Izquierdo M A, Marcuello E, Gomez de Segura G, Blanco R, Canals E, Gomez A, Sampedro F
Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Autonomous University, Barcelona, Spain.
Cancer. 1993 Jan 15;71(2):287-92. doi: 10.1002/1097-0142(19930115)71:2<287::aid-cncr2820710203>3.0.co;2-g.
For patients with unresectable nonmetastatic squamous cell carcinoma of the esophagus (SCCE), the conventional treatment has been radiation therapy (RT). Because RT alone is unsatisfactory, there has been increasing interest in including chemotherapy (CT) in the management of these patients.
Twenty-five previously untreated patients with unresectable nonmetastatic SCCE were treated with sequential CT and RT. CT consisted of cisplatin 35 mg/m2/day for 3 days plus bleomycin 15 mg/day for 3 days as an 18-hour infusion every 3 weeks. After three courses of CT, RT was administered (dose, 200 rads/day with a planned total dose of 50-60 Gy).
Nineteen tumors were T3; six were T2 and larger than 7 cm. Fifteen patients (60%) had severe dysphagia that required placement of nasogastric tubes in 14 and gastrostomy in 1. All patients were evaluable for response. Thirteen patients (52%) had a partial response to CT. After combined treatment, four patients had complete responses (16%), and nine had partial responses (36%; overall response rate, 52%). The median survival was 8 months; 20% were alive at 1 year, and 8% lived more than 4 years. The median survival for responders to CT was 8 months compared with 5 months for nonresponders (P = 0.005). Combined treatment improved dysphagia in 16 patients (64%) with complete resolution in 13. Toxicity was mild.
The use of sequential CT (cisplatin and bleomycin) and RT in this group of patients is feasible; there is little additional toxicity, and good palliative effects can be achieved. The patient's response to CT is a good prognostic factor. The development of more effective combinations that induce more durable responses and higher rates of complete response are required.
对于不可切除的非转移性食管鳞状细胞癌（SCCE）患者，传统治疗方法一直是放射治疗（RT）。由于单纯放疗效果不佳，将化疗（CT）纳入这些患者的治疗方案越来越受到关注。
25例先前未接受过治疗的不可切除非转移性SCCE患者接受序贯化疗和放疗。化疗方案为顺铂35mg/m²/天，连用3天，加用博来霉素15mg/天，连用3天，每3周进行一次18小时静脉输注。三个疗程化疗后进行放疗（剂量为200拉德/天，计划总剂量为50 - 60戈瑞）。
19个肿瘤为T3期；6个为T2期且大于7cm。15例患者（60%）有严重吞咽困难，其中14例需要放置鼻胃管，1例需要胃造瘘。所有患者均可评估疗效。13例患者（52%）对化疗部分缓解。联合治疗后，4例患者完全缓解（16%），9例部分缓解（36%；总缓解率为52%）。中位生存期为8个月；1年生存率为20%，8%存活超过4年。化疗有反应者的中位生存期为8个月，无反应者为5个月（P = 0.005）。联合治疗使16例患者（64%）吞咽困难得到改善，其中13例完全缓解。毒性反应较轻。
在这组患者中使用序贯化疗（顺铂和博来霉素）和放疗是可行的；几乎没有额外毒性，并且可以取得良好的姑息效果。患者对化疗的反应是一个良好的预后因素。需要开发更有效的联合方案，以诱导更持久的反应和更高的完全缓解率。
