Melcher A A, Mort D, Maughan T S
Velindre Hospital, Whitchurch, Cardiff, UK.
Br J Cancer. 1996 Nov;74(10):1651-4. doi: 10.1038/bjc.1996.604.
High response rates have been reported in the treatment of advanced gastric cancer with epirubicin, cisplatin and continuous infusion 5-fluorouracil (ECF), including instances of unresectable disease being rendered operable by chemotherapy. We report our experience with ECF as neoadjuvant treatment in gastric and lower oesophageal carcinoma. Twenty-seven patients were treated, of whom ten (37%) had carcinoma of the stomach and 17 (63%) tumours of the lower oesophagus. Histology in the majority of cases, 21 (78%), was adenocarcinoma. Before chemotherapy ten patients (37%) had evidence of initially unresectable locally advanced disease, 16 (59%) had localised disease only and one patient (4%) had a localised primary with a single liver metastasis. Epirubicin (50 mg m(-2) i.v.) and cisplatin (60 mg m(-2) i.v.) were administered every 3 weeks for four cycles together with a continuous 12 week infusion of 5-fluorouracil (200 mg m(-2) day(-1)). Fifteen of 24 assessable patients (62%) had symptomatic improvement on chemotherapy. On combined surgical and/or radiological assessment, 15 of the 27 patients (56%) had objective evidence of tumour response. In all patients assessment for radical surgery was made following chemotherapy. Eighteen patients (67%) proceeded to operation: of these, 11 had complete resection of their disease, one had a histologically incomplete resection and six were found to have unresectable disease. No pathological complete responses were observed. Only one of the ten patients with locally advanced disease achieved complete surgical resection after chemotherapy. At a median follow-up of 36 months from date of diagnosis (range 30-47 months), 19 of the 27 patients (70%) have died. Of 11 patients who had a complete surgical resection, one died post-operatively, three have subsequently relapsed (of whom two have died) and seven remain disease free. Toxicity from treatment was mild and included emesis, myelosuppression, stomatitis and exfoliation. Myelosuppression caused modification of treatment in 14 of 108 chemotherapy cycles (13%). There was one surgical death but no chemotherapy-related deaths. These early results show encouraging symptomatic and objective responses of gastro-oesophageal carcinoma to ECF, but provide no instances of ECF achieving complete pathological response. Only randomised trials can establish the role of neoadjuvant ECF chemotherapy in both initially resectable and unresectable carcinoma of the stomach and lower oesophagus.
表柔比星、顺铂和持续输注5-氟尿嘧啶（ECF）治疗晚期胃癌的缓解率较高，包括通过化疗使不可切除的疾病变为可手术切除的情况。我们报告了ECF作为胃和食管下段癌新辅助治疗的经验。共治疗27例患者，其中10例（37%）为胃癌，17例（63%）为食管下段肿瘤。大多数病例（21例，78%）的组织学类型为腺癌。化疗前，10例患者（37%）有最初不可切除的局部晚期疾病证据，16例（59%）仅有局限性疾病，1例患者（4%）有局限性原发灶伴单个肝转移。表柔比星（50mg/m²静脉注射）和顺铂（60mg/m²静脉注射）每3周给药1次，共4个周期，同时持续12周输注5-氟尿嘧啶（2mg/m²/天）。24例可评估患者中有15例（62%）化疗后症状改善。综合手术和/或影像学评估，27例患者中有15例（56%）有肿瘤反应的客观证据。所有患者化疗后均进行了根治性手术评估。18例患者（67%）接受了手术：其中11例疾病完全切除，1例组织学切除不完全，6例发现不可切除。未观察到病理完全缓解。10例局部晚期疾病患者中只有1例化疗后实现了完全手术切除。自诊断之日起的中位随访时间为36个月（范围30 - 47个月），27例患者中有19例（70%）死亡。11例接受了完全手术切除的患者中，1例术后死亡，3例随后复发（其中2例死亡），7例仍无疾病复发。治疗毒性较轻，包括呕吐、骨髓抑制、口腔炎和皮肤脱屑。108个化疗周期中有14个周期（13%）因骨髓抑制调整了治疗方案。有1例手术死亡，但无化疗相关死亡。这些早期结果显示胃食管癌对ECF有令人鼓舞的症状缓解和客观反应，但未出现ECF实现完全病理缓解的情况。只有随机试验才能确定新辅助ECF化疗在最初可切除和不可切除的胃癌及食管下段癌中的作用。
