Bamias A, Hill M E, Cunningham D, Norman A R, Ahmed F Y, Webb A, Watson M, Hill A S, Nicolson M C, O'Brien M E, Evans T C, Nicolson V
Cancer Research Campaign Section of Medicine, Institute of Cancer Research, Sutton, Surrey, UK.
Cancer. 1996 May 15;77(10):1978-85. doi: 10.1002/(SICI)1097-0142(19960515)77:10<1978::AID-CNCR3>3.0.CO;2-D.
The results of chemotherapy for patients with esophagogastric carcinoma have generally been modest but regimens developed more recently have produced higher response rates, and rekindled interest in neoadjuvant chemotherapy. One such regimen is epirubicin, cisplatin, and 5-fluorouracil (ECF). This study evaluates its efficacy, toxicity, impact on quality of life (QL), and impact on survival in a large consecutive series of patients with metastatic and locally advanced disease (LAD).
Patients with histologically confirmed esophagogastric carcinoma were treated with ECF (epirubicin 50 mg/m2 and cisplatin 60 mg/m2 every 3 weeks with continuous infusion of 5-fluorouracil (5-FU) 200 mg/m2/d). Responses were evaluated with computed tomography (CT) scan and endoscopy. QL was assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire.
A total of 235 patients were treated, 173 with metastatic disease and 62 with LAD. The mean number of cycles delivered was 6 (range: 1-11) and patients were followed-up for a median of 8 months. Response was observed in 135 of 220 (61%) evaluable patients, with a complete response (C(R)), 11% of the patients and a partial response in 50% of the patients. Patients with moderately differentiated adenocarcinomas and LAD responded most favorably. Symptomatic improvement was achieved in the majority of cases (63-78% depending on the symptom). Toxicity was generally only mild to moderate, with severe non hematologic toxicity in less than 12% of the patients and only 6 (2.5%) treatment related deaths. QL assessment showed no significant negative impact on emotional functioning and good symptomatic control. Surgery following response to ECF was performed in 29 of the LAD patients, and in 19 cases (66%) a potentially curative resection was possible, with histologic CR in 32% of the patients.
ECF is a highly active regimen with acceptable toxicity in patients with esophagogastric adenocarcinoma. In a proportion of patients with LAD, chemotherapy enabled potentially curative surgery to be performed. The results justify further investigation of this regimen in a neoadjuvant setting.
食管癌和胃癌患者的化疗效果总体一般，但最近研发的方案产生了更高的缓解率，重新燃起了人们对新辅助化疗的兴趣。其中一种方案是表柔比星、顺铂和5-氟尿嘧啶（ECF）。本研究评估了其对一系列连续的大量转移性和局部晚期疾病（LAD）患者的疗效、毒性、对生活质量（QL）的影响以及对生存的影响。
组织学确诊的食管癌和胃癌患者接受ECF治疗（表柔比星50mg/m²和顺铂60mg/m²，每3周一次，同时持续输注5-氟尿嘧啶（5-FU）200mg/m²/天）。通过计算机断层扫描（CT）和内镜检查评估缓解情况。使用欧洲癌症研究与治疗组织的QLQ-C30问卷评估生活质量。
共治疗235例患者，其中173例为转移性疾病，62例为LAD。平均化疗周期数为6个（范围：1-11个），患者中位随访8个月。220例可评估患者中有135例（61%）出现缓解，其中完全缓解（CR）占11%，部分缓解占50%。中分化腺癌和LAD患者缓解最为明显。大多数病例（63%-78%，取决于症状）症状得到改善。毒性一般仅为轻度至中度，严重非血液学毒性患者不到12%，仅6例（2.5%）与治疗相关死亡。生活质量评估显示对情绪功能无显著负面影响且症状控制良好。LAD患者中有29例在ECF治疗有反应后接受了手术，19例（66%）可行潜在根治性切除，32%的患者组织学达到CR。
ECF是一种对食管癌和胃癌患者毒性可接受的高活性方案。在一部分LAD患者中，化疗使潜在根治性手术得以进行。这些结果证明在新辅助治疗中进一步研究该方案是合理的。
