受了食管切除术。他们的 3 年 OS 为 50%。13 例（81.3%）患者发生 3 级发热性中性粒细胞减少症。7 例（62.5%）患者需要禁食以治疗腹泻。3 例（25%）患者发生吻合口漏。6 例（50%）患者出现部分喉返神经麻痹。
尽管不良事件和手术并发症的发生率略高于以往报道，但仍在可接受范围内。对于 T4b EC，进行诱导 DCF-RT 是有用的。
