Kim S B, Kim S H, Lee K H, Lee J W, Kim S W, Suh C W, Lee J S, Song H Y, Chang H S, Choi E K
Department of Medicine, College of Medicine, University of Ulsan, Seoul, Korea.
J Korean Med Sci. 1995 Apr;10(2):111-20. doi: 10.3346/jkms.1995.10.2.111.
Conventional treatment of esophageal cancer with surgery or radiation alone has afforded few long-term survivors. In order to improve outcome and determine the efficacy of a combined modality approach, this prospective study was performed. Between May 1993 and August 1994, 27 patients with loco-regional squamous cell carcinoma of the esophagus were treated with 2 courses of combined fluorouracil(1000mg per square meter of body-surface area daily for 5 days) and cisplatin(60mg per square meter on the first day)(D1 and D29) plus 48Gy of radiation therapy(RT) over 4 weeks. A transhiatal esophagectomy was planned 3-4 weeks after chemoradiotherapy. Twenty-seven patients completed a full course of therapy. Clinical response was evaluable in 26 patients: 22 patients showed improvement and relief from dysphagia, 2 patients stable disease, and 2 patients progression. One patient died of sepsis 1 week after completion of chemoradiotherapy and was excluded from the analysis. Ten patients underwent operation after chemoradiation. Of them, 5 showed complete histologic response. One of the complete responders died of recurred disease 8.5months after operation, the other 2 patients died of sudden death, and sepsis from wound deheiscence 7 days after operation, respectively. Nine patients refused operation because of excellent relief of their dysphagia and 6 patients were denied because of disease progression(2), fear of operations(2), old age and family member's disapprovement(1), and underlying liver cirrhosis(1). The last one patient was awaiting for operation. Of 13 patients who refused or denied operation, 6 patients finished further chemotherapy and radiatherapy(external radiation 1200 cGy+intracavitary radiation 900 cGy, 2 cycles of 5FU+cisplatin). This intensive preoperative chemoradiotherapy is feasible, and allows for a high rate of resectability and a high rate of complete pathologic response in a locoregional esophageal cancer. Toxicity is considerable but manageable. This study warrants further investigation.
单纯采用手术或放疗对食管癌进行传统治疗，长期存活者寥寥无几。为改善治疗效果并确定综合治疗方法的疗效，开展了这项前瞻性研究。1993年5月至1994年8月期间，27例局限性食管鳞状细胞癌患者接受了两个疗程的联合治疗，即氟尿嘧啶（每日每平方米体表面积1000毫克，共5天）和顺铂（第1天60毫克每平方米）（第1天和第29天）加4周内48戈瑞的放射治疗（RT）。计划在放化疗后3至4周进行经胸食管切除术。27例患者完成了整个疗程的治疗。26例患者的临床反应可评估：22例患者病情改善，吞咽困难缓解，2例病情稳定，2例病情进展。1例患者在放化疗完成1周后死于败血症，被排除在分析之外。10例患者在放化疗后接受了手术。其中，5例显示完全组织学缓解。1例完全缓解者在术后8.5个月死于疾病复发，另外2例患者分别死于猝死和术后7天伤口裂开引起的败血症。9例患者因吞咽困难得到极大缓解而拒绝手术，6例患者因疾病进展（2例）、害怕手术（2例）、年龄大及家属不同意（1例）和潜在肝硬化（1例）而未被允许手术。最后1例患者在等待手术。在13例拒绝或未被允许手术的患者中，6例完成了进一步的化疗和放疗（外照射1200厘戈瑞+腔内照射900厘戈瑞，2个周期的5-氟尿嘧啶+顺铂）。这种强化的术前放化疗是可行的，对于局限性食管癌可实现高切除率和高完全病理缓解率。毒性相当大但可控。本研究值得进一步探究。
