Feasibility of extended chemoradiotherapy plus surgery for patients with cT4b esophageal carcinoma
Feasibility of extended chemoradiotherapy plus surgery for patients with cT4b esophageal carcinoma
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DOI：
10.1016/j.ejso.2019.10.023
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发表时间：
2020-04-01
期刊：
影响因子：
3.8
通讯作者：
Henegouwen, Mark I. van Berge
中科院分区：
文献类型：
--
作者：
Anderegg, Martinus C. J.;Ruurda, Jelle P.;Henegouwen, Mark I. van Berge
背景：cT4b食道癌的治疗通常包括明确的放化疗(DCRT)。然而，这些患者接受dCRT后的结果很差。手术是否应该在cT4b食道癌的治疗中占有一席之地仍存在争议。本研究的目的是评估cT4b食道癌患者在延长放化疗后行食道切除术的可行性。方法：经胃镜超声和(PET)CT确诊的cT4b食道癌患者均符合此二期研究的条件。患者接受卡铂+紫杉醇每周50.4Gy28次放射治疗5.5周，如可行则行开胸探查和食道切除术。结果：自2011年7月至2013年3月，16例患者入选。5例患者因CRT术中或术后发现远处转移(n=3)、不愿手术(n=1)或CRT开始前死亡(n=1)而未行手术。在完成CRT的13名患者中，3名患者出现了严重的血液毒性(3级)。根治性(R0)切除9例。术后发生并发症9例。2例再次手术，2例术后住院死亡。平均间隔17个月后，3例患者复发(1例局部复发，2例全身复发)。所有纳入患者的中位总生存期为14.3个月。结论：对于某些cT4b食道癌患者，放化疗后可以进行根治性切除。然而，这种治疗与相当大的并发症相关，因此应该保留给身体健康的患者。(C)2019年由爱思唯尔有限公司出版。
Background: Treatment of cT4b esophageal carcinoma usually consists of definitive chemoradiotherapy (dCRT). However, outcome after dCRT in these patients is poor. Whether surgery should have a place in the treatment of cT4b esophageal cancer is still subject to debate. Goal of this study was to evaluate the feasibility of esophagectomy after extended chemoradiotherapy in patients with cT4b esophageal cancer.Methods: Patients with cT4b esophageal carcinoma, as determined by endoscopic ultrasound and (PET-) CT, were eligible for this phase-2 study. Patients were treated with weekly carboplatin + paclitaxel with 50.4 Gy radiotherapy in 28 fractions for 5.5 weeks followed by an explorative thoracotomy and esophagectomy if deemed feasible.Results: From July 2011 through March 2013, 16 patients were enrolled. Five patients did not undergo surgery because of detection of distant metastases during/after CRT (n = 3), unwillingness to undergo surgery (n =1) or death before start of CRT (n = 1). Of the 13 patients who completed CRT, 3 patients experienced major hematologic toxicity (grade 3). A radical (R0) resection was achieved in 9 of 11 patients. Postoperative complications occurred in 9 patients. A reoperation was performed in 2 patients and 2 patients died in hospital after surgery. Three patients developed recurrent disease (1 locoregional and 2 systemic) after a mean interval of 17 months. Median overall survival of all included patients was 14.3 months.Conclusions: In certain patients with cT4b esophageal carcinoma a radical resection can be accomplished after chemoradiotherapy. However, this treatment is associated with considerable complications and should therefore be reserved for physically fit patients. (C) 2019 Published by Elsevier Ltd.