Combined modality therapy of esophageal carcinoma
Combined modality therapy of esophageal carcinoma
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食管癌的综合治疗
作者：
D. Kelsen;R. Ahuja;S. Hopfan;M. Bains;C. Kosloff;N. Martini;P. McCormack;R. Golbey
110 名食管表皮样癌患者在纪念斯隆凯特琳癌症中心 (MSKCC) 接受了包括术前放疗 (RT) 和手术以及术前化疗 (CT)、手术和放疗在内的综合治疗技术。 1965年至1976年期间接受术前放疗的76名患者的总体可切除率为54%，手术死亡率为12%；长期幸存者（>3 年）很少（7%）。对于 34 名接受顺铂和博莱霉素术前 CT 治疗的患者，到第 18 天时，20% 的患者出现主要客观肿瘤消退（>50%），另外 44% 的患者在食管钡餐造影和吞咽功能方面有较小但明确的改善。在接受术前 CT 治疗的患者中，76% 的病灶可切除，手术死亡率为 11%。该组的中位随访时间为 24 个月；在对 30 名患者进行至少 12 个月的随访后，20% 的患者仍然活着，没有任何疾病迹象。尽管术前化疗后的切除率似乎更高，因此可以更好地姑息治疗，但术前放疗或顺铂和博来霉素化疗均未对长期生存产生重大影响。
One hundred ten patients with epidermoid carcinoma of the esophagus were treated at the Memorial Sloan‐Kettering Cancer Center (MSKCC) with combined modality techniques involving preoperative irradiation (RT) and surgery, and with preoperative chemotherapy (CT), surgery, and irradiation. For the 76 patients receiving preoperative RT during the period 1965–1976, the overall resectability rate was 54% with an operative mortality of 12%; long‐term survivors (>3 years) were few (7%). For 34 patients receiving preoperative CT with cisplatin and bleomycin, major objective tumor regression (>50%) was seen by day 18 in 20%, with an additional 44% having smaller but definite improvement in the barium esophagram and in swallowing function. Of those receiving preoperative CT, 76% had resectable lesions, with an operative mortality of 11%. The median follow‐up for this group is 24 months; of the 30 patients followed for at least 12 months, 20% are alive without evidence of disease. Although the resection rate following preoperative chemotherapy seems to be higher, thus allowing better palliation, neither preoperative radiation nor chemotherapy with cisplatin and bleomycin have had a major impact on long‐term survival.