Girvin G W, Matsumoto G H, Bates D M, Garcia J M, Clyde J C, Lin P H
Sacred Heart Medical Center, Spokane, Washington, USA.
Am J Surg. 1995 May;169(5):557-9. doi: 10.1016/S0002-9610(99)80218-9.
Treatment of esophageal cancer has been primarily palliative. Recent studies have shown that preoperative combination chemo- and radiation therapy increases the effectiveness of surgical excision.
Beginning in 1990, 29 patients in the Spokane area were treated with preoperative chemo- and radiation therapy. They were 23 men and 6 women whose mean age was 66 years. Twenty-five had adenocarcinoma, of whom 3 had Barrett's esophagitis. Four had squamous cell carcinoma. The chemotherapy included fluorouracil, cisplatin, and vinblastine. Radiation was given concomitantly, BID for 21 days. Surgical excision was performed about 3 weeks after the last radiation session, pending recovery from cytopenia.
There was 1 operative death, for an operative mortality of 3.4%. Twenty-three patients (79%) were found to have no residual cancer at the time of resection. Of this group, 8 died of metastatic cancer at a mean of 15 months postoperatively (range 1 to 28), and 15 were alive at a mean of 28 months (range 12 to 46). Six patients (21%) had residual cancer in the resected specimen, either at the primary site or--more often--in adjacent lymph nodes. Five have died at 6, 8, 9, 24, and 28 months postoperatively; 1 remains alive at 14 months. The mean survival among these 6 patients is 15 months.
Combined chemo- and radiation therapy prior to esophagectomy appeared to improve outcome in this small series of patients with esophageal cancer. Local control was excellent, but distant metastasis continues to be a significant problem.
食管癌的治疗主要是姑息性的。最近的研究表明，术前联合化疗和放疗可提高手术切除的有效性。
从1990年开始，斯波坎地区的29例患者接受了术前化疗和放疗。他们中有23名男性和6名女性，平均年龄为66岁。25例患有腺癌，其中3例有巴雷特食管炎。4例患有鳞状细胞癌。化疗包括氟尿嘧啶、顺铂和长春碱。放疗同时进行，每日两次，共21天。在最后一次放疗疗程约3周后进行手术切除，等待血细胞减少症恢复。
有1例手术死亡，手术死亡率为3.4%。23例患者（79%）在切除时未发现残留癌。在这组患者中，8例死于转移性癌症，术后平均15个月（范围1至28个月），15例存活，平均28个月（范围12至46个月）。6例患者（21%）在切除标本中发现残留癌，要么在原发部位，要么更常见的是在相邻淋巴结。5例已在术后6、8、9、24和28个月死亡；1例在14个月时仍存活。这6例患者的平均生存期为15个月。
在这一小系列食管癌患者中，食管切除术前联合化疗和放疗似乎改善了预后。局部控制良好，但远处转移仍然是一个重大问题。
