MacFarlane S D, Hill L D, Jolly P C, Kozarek R A, Anderson R P
Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, Wash.
J Thorac Cardiovasc Surg. 1988 Mar;95(3):415-22.
Combined treatment with chemotherapy and radiation (chemoradiation) preceding surgical exploration for esophageal or gastroesophageal squamous cell carcinoma or adenocarcinoma was compared with surgical exploration alone to determine if there was an influence on tumor status at exploration, tumor resectability, disease recurrence, and patient survival. Preoperative chemoradiation resulted in significant tumor response as measured by decreased nodal involvement and 36% incidence of no residual tumor at resection (total response) and was reflected by an improvement in resectability. Local tumor recurrence was eliminated by preoperative chemoradiation preceding resection. Distant recurrence was not reduced and remained the major cause of death. The 2-year survival rate after tumor resection alone was 33% versus 66% after preoperative chemoradiation and resection (p = 0.13). Patient survival after resection alone was predicted by pathologic extent of local disease as measured by lymph node status. In contrast, survival after chemoradiation and resection was not predicted by pathologic extent of local disease. Surgical resection appears to have been an important component of therapy, primarily because survival was improved in patients after resection of residual local disease.
将食管或胃食管鳞状细胞癌或腺癌手术探查前的化疗与放疗联合治疗（放化疗）与单纯手术探查进行比较，以确定其对探查时肿瘤状态、肿瘤可切除性、疾病复发和患者生存是否有影响。术前放化疗导致明显的肿瘤反应，表现为淋巴结受累减少，切除时无残留肿瘤的发生率为36%（完全反应），并反映在可切除性的改善上。术前放化疗消除了切除前的局部肿瘤复发。远处复发未减少，仍然是主要死因。单纯肿瘤切除后的2年生存率为33%，而术前放化疗及切除后的生存率为66%（p = 0.13）。单纯切除后的患者生存可通过淋巴结状态所衡量的局部疾病病理范围来预测。相比之下，放化疗及切除后的生存不能通过局部疾病病理范围来预测。手术切除似乎是治疗的一个重要组成部分，主要是因为切除残留局部疾病后的患者生存率有所提高。
