Bi-modality (chemo-radiation) versus tri-modality (chemo-radiation followed by surgery) treatment for carcinoma of the esophagus
Bi-modality (chemo-radiation) versus tri-modality (chemo-radiation followed by surgery) treatment for carcinoma of the esophagus
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DOI：
10.1046/j.1442-2050.2001.00185.x
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发表时间：
2001-01-01
影响因子：
2.6
通讯作者：
Zwischenberger, J
中科院分区：
文献类型：
--
作者：
Chan, R;Morrill, S;Zwischenberger, J
本研究的目的是研究局部食管癌患者接受化疗-放疗（双模式，BM）或化疗-放疗后手术（三模式，TM）治疗的总生存率的差异。从1981年到1999年，在加尔维斯顿的德克萨斯大学医学分支确定了65例接受同步放化疗（BM，n = 22）或同步放化疗后手术（TM，n = 43）治疗的局部食管癌患者。所有65例患者均接受同步化疗和外照射。放射治疗由直线加速器（大于或等于6 MV）提供，但有一名患者的部分治疗由钴-60机器提供。化疗包括5-氟尿嘧啶和顺铂+/-长春碱不同方案。所有患者的中位随访时间为10个月（范围1-195个月）。在14例仍然存活的患者中，中位随访时间为32个月（范围2-192个月）。两个治疗组之间未检测到总生存期的差异，BM与TM（P = 0.394），尽管存在有利于TM组的选择偏倚。BM和TM组的5年生存率分别为17%和18%; 10年生存率分别为17%和12%。TM组中存在显著的既往病史（P = 0.017）和完全的病理反应（P < 0.001）是生存率的显著独立预测因素。我们没有发现在局部食管癌患者中，化疗-放疗或化疗-放疗后手术的生存率有任何差异。应探索生物标志物和功能成像的使用，以便将具有不同肿瘤生物学的患者分开，使用不同的治疗策略进行治疗。
The purpose of the study was to investigate the difference in overall survival in patients with localized carcinoma of esophagus treated using chemo-radiation (bi-modality, BM) or chemo-radiation followed by surgery (tri-modality, TM). From 1981 to 1999, 65 patients were identified who had localized carcinoma of the esophagus treated with either concurrent chemo-radiation (BM, n = 22) or concurrent chemo-radiation followed by surgery (TM, n = 43) at the University of Texas Medical Branch at Galveston. All 65 patients received concurrent chemotherapy and external beam radiation. Radiation was delivered by linear accelerators (greater than or equal to6 MV), except in one patient who had part of his treatment given by a Co-60 machine. Chemotherapy consisted of 5-fluorouracil and cisplatin +/- vinblastine under different regimens. Median follow-up time was 10 months (range 1-195 months) for all patients. Of the 14 patients still alive, the median follow-up time was 32 months (range 2-192 months). No difference in overall survival was detected between the two treatment groups, BM vs. TM (P = 0.394) despite a selection bias favoring the TM group. Five-year survival rates of the BM and TM groups were 17% and 18%, respectively; 10-year survival rates were 17% and 12%, respectively. The presence of significant past medical history (P = 0.017) and a complete pathologic response in the TM group (P < 0.001) were significant independent predictors of survival. We did not find any difference in survival between chemo-radiation or chemo-radiation followed by surgery in patients with localized carcinoma of the esophagus. Use of biologic markers and functional imaging should be explored in order to segregate patients with different tumor biology for treatment using different treatment strategies.