新辅助放化疗后食管癌的主动监测：吞咽困难不常见。

Active surveillance of oesophageal cancer after response to neoadjuvant chemoradiotherapy: dysphagia is uncommon.

机构信息

Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.

Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.

出版信息

Br J Surg. 2023 Sep 6;110(10):1381-1386. doi: 10.1093/bjs/znad211.

DOI:10.1093/bjs/znad211

PMID:37418342

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10480037/

Abstract

BACKGROUND

Active surveillance is being investigated as an alternative to standard surgery after neoadjuvant chemoradiotherapy for oesophageal cancer. It is unknown whether dysphagia persists or develops when the oesophagus is preserved after neoadjuvant chemoradiotherapy. The aim of this study was to assess the prevalence and severity of dysphagia during active surveillance in patients with an ongoing response.

METHODS

Patients who underwent active surveillance were identified from the Surgery As Needed for Oesophageal cancer ('SANO') trial. Patients without evidence of residual oesophageal cancer until at least 6 months after neoadjuvant chemoradiotherapy were included. Study endpoints were assessed at time points that patients were cancer-free and remained cancer-free for the next 4 months. Dysphagia scores were evaluated at 6, 9, 12, and 16 months after neoadjuvant chemoradiotherapy. Scores were based on the European Organisation for Research and Treatment of Cancer oesophago-gastric quality-of-life questionnaire 25 (EORTC QLQ-OG25) (range 0-100; no to severe dysphagia). The rate of patients with a (non-)traversable stenosis was determined based on all available endoscopy reports.

RESULTS

In total, 131 patients were included, of whom 93 (71.0 per cent) had adenocarcinoma, 93 (71.0 per cent) had a cT3-4a tumour, and 33 (25.2 per cent) had a tumour circumference of greater than 75 per cent at endoscopy; 60.8 to 71.0 per cent of patients completed questionnaires per time point after neoadjuvant chemoradiotherapy. At all time points after neoadjuvant chemoradiotherapy, median dysphagia scores were 0 (interquartile range 0-0). Two patients (1.5 per cent) underwent an intervention for a stenosis: one underwent successful endoscopic dilatation; and the other patient required temporary tube feeding. Notably, these patients did not participate in questionnaires.

CONCLUSION

Dysphagia and clinically relevant stenosis are uncommon during active surveillance.

摘要

背景

新辅助放化疗后，主动监测被认为是替代标准手术的一种方法。目前尚不清楚新辅助放化疗后保留食管时是否会持续或出现吞咽困难。本研究旨在评估持续缓解的患者在主动监测期间吞咽困难的发生率和严重程度。

方法

从“按需手术治疗食管癌（SANO）”试验中确定接受主动监测的患者。在新辅助放化疗后至少 6 个月无残留食管癌证据的患者被纳入研究。研究终点在患者无癌且在接下来的 4 个月内保持无癌时进行评估。在新辅助放化疗后 6、9、12 和 16 个月评估吞咽困难评分。评分基于欧洲癌症研究与治疗组织（EORTC）食管胃质量生活问卷 25（EORTC QLQ-OG25）（范围 0-100；无至严重吞咽困难）。根据所有可用的内镜报告确定有（无）可通过狭窄的患者比例。

结果

共纳入 131 例患者，其中 93 例（71.0%）为腺癌，93 例（71.0%）为 cT3-4a 肿瘤，33 例（25.2%）在内镜下肿瘤周长大于 75%；60.8%至 71.0%的患者在新辅助放化疗后每个时间点完成问卷。在新辅助放化疗后的所有时间点，中位吞咽困难评分为 0（四分位距 0-0）。2 例患者（1.5%）因狭窄行介入治疗：1 例成功行内镜扩张；另 1 例患者需要临时管饲。值得注意的是，这 2 例患者未参与问卷调查。