Localized squamous-cell cancer of the esophagus: retrospective analysis of three treatment schedules
Localized squamous-cell cancer of the esophagus: retrospective analysis of three treatment schedules
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DOI：
10.1016/s0167-8140(01)00307-3
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发表时间：
2001-05-01
影响因子：
5.7
通讯作者：
Segol, P
中科院分区：
文献类型：
--
作者：
Delcambre, C;Jacob, JH;Segol, P
背景与目的：一项回顾性研究，比较局限性食管鳞状细胞癌的化疗与放疗、单纯食管切除术以及术前放化疗加手术的疗效。
材料与方法：1989年至1995年期间，两个不同机构共治疗了139例患者（根据UICC 78年TNM分期，40例为I期，77例为IIA期，22例为IIB期）。根据所采用的治疗方法将患者分为三组：E组（采用食管切除术治疗；n = 30），RCT + E组（采用术前放化疗加食管切除术治疗；n = 46），RCT组（采用放化疗治疗；n = 63）。所有组的年龄、肿瘤部位和分期等因素相似。进行了意向性治疗分析。
结果：E组无术后死亡病例，而RCT + E组手术死亡率为12.8%。RCT组死亡率为1.7%。术前放化疗后，25%的病例观察到病理完全缓解，根治性切除率更高（RCT + E组为82%，E组为60%）。三组之间的5年生存率差异无统计学意义（E组为12.6%；RCT组为25.8%；RCT + E组为38.7%）。中位生存期分别为29个月、24个月和28.5个月。E组和RCT组的无事件生存期相同。对于接受放化疗的患者，食管切除术显著降低了局部和/或远处复发率（RCT + E组患者复发率为51%，RCT组为75%，P = 0.017）。为改善吞咽困难而进行的姑息治疗（扩张术、假体植入、胃造口术或空肠造口术），单纯接受放化疗的患者中有38%需要，而接受手术治疗的患者中只有11%需要（P = 0.001）。
结论：食管切除术或放化疗的治疗效果无显著差异。术前放化疗加手术比单纯放化疗的生存率更高，但术后死亡率较高。本研究提示进行前瞻性随机试验比较RCT + E和单纯RCT的相关性。（C）2001 Elsevier Science Ireland Ltd.保留所有权利。
Background and purpose: A retrospective study comparing chemotherapy and radiation, esophagectomy alone versus preoperative radiochemotherapy and surgery in localized squamous-cell esophageal carcinoma.Materials and methods: Between 1989 and 1995, 139 patients (40 stage I, 77 stage IIA and 22 stage IIB according to the UICC 78 TNM classification) were treated in two different institutions. They were divided into three groups according to the treatment proposed: E group (treatment by esophagectomy; n = 30), RCT + E group (treatment by preoperative radiochemotherapy and esophagectomy; n = 46), RCT group (treatment by radiochemotherapy; n = 63). Factors like age, tumor localization and stage were similar in all groups. An intention to treat analysis was made.Results: The E group showed no postoperative mortality, while in the RCT + E group, the surgery mortality was 12.8%. The mortality after RCT was 1.7%. After preoperative radiochemotherapy, a pathological complete response was observed in 25% of cases and the curative resection rate was higher (82% after RCT + E versus 60% after E). The 5-year survival difference between the three groups was not relevant (E group, 12.6%; RCT group, 25.8%; RCT + E group, 38.7%). The median survival was 29, 24 and 28.5 months, respectively. The event-free survival was identical for the E group and the RCT group. For patients treated by radiochemotherapy, local and/or distant relapses were significantly reduced by esophagectomy (relapses occurred in 51% of patients in the RCT + E group versus 75% in the RCT group, P = 0.017). Palliative care (dilatations, prosthesis, gastrostomy or jejunostomy) to improve dysphagia was necessary for 38% of patients treated by exclusive radiochemotherapy versus 11% of patients treated by surgery (P = 0.001).Conclusions: Treatments by esophagectomy or radiochemotherapy were not significantly different. Preoperative radiochemotherapy and surgery lead to a higher survival rate than exclusive radiochemotherapy, however, with a high postoperative mortality rate. This study suggests the relevance of a prospective randomized trial to compare RCT + E and RCT alone. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.