Definitive chemoradiotherapy for squamous cell carcinoma of the esophagus: outcomes for borderline-resectable disease
Definitive chemoradiotherapy for squamous cell carcinoma of the esophagus: outcomes for borderline-resectable disease
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DOI：
10.1093/jrr/rraa008
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发表时间：
2020-05-01
影响因子：
2
通讯作者：
Shibamoto, Yuta
中科院分区：
文献类型：
--
作者：
Ishikura, Satoshi;Kondo, Takuhito;Shibamoto, Yuta
根治性放化疗（dCRT）是不可切除食管癌的标准治疗方法。针对可切除和不可切除疾病的诱导化疗已得到积极研究，但相对于 dCRT 的优越性尚未得到证实。本研究的目的是评估 dCRT 的结果，特别关注临界可切除疾病。本回顾性分析纳入了 2004 年 1 月至 2016 年 11 月期间接受 dCRT 治疗的食管癌患者。化疗包括两个周期的第 1 天顺铂 (70-75 mg/m(2)) 和第 1-4 天 5-氟尿嘧啶 (700-1000 mg/m(2) 每天) 或低剂量顺铂 (10 mg/m(2) 每天) 和 5-氟尿嘧啶 (175 mg/m(2) 每天)，持续 20 天。放射治疗的剂量为每日 1.8-2 Gy，总剂量为 50-70 Gy。总共纳入 104 例患者：34 例可切除，35 例可切除边缘，35 例不可切除。 44 名患者 (42%) 获得完全缓解。 18 名患者（17%）出现 2 级或以上心肺毒性，7 名患者（7%）出现 3 级心肺毒性。截至本次分析时，已有 59 名患者死亡，45 名患者接受审查。可切除、临界可切除和不可切除患者的 3 年总生存率分别为 64%、46% 和 21%。完全缓解和不完全缓解的临界可切除患者的总生存率存在显着差异（P < 0.001），3 年生存率分别为 70% 和 8%。患有临界可切除疾病的完全缓解患者的总生存率令人鼓舞。需要进一步研究以找到适合食管保留治疗的亚组。
Definitive chemoradiotherapy (dCRT) is the standard treatment for unresectable esophageal cancer. Induction chemotherapy has been actively investigated for borderline-resectable and unresectable disease, but the superiority over dCRT has yet to be confirmed. The purpose of this study was to evaluate the outcome of dCRT with special interest in borderline-resectable disease. Patients with esophageal cancer treated with dCRT between January 2004 and November 2016 were included in this retrospective analysis. Chemotherapy consisted of two cycles of cisplatin (70-75 mg/m(2)) on day 1 and 5-fluorouracil (700-1000 mg/m(2) per day) on days 1-4 or low-dose cisplatin (10 mg/m(2) per day) and 5-fluorouracil (175 mg/m(2) per day) for 20 days. Radiotherapy was given with a daily fraction of 1.8-2 Gy to a total dose of 50-70 Gy. A total of 104 patients were included: 34 were resectable, 35 were borderline-resectable and 35 were unresectable. Complete response was achieved in 44 patients (42%). Eighteen patients (17%) suffered Grade 2 or greater cardiopulmonary toxicity and seven patients (7%) suffered Grade 3 cardiopulmonary toxicity. At the time of this analysis, 59 patients were dead and 45 were censored. The 3-year overall survival proportions for resectable, borderline-resectable and unresectable patients were 64%, 46% and 21%, respectively. The overall survival for borderline-resectable patients with complete response and noncomplete response was significantly different (P < 0.001), with 3-year survival of 70% and 8%, respectively. The overall survival for complete response patients with borderline-resectable disease was encouraging. Further investigation to find a subgroup fit for esophagus-preserving treatment is warranted.