Chan Wing-Lok, Choi Cheuk-Wai, Wong Ian Yu-Hong, Tsang Terence Hon-Ting, Lam Adrian Tin-Chung, Tse Rosa Pui-Ying, Chan K K, Wong Claudia, Law Betty Tze-Ting, Cheung Emina Edith, Chan Siu-Yin, Lam Ka-On, Kwong Dora, Law Simon
Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.
School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.
Ann Surg Oncol. 2023 Feb;30(2):861-870. doi: 10.1245/s10434-022-12694-8. Epub 2022 Oct 28.
The standard treatment for locoregionally advanced unresectable esophageal squamous cell carcinoma was radical chemoradiotherapy. However, the prognosis was modest. Emerging evidence showed the concept of induction chemotherapy with a goal of conversion surgery.
We reviewed the long-term, clinical outcomes and safety data of induction chemotherapy using docetaxel-cisplatin-5FU (DCF) and subsequent definitive treatment, either surgery or radical chemoradiotherapy (CRT), in locally advanced unresectable esophageal cancer in Queen Mary Hospital, Hong Kong. A total of 47 patients (median age 62 years, male: 41 (87.2%)) with locoregionally advanced unresectable esophageal cancer received induction DCF. The response rate was 65.9% (complete/partial response: n = 31). After induction DCF, 24 patients (41.4%) had radical surgery and 7 (14.9%) had definitive CRT.
The median overall survival (mOS) was significantly longer in patients received subsequent surgery compared with those with definitive CRT (mOS: 40.2 vs. 9.1 months, hazard ratio 3.33, 95% confidence interval 1.22-9.07, p = 0.02) and no definitive treatment (mOS: 40.2 vs. 6.3 months, hazard ratio 8.51, 95% confidence interval 3.7-19.73, p < 0.001). Patients who received surgery, female, and those with supraclavicular lymph node involvement had a better OS. Twenty-one patients (44.7%) developed grade 3/4 adverse events during induction DCF, and two died after chemotherapy because of trachea-esophageal fistula complicated with sepsis. Eleven patients who had surgery had postoperative complications and none had postoperative mortality.
Induction DCF and subsequent conversion surgery offered a chance of cure with long-term survival benefit and manageable toxicities in patients with locoregionally advanced unresectable esophageal cancer.
局部晚期不可切除食管鳞状细胞癌的标准治疗方法是根治性放化疗。然而，其预后一般。新出现的证据表明了以转化手术为目标的诱导化疗的概念。
我们回顾了香港玛丽医院对局部晚期不可切除食管癌患者使用多西他赛-顺铂-5-氟尿嘧啶（DCF）进行诱导化疗以及随后进行确定性治疗（手术或根治性放化疗[CRT]）的长期临床结果和安全性数据。共有47例局部晚期不可切除食管癌患者（中位年龄62岁，男性41例[87.2%]）接受了诱导DCF治疗。缓解率为65.9%（完全缓解/部分缓解：n = 31）。诱导DCF治疗后，24例患者（41.4%）接受了根治性手术，7例患者（14.9%）接受了确定性CRT。
与接受确定性CRT的患者相比，接受后续手术的患者的中位总生存期（mOS）显著更长（mOS：40.2个月对9.1个月，风险比3.33，95%置信区间1.22 - 9.07，p = 0.02），与未接受确定性治疗的患者相比也更长（mOS：40.2个月对6.3个月，风险比8.51，95%置信区间3.7 - 19.73，p < 0.001）。接受手术的患者、女性患者以及有锁骨上淋巴结转移的患者总生存期更好。21例患者（44.7%）在诱导DCF治疗期间发生3/4级不良事件，2例患者化疗后因气管食管瘘合并脓毒症死亡。11例接受手术的患者有术后并发症，无术后死亡病例。
诱导DCF及随后的转化手术为局部晚期不可切除食管癌患者提供了治愈机会，具有长期生存获益且毒性可控。
