Does paclitaxel improve the chemoradiotherapy of locoregionally advanced esophageal cancer? A nonrandomized comparison with fluorouracil-based therapy
Does paclitaxel improve the chemoradiotherapy of locoregionally advanced esophageal cancer? A nonrandomized comparison with fluorouracil-based therapy
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DOI：
10.1200/jco.2000.18.10.2032
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发表时间：
2000-05-01
影响因子：
45.3
通讯作者：
Zuccaro, G
中科院分区：
文献类型：
--
作者：
Adelstein, DJ;Rice, TW;Zuccaro, G
目的：本研究采用加速分割放射联合顺铂和紫杉醇同步化疗的II期临床试验，探讨紫杉醇替代氟尿嘧啶（5-FU）在食管癌放化疗中的作用。患者和方法：食管超声分期为T-3或N-1或M-1（淋巴结）食管癌的患者接受两个疗程的顺铂输注（20 mg/m2/d，持续4天）和紫杉醇（175 mg/m2，持续24小时），同时进行加速分割放射（1.5戈伊，bid，总剂量为45戈伊）。4 ~ 6周后进行手术切除，对手术时有明显残留肿瘤的患者进行单一相同的术后放化疗（24戈伊）。毒性和这种治疗的结果进行了回顾性比较，与我们以前的5-FU和顺铂放化疗experience.Results：1995年9月至1997年7月，40例患者进入本研究。虽然吞咽困难在我们的5-FU治疗的患者中更严重，但严重的白细胞减少和需要计划外住院在紫杉醇组中更常见。37例患者（93%）证实可切除治愈。3年预计总生存率为30%，局部控制率为81%，远处转移性疾病中心为44%。当与一个类似的分期队列的5-FU治疗的患者相比，没有任何优势的生存functionsstudyed.Conclusion：这种紫杉醇为基础的治疗方案局部晚期食管癌产生的毒性增加，结果没有改善时，与我们以前的5-FU的经验。基于紫杉醇的治疗在纳入食管癌的标准治疗之前必须进行仔细和前瞻性的研究。J Clin Oncol 18：2032-2039. (C)2000年，美国临床肿瘤学会。
Purpose: A phase II trial of accelerated fractionation radiation with concurrent cisplatin and paclitaxel chemotherapy was performed ta investigate the role of the paclitaxel, when substituted for fluorouracil (5-FU), in the chemoradiotherapy of esophageal cancer. patients andMethods: patients with an esophageal ultrasound stage of T-3 or N-1 or M-1 (nodal) esophageal cancer were created with two courses of a cisplatin infusion (20 mg/m(2)/d for 4 days) and paclitaxel (175 mg/m(2) over 24 hours) concurrent with a split course of accelerated fractionation radiation (1.5 Gy bid to a total dose of 45 Gy). Surgical resection was performed 4 to 6 weeks later followed by a single identical postoperative course of chemoradiotherapy (24 Gy) in patients with significant residual tumor at surgery. Toxicity and results of this treatment were retrospectively compared with our previous 5-FU and cisplatin chemoradiotherapy experience.Results: Between September 1995 and July 1997, 40 patients were entered onto this study. Although dysphagia proved worse in our 5-FU-treated patients, profound leukopenia and a need for unplanned hospitalization were significantly more common in the paclitaxel group. Thirty-seven patients (93%) proved resectable for cure. The 3-year projected overall survival is 30%, locoregional control is 81%, and distant metastatic disease central is 44%. When compared with a similarly staged cohort of 5-FU-treated patients, there was no advantage for any survival function studied.Conclusion: This paclitaxel-based treatment regimen for locoregionally advanced esophageal cancer produced increased toxicity with no improvement in results when compared with our previous 5-FU experience. paclitaxel-based treatments must be carefully and prospectively studied before their incorporation into the standard management of esophageal cancer. J Clin Oncol 18:2032-2039. (C) 2000 by American Society of Clinical Oncology.