Triboulet J P, Amrouni H, Guillem P, Vandenhaute B, Lecomte-Houcke M, Adenis A
Service de Chirurgie Générale et Endocrinienne, Hôpital Claude-Huriez, Lille.
Ann Chir. 1998;52(6):503-8.
Improvements of the results of combined chemoradiotherapy (CRT) in esophageal cancer has led several groups to adopt a non surgical attitude specially in case of complete response (endoscopy +/- biopsy). Few information are available about the follow-up of these patients. We studied long-term results of 35 patients who underwent resection after complete response to preoperative chemoradiotherapy.
161 patients with resecable carcinoma of the thoracic esophagus have received the same protocol of CRT (cisplatin 80 mg/m2, radiation therapy split course: 37.5 Gy) all patients were followed every for 4 months (no lost of view).
Complete response (endoscopy and biopsy) was obtained for 35 patients (21.7%), 19 of them (54%) had pathologic complete response (PCR) (no tumor in the specimen), 16 have microscopic foci of residual tumor (46%). The overall 5-year survival rate was 49.8% for the whole group (median survival 64 months), 70% for the group without tumor in the specimen, 48% for the group with microscopic foci of residual tumor (NS).
One half of the complete response (endoscopy + biopsy) have not a pathologic complete response (microscopic foci of residual tumor in the specimen). The 49.8% of five year survival suggests a benefit from esophagectomy for complete response after combined chemoradiotherapy.
食管癌综合放化疗（CRT）效果的改善使得一些团队采取了非手术治疗策略，尤其是在出现完全缓解（内镜检查±活检）的情况下。关于这些患者的随访信息较少。我们研究了35例术前放化疗后获得完全缓解并接受手术切除患者的长期结果。
161例可切除的胸段食管癌患者接受了相同的CRT方案（顺铂80mg/m²，分割放疗：37.5Gy），所有患者每4个月进行一次随访（无失访）。
35例患者（21.7%）获得完全缓解（内镜检查及活检），其中19例（54%）达到病理完全缓解（PCR）（标本中无肿瘤），16例有微小残留肿瘤灶（46%）。整个组的5年总生存率为49.8%（中位生存期64个月），标本中无肿瘤的组为70%，有微小残留肿瘤灶的组为48%（无统计学差异）。
一半的完全缓解（内镜检查+活检）患者未达到病理完全缓解（标本中有微小残留肿瘤灶）。49.8%的5年生存率表明，食管癌综合放化疗后完全缓解患者行食管切除术有益。
