Wang L S, Chi K H, Hu M H, Fahn H J, Huang M H
Department of Surgery, Veterans General Hospital-Taipei, Taiwan, Republic of China.
J Surg Oncol. 1996 May;62(1):22-9. doi: 10.1002/(SICI)1096-9098(199605)62:1<22::AID-JSO5>3.0.CO;2-T.
Available data concerning the treatment of patients with advanced T4 esophageal carcinoma are limited. A consecutive series of 42 patients with advanced T4M0 epidermoid carcinoma of the esophagus were studied from June 1987 to July 1992. The aim of this study was to evaluate the efficacy of various therapeutic modalities, and further evaluate the therapeutic options. The various therapeutic modalities included the following: Group I, feeding jejunostomy or endoesophageal intubation, 6 patients; Group II, palliative subtotal esophagectomy only, 8 patients; Group III, bypass procedures without tumor resection, 9 patients; Group IV, nutritional support and then treatment with irradiation (n=8) or concurrent radio-chemotherapy (n=4), 12 patients; Group V, subtotal esophagectomy, followed by aggressive concurrent radiochemotherapy, 7 patients. The total prescribed irradiation dose was 60 Gy (10 Gy/5 fractions/week). A combination regimen of chemotherapy consisted of cisplatin, 5-fluorouracil, and leucovorin (PFL regimen). For the patients undergoing esophagectomy or bypass procedures (n=24), the rates of operative complication and mortality were 45.8% and 25%, respectively. Side effects of adjuvant therapy (n=24) consisted of main airway irritation (100%), mucositis or gastrointestinal symptoms (83.3%), hematologic toxicity (79.2%), esophagitis or gastric ulcer (62.5%), alopecia (37.5%), and pneumonia (20.8%). The mortality due to toxicity of adjuvant therapy was 21.1% (4/19 patients). The mean survival times for each of the different groups was 1.9+/-0.5 months for Group I, 4.8+/-1.6 months for Group II, 5.2+/-1.2 months for Group III, 7.3+/-2.0 months for Group IV, and 20.3+/-2.5 months for Group V, respectively. Compared with patients of Groups I--IV, the Group V patients had a significantly superior one-year survival rate (P<0.01). Our results demonstrated that esophagectomy followed by concurrent irradiation and PFL combination chemotherapy may provide a significant improvement in the quality of life and survival for appropriate patients with advanced T4M0 epidermoid carcinoma of the esophagus. Furthermore, more than one cycle of PFL regimen chemotherapy may result in a better prognosis. During the performance of such an aggressive treatment, the utmost care must be taken with the patient's nutrition and to prevent pulmonary complications.
关于晚期T4食管癌患者治疗的现有数据有限。对1987年6月至1992年7月期间连续收治的42例晚期T4M0食管表皮样癌患者进行了研究。本研究的目的是评估各种治疗方式的疗效，并进一步评估治疗选择。各种治疗方式如下：第一组，空肠造口喂养或食管内插管，6例患者；第二组，仅行姑息性食管次全切除术，8例患者；第三组，未切除肿瘤的旁路手术，9例患者；第四组，营养支持后行放疗（n = 8）或同步放化疗（n = 4），12例患者；第五组，食管次全切除术后行积极的同步放化疗，7例患者。规定的总放疗剂量为60 Gy（10 Gy/5次/周）。化疗联合方案由顺铂、5-氟尿嘧啶和亚叶酸组成（PFL方案）。对于接受食管切除术或旁路手术的患者（n = 24），手术并发症发生率和死亡率分别为45.8%和25%。辅助治疗（n = 24）的副作用包括主要气道刺激（100%）、粘膜炎或胃肠道症状（83.3%）、血液学毒性（79.2%）、食管炎或胃溃疡（62.5%）、脱发（37.5%）和肺炎（20.8%）。辅助治疗毒性导致的死亡率为21.1%（4/19例患者）。不同组的平均生存时间分别为：第一组1.9±0.5个月，第二组4.8±1.6个月，第三组5.2±1.2个月，第四组7.3±2.0个月，第五组20.3±2.5个月。与第一至四组患者相比，第五组患者的一年生存率显著更高（P<0.01）。我们的结果表明，对于合适的晚期T4M0食管表皮样癌患者，食管切除术后同步放疗和PFL联合化疗可能显著改善生活质量和生存率。此外，多周期的PFL方案化疗可能导致更好的预后。在进行这种积极治疗期间，必须极其小心地关注患者的营养状况并预防肺部并发症。
