Definitive chemoradiotherapy for T4 and/or M1 lymph node squamous cell carcinoma of the esophagus
Definitive chemoradiotherapy for T4 and/or M1 lymph node squamous cell carcinoma of the esophagus
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DOI：
10.1200/jco.1999.17.9.2915
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发表时间：
1999-09-01
影响因子：
45.3
通讯作者：
Nakamura, A
中科院分区：
文献类型：
--
作者：
Ohtsu, A;Boku, N;Nakamura, A
目的：探讨同步放化疗治疗局部晚期食管癌的疗效和可行性。
患者与方法：54例临床分期为T4和/或M1淋巴结（LYM）的食管鳞状细胞癌患者入选。患者在第1 - 5天和第8 - 12天接受氟尿嘧啶400mg/m²/24小时持续输注，在第1天和第8天接受顺铂40mg/m² 2小时输注，并同步接受放疗，剂量为3周内15次共30Gy。35例患者预防性使用非格司亭。此方案每5周重复两次，总放疗剂量为60Gy，随后进行两个疗程的氟尿嘧啶（800mg/m²/24小时，持续5天）和顺铂（第1天80mg/m²）治疗。
结果：T4M0疾病患者21例，T2M1 LYM患者1例，T3M1 LYM患者17例，T4M1 LYM患者15例。49例患者（91%）至少完成了放化疗阶段。18例（33%）达到完全缓解的患者中，36例T4疾病患者中有9例（25%），18例非T4疾病患者中有9例（50%）。主要毒性反应为白细胞减少和食管炎；有4例（7%）治疗相关死亡。预防性使用非格司亭降低了3级或更严重白细胞减少的发生率，但未提高剂量强度或缓解率。中位随访时间为43个月，中位生存时间为9个月。3年生存率为23%。
结论：尽管毒性显著，但这种联合治疗模式似乎即使在局部晚期食管癌病例中也具有治愈潜力。（C）1999年美国临床肿瘤学会
Purpose: To investigate the efficacy and feasibility of concurrent chemoradiotherapy for locally advanced carcinoma of the esophagus.Patients and Methods: Fifty-four patients with clinically T4 and/or M1 lymph node (LYM) squamous cell carcinoma of the esophagus were enrolled. patients received protracted infusion of fluorouracil 400 mg/m(2)/24 hours on days 1 to 5 and 8 to 12, 2-hour infusion of cisplatin 40 mg/m(2) on days 1 and 8, and concurrent radiation therapy at a dose of 30 Gy in 15 fractions over 3 weeks. Filgrastim was prophylactically administered to 35 patients. This schedule was repeated twice every 5 weeks, for a total radiation dose of 60 Gy, followed by two courses of fluorouracil (800 mg/m(2)/24 hours for 5 days) and cisplatin (80 mg/m(2) on day 1).Results: There were 21 patients with T4M0 disease, one with T2M1 LYM, 17 with T3M1 LYM, and 15 with T4M1 LYM. Forty-nine patients (91%)completed at least the chemoradiotherapy segment. the 18 patients (33%) who achieved a complete response included nine (25%) of the 36 with T4 disease and nine (50%) of the 18 with non-T4 disease. Major toxicities were leukocytopenia and esophagitis; there were four (7%) treatment-related deaths. Prophylactic filgrastim reduced the incidence of grade 3 or worse leukopenia without improving dose-intensity or response. With a median follow-up duration of 43 months, median survival time was 9 months. The 3-year survival rate was 23%.Conclusion: Despite its significant toxicity, this combined modality seemed to have curative potential even in cases of locally advanced carcinoma of the esophagus. (C) 1999 by American Society of Clinical Oncology.