Fietkau R, Grabenbauer G G, Sauer R
Strahlentherapeutische Klinik, Universität Erlangen.
Strahlenther Onkol. 1994 Feb;170(2):69-78.
The records of 52 patients with inoperable but localized squamous cell carcinomas of the esophagus were reviewed to determine the influence of different treatment modalities on survival, dysphagia and sites of recurrence.
22 patients were treated by concurrent radio-chemotherapy with cis-platin/5-FU or carboplatin/5-FU; 19 patients by radiotherapy alone; six patients by chemotherapy followed by irradiation and five patients by concurrent radio-chemotherapy with various drugs. External beam radiotherapy consisted of treating the primary lesion (mean dose 53 Gy) and the lymphatic areas (mean dose 31 +/- 26 Gy) at the rate of 2 Gy/day for five days/week. Additional intraluminal high-dose-rate radiotherapy was performed in 13 patients with single fractions of 6 Gy as a boost. Minimum follow-up was twelve months, median follow-up 4.3 years.
For the whole population a remission rate of 65% (34/52 patients) was achieved (complete remission 18/52 patients = 35%; partial remission 16/52 patients = 31%). Relief of dysphagia accompanied tumor regression. Median survival was eleven months; three-year survival rate 23%; five-year survival rate 7.6%. The analysis of recurrence revealed a high rate of local failures (26/52 patients = 50%) and distant metastases (9/52 patients = 18%). Comparing the different modalities the best results were achieved by concurrent radio-chemotherapy with cis-platin/5-FU or carboplatin/5-FU: Complete remission could be determined in 46% and median survival was 14.9 months. Additional intracavitary radiotherapy resulted in a slightly better local control rate (54% vs. 46%) and three-year-survival rate (30% vs. 20%) compared to external beam irradiation alone.
Concurrent radio-chemotherapy with cis-platin/5-FU is superior to other treatment modalities in inoperable carcinoma of the esophagus. Additional intraluminal radiotherapy may increase local control rate.
回顾52例无法手术但局限期食管鳞状细胞癌患者的记录，以确定不同治疗方式对生存、吞咽困难和复发部位的影响。
22例患者接受顺铂/5-氟尿嘧啶或卡铂/5-氟尿嘧啶同步放化疗；19例患者仅接受放疗；6例患者先化疗后放疗，5例患者接受不同药物同步放化疗。外照射放疗包括以每天2 Gy、每周5天的剂量率治疗原发灶（平均剂量53 Gy）和淋巴区域（平均剂量31±26 Gy）。13例患者额外接受了腔内高剂量率放疗，单次剂量为6 Gy作为增敏。最短随访时间为12个月，中位随访时间为4.3年。
总体人群的缓解率为65%（34/52例患者）（完全缓解18/52例患者 = 35%；部分缓解16/52例患者 = 31%）。吞咽困难的缓解伴随着肿瘤缩小。中位生存期为11个月；三年生存率为23%；五年生存率为7.6%。复发分析显示局部失败率较高（26/52例患者 = 50%）和远处转移率较高（9/52例患者 = 18%）。比较不同治疗方式，顺铂/5-氟尿嘧啶或卡铂/5-氟尿嘧啶同步放化疗取得了最佳结果：完全缓解率可达46%，中位生存期为14.9个月。与单纯外照射放疗相比，额外的腔内放疗导致局部控制率略有提高（54%对46%）和三年生存率提高（30%对20%）。
顺铂/5-氟尿嘧啶同步放化疗在无法手术的食管癌治疗中优于其他治疗方式。额外的腔内放疗可能提高局部控制率。
