Department of Surgery, Upper GI Service, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
Department of Pathology, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Vienna, Austria.
Strahlenther Onkol. 2020 Sep;196(9):779-786. doi: 10.1007/s00066-020-01594-z. Epub 2020 Feb 13.
Neoadjuvant radiochemotherapy (RCTH) is proven to be highly effective in the treatment of esophageal cancer (EC). We investigated oncological outcome and morbidity in patients treated with a modified CROSS protocol followed by esophagectomy at our institution.
Patients with EC receiving neoadjuvant RCTH with paclitaxel and carboplatin and concurrent radiotherapy (46 Gy) followed by esophagectomy were included in this retrospective analysis. Histopathological response, overall survival (OS) and recurrence-free interval (RFI) as well as perioperative morbidity were investigated.
Thirty-six patients (86.1% male, mean age 61.3 years, standard deviation 11.52) received neoadjuvant RCTH before surgery. Sixteen patients (44.4%) were treated for squamous cell cancer, whereas 20 patients (55.6%) had adenocarcinoma. The majority (75%) underwent abdominothoracic esophageal resection. Major complications occurred in 7 patients (19.5%) including anastomotic leakage in 4 patients (11.1%). A R0 resection was achieved in 97.2%. A complete pathological remission was seen in 13 patients (36.1%). Major response, classified as Mandard tumor regression grade 1 and 2, was found in 26 patients (72.2%). Median OS and RFI were not reached.
Neoadjuvant radiotherapy with 46 Gy and concomitant chemotherapy with paclitaxel and carboplatin for the treatment of locally advanced esophageal carcinoma is safe and effective. The results of this modified radiotherapy protocol are encouraging and should be considered in future patient treatment and study designs.
新辅助放化疗（RCTH）已被证明在治疗食管癌（EC）方面非常有效。我们研究了在我院接受改良 CROSS 方案治疗并随后行食管切除术的患者的肿瘤学结果和发病率。
本回顾性分析纳入了接受紫杉醇和卡铂新辅助 RCTH 联合同期放疗（46Gy）后行食管切除术的 EC 患者。研究了组织病理学反应、总生存期（OS）和无复发生存期（RFI）以及围手术期发病率。
36 例患者（86.1%为男性，平均年龄 61.3 岁，标准差 11.52）在手术前接受了新辅助 RCTH。16 例（44.4%）患者为鳞状细胞癌，20 例（55.6%）为腺癌。大多数（75%）患者行胸腹联合食管切除术。7 例患者（19.5%）发生了主要并发症，包括 4 例（11.1%）吻合口漏。97.2%的患者达到了 R0 切除。13 例（36.1%）患者完全缓解。26 例（72.2%）患者的主要反应为 Mandard 肿瘤消退分级 1 和 2。中位 OS 和 RFI 未达到。
对于局部晚期食管癌，46Gy 的新辅助放疗和紫杉醇与卡铂的同期化疗是安全有效的。该改良放疗方案的结果令人鼓舞，应在未来的患者治疗和研究设计中考虑。
