Dröge Leif Hendrik, Karras Philipp Johannes, Guhlich Manuel, Schirmer Markus Anton, Ghadimi Michael, Rieken Stefan, Conradi Lena-Christin, Leu Martin
Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, 37075 Göttingen, Germany.
Cancers (Basel). 2021 Apr 12;13(8):1834. doi: 10.3390/cancers13081834.
We retrospectively studied outcomes in patients treated with preoperative radiochemotherapy and surgery for esophageal squamous cell cancer. We put special focus on the comparison of patients treated with 5-fluorouracil/cisplatin ('Walsh') or carboplatin/paclitaxel ('CROSS'). We compared characteristics between patients treated according to 'Walsh' vs. 'CROSS'. Cox regression was performed to test for an association of parameters with outcomes. Study eligibility was met by 90 patients. First, the higher age and more comorbidities of the 'CROSS' patients, along with a shorter intensive care/intermediate care stay, might reflect an improvement in supportive and surgical/perioperative procedures over the periods. Second, the 'CROSS' patients experienced more hematologic toxicity and were less likely to complete chemotherapy as per protocol. This indicates that efforts should be taken to guide patients through a toxic treatment regimen by supportive measures. Third, the negative prognostic impact of radiochemotherapy-related toxicities (i.e., dysphagia and hematologic toxicities) and the duration of the intensive care/intermediate care unit stay underlines that further optimization of treatment procedures remains an important goal. We found no differences in tumor downstaging and survival between treatment regimen. Toxicity profiles could be improved by tailoring the regimen to individual patients (e.g., careful use of the taxane-based regimen in elderly patients).
我们回顾性研究了接受术前放化疗及手术治疗的食管鳞状细胞癌患者的预后情况。我们特别关注了接受5-氟尿嘧啶/顺铂（“沃尔什”方案）或卡铂/紫杉醇（“CROSS”方案）治疗的患者之间的比较。我们比较了按照“沃尔什”方案与“CROSS”方案治疗的患者的特征。进行Cox回归以检验参数与预后之间的关联。90例患者符合研究纳入标准。首先，“CROSS”方案组患者年龄较大且合并症更多，同时重症监护/中级护理住院时间较短，这可能反映出在这期间支持治疗以及手术/围手术期操作方面有所改善。其次，“CROSS”方案组患者出现更多血液学毒性，且按方案完成化疗的可能性较小。这表明应采取措施通过支持性措施指导患者完成毒性较大的治疗方案。第三，放化疗相关毒性（即吞咽困难和血液学毒性）以及重症监护/中级护理病房住院时间的负面预后影响突显了进一步优化治疗程序仍然是一个重要目标。我们发现不同治疗方案在肿瘤降期和生存率方面没有差异。通过根据个体患者调整治疗方案（例如，老年患者谨慎使用基于紫杉烷的方案），毒性特征可能会得到改善。
