Burmeister B H, Denham J W, O'Brien M, Jamieson G G, Gill P G, Devitt P, Yeoh E, Hamilton C S, Ackland S P, Lamb D S
Queensland Radium Institute, Mater Misericordiae Hospital, South Brisbane, Australia.
Int J Radiat Oncol Biol Phys. 1995 Jul 15;32(4):997-1006. doi: 10.1016/0360-3016(94)00449-u.
This report updates local control and survival experience and focuses on treatment toxicity in 294 patients with esophageal cancer who have been treated at six Australasian centers using three prospective unrandomized protocols that used concurrent radiation, cisplatin, and modest dose infusional fluorouracil.
Protocol 1--"definitive" chemoradiation. One hundred and thirty-seven patients have been treated with "definitive" radiation to 60 Gy in 6 weeks plus two courses of cisplatin (80 mg/m2) and infusional fluorouracil (800 mg/m2/day over 4 days) during the first and fourth weeks of radiation. Protocol 2--"preoperative" chemoradiation and surgery. Seventy-eight patients received chemoradiation using the same chemotherapy, but 30-35 Gy in 3-4 weeks prior to surgery. Protocol 3--"palliative" chemoradiation. Seventy-nine patients deemed incurable were treated "palliatively" with the same chemoradiation protocol without surgery. Follow-up ranges from 6 months to 7 years (mean 22 months) in live patients.
Durable palliation of dysphagia in all three treatment groups has been reflected by encouraging 3-year survival expectations of 43.2 +/- 5% in definitively treated patients, 40.3 +/- 7.65% in surgically treated patients, and 8.5% +/- 3.9% in the palliatively treated patients. There are early indications that female patients have fared better than males. Toxicity levels were modest in all three groups. Following definitive treatment, severe myelotoxicity (World Health Organization grades 3 and 4) occurred in 19%, severe esophagitis (World Health Organization grade 3) in 11%, and moderate or severe benign stricture in 17%, depending upon age and sex of the patient (being worse in female patients).
These studies demonstrate that the concurrent addition of modest dose cisplatin and infusional dose fluorouracil to radiation in the definitive, preoperative, and palliative settings contribute to high rates of durable dysphagia-free survival, with overall survival comparable to (and possibly better than) the chemoradiation arm of the recently reported Intergroup Study, but at the cost of less morbidity.
本报告更新了局部控制和生存经验，并重点关注了294例食管癌患者的治疗毒性。这些患者在澳大利亚的六个中心接受治疗，采用了三种前瞻性非随机方案，即同步放疗、顺铂和适度剂量的氟尿嘧啶持续静脉输注。
方案1——“根治性”放化疗。137例患者接受了“根治性”放疗，6周内给予60 Gy剂量，同时在放疗的第一周和第四周给予两疗程顺铂（80 mg/m²）和氟尿嘧啶持续静脉输注（4天内每日800 mg/m²）。方案2——“术前”放化疗及手术。78例患者接受相同化疗方案的放化疗，但在手术前3 - 4周给予30 - 35 Gy剂量。方案3——“姑息性”放化疗。79例被认为无法治愈的患者接受了相同放化疗方案的“姑息性”治疗，未进行手术。存活患者的随访时间为6个月至7年（平均22个月）。
所有三个治疗组吞咽困难的持久缓解体现在令人鼓舞的3年生存率上，根治性治疗患者为43.2±5%，手术治疗患者为40.3±7.65%，姑息性治疗患者为8.5%±3.9%。有早期迹象表明女性患者的预后优于男性。所有三组的毒性水平均适中。根治性治疗后，严重骨髓毒性（世界卫生组织3级和4级）发生率为19%，严重食管炎（世界卫生组织3级）发生率为11%，中度或重度良性狭窄发生率为17%，具体取决于患者的年龄和性别（女性患者情况更差）。
这些研究表明，在根治性、术前和姑息性治疗中，同步添加适度剂量的顺铂和氟尿嘧啶持续静脉输注至放疗中，有助于实现高比例的持久无吞咽困难生存，总体生存率与最近报道的国际协作组研究的放化疗组相当（可能更好），但发病率较低。
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