Yan Mao-Hui, Liu Fang, Qu Bao-Lin, Cai Bo-Ning, Yu Wei, Dai Xiang-Kun
Department of Radiotherapy, The First Medical Center of the Chinese People's Liberation Army (PLA) General Hospital, Beijing 100853, China.
World J Gastrointest Oncol. 2021 Nov 15;13(11):1781-1790. doi: 10.4251/wjgo.v13.i11.1781.
Albumin-bound paclitaxel (ABP) has been used as second- and higher-line treatments for advanced esophageal cancer, and its efficacy and safety have been well demonstrated. Lobaplatin (LBP) is a third-generation platinum antitumor agent; compared with the first two generations of platinum agents, it has lower toxicity and has been approved for the treatment of breast cancer, small cell lung cancer, and chronic granulocytic leukemia. However, its role in the treatment of esophageal cancer warrants further investigations.
To investigate the efficacy and safety of induction chemotherapy with ABP plus LBP followed by concurrent radiochemotherapy (RCT) for locally advanced esophageal cancer.
Patients with pathologically confirmed advanced esophageal squamous cell carcinoma (ESCC) at our hospital were enrolled in this study. All patients were treated with two cycles of induction chemotherapy with ABP plus LBP followed by concurrent RCT: ABP 250 mg/m, ivgtt, 30 min, d1, every 3 wk; and LBP, 30 mg/m, ivgtt, 2 h, d1, every 3 wk. A total of four cycles were scheduled. The dose of the concurrent radiotherapy was 56-60 Gy/28-30 fractions, 1.8-2.0 Gy/fraction, and 5 fractions/wk.
A total of 29 patients were included, and 26 of them completed the treatment protocol. After the induction chemotherapy, the objective response rate (ORR) was 61.54%, the disease control rate (DCR) was 88.46%, and the progressive disease (PD) rate was 11.54%; after the concurrent RCT, the ORR was 76.92%, the DCR was 88.46%, and the PD rate was 11.54%. The median progression-free survival was 11.1 mo and the median overall survival was 15.83 mo. Cox multivariate analysis revealed that two cycles of induction chemotherapy followed by concurrent RCT significantly reduced the risk of PD compared with two cycles of chemotherapy alone ( = 0.0024). Non-hematologic toxicities were tolerable, and the only grade 3 non-hematologic toxicity was radiation-induced esophagitis (13.79%). The main hematologic toxicity was neutropenia, and no grade 4 adverse event occurred.
Induction chemotherapy with ABP plus LBP followed by concurrent RCT is effective in patients with locally advanced ESCC, with mild adverse effects. Thus, this protocol is worthy of clinical promotion and application.
白蛋白结合型紫杉醇（ABP）已被用作晚期食管癌的二线及以上治疗药物，其疗效和安全性已得到充分证实。洛铂（LBP）是第三代铂类抗肿瘤药物；与前两代铂类药物相比，它的毒性较低，已被批准用于治疗乳腺癌、小细胞肺癌和慢性粒细胞白血病。然而，其在食管癌治疗中的作用仍有待进一步研究。
探讨ABP联合LBP诱导化疗后序贯同步放化疗（RCT）治疗局部晚期食管癌的疗效和安全性。
选取我院经病理确诊的晚期食管鳞状细胞癌（ESCC）患者纳入本研究。所有患者均接受两个周期的ABP联合LBP诱导化疗，随后进行同步RCT：ABP 250 mg/m²，静脉滴注，30分钟，第1天，每3周一次；LBP 30 mg/m²，静脉滴注，2小时，第1天，每3周一次。共计划进行四个周期。同步放疗剂量为56 - 60 Gy/28 - 30次，1.8 - 2.0 Gy/次，每周5次。
共纳入29例患者，其中26例完成治疗方案。诱导化疗后，客观缓解率（ORR）为61.54%，疾病控制率（DCR）为88.46%，疾病进展（PD）率为11.54%；同步RCT后，ORR为76.92%，DCR为88.46%，PD率为11.54%。中位无进展生存期为11.1个月，中位总生存期为15.83个月。Cox多因素分析显示，与单纯两个周期化疗相比，两个周期诱导化疗后序贯同步RCT显著降低了PD风险（P = 0.0024）。非血液学毒性可耐受，唯一的3级非血液学毒性为放射性食管炎（13.79%）。主要血液学毒性为中性粒细胞减少，未发生4级不良事件。
ABP联合LBP诱导化疗后序贯同步RCT治疗局部晚期ESCC患者有效，不良反应轻微。因此，该方案值得临床推广应用。
