PROSPECTIVE COMPARISON OF SURGERY ALONE AND CHEMORADIOTHERAPY WITH SELECTIVE SURGERY IN RESECTABLE SQUAMOUS CELL CARCINOMA OF THE ESOPHAGUS
PROSPECTIVE COMPARISON OF SURGERY ALONE AND CHEMORADIOTHERAPY WITH SELECTIVE SURGERY IN RESECTABLE SQUAMOUS CELL CARCINOMA OF THE ESOPHAGUS
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DOI：
10.1016/j.ijrobp.2009.02.086
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发表时间：
2009-10-01
影响因子：
7
通讯作者：
Yamada, Shogo
中科院分区：
文献类型：
--
作者：
Ariga, Hisanori;Nemoto, Kenji;Yamada, Shogo
目的：食管切除术仍然是食管癌的主要治疗方法，尽管回顾性研究表明放化疗（CRT）与手术一样有效。为了确定CRT是否可以取代手术作为主要的治疗方式，我们进行了一个前瞻性的直接比较治疗后的结果与可切除的食管癌患者接受CRT和那些谁经历surgery.Methods和Materials：符合条件的患者有可切除的T1- 3 N 0 - 1 M0胸段食管癌。在外科医生详细解释治疗后，患者选择CRT（CRT组）或手术（OP组）。CRT疗程包括2个周期的顺铂和氟尿嘧啶，同时分程放疗60 Gy，30次。CRT期间进行性疾病和/或CRT后持续或复发性疾病的患者接受挽救性切除术。结果：在2001年1月至2005年12月登记的99例符合条件的鳞状细胞癌患者中，51例选择CRT，48例选择手术。CRT组中，13例（25.5%）患者接受食管切除术作为挽救治疗。CRT组的3年和5年生存率分别为78.3%和75.7%，而OP组分别为56.9%和50.9%（p = 0.0169）。OP组的患者有显着更多的转移复发比那些在CRT group.Conclusions：可切除的胸段食管鳞状细胞癌患者的治疗结果相当或上级CRT（挽救治疗，如果需要的话）单独手术后的结果。(C)2009 Elsevier Inc.
Purpose: Esophagectomy remains the mainstay treatment for esophageal cancer, although retrospective studies have suggested that chemoradiotherapy (CRT) is as effective as surgery. To determine whether CRT can substitute for surgery as the primary treatment modality, we performed a prospective direct comparison of outcomes after treatment in patients with resectable esophageal cancer who had received CRT and those who had undergone surgery.Methods and Materials: Eligible patients had resectable T1-3N0-1M0 thoracic esophageal cancer. After the surgeon explained the treatments in detail, the patients selected either CRT (CRT group) or surgery (OP group). The CRT course consisted of two cycles of cisplatin and fluorouracil with split-course concurrent radiotherapy of 60Gy in 30 fractions. Patients with progressive disease during CRT and/or with persistent or recurrent disease after CRT underwent salvage resection.Results: Of 99 eligible patients with squamous cell carcinoma registered between January 2001 and December 2005, 51 selected CRT and 48 selected surgery. Of the patients in the CRT group, 13 (25.5%) underwent esophagectomy as salvage therapy. The 3- and 5-year survival rates were 78.3% and 75.7%, respectively, in the CRT group compared with 56.9% and 50.9%, respectively, in the OP group (p = 0.0169). Patients in the OP group had significantly more metastatic recurrence than those in the CRT group.Conclusions: Treatment outcomes among patients with resectable thoracic esophageal squamous cell carcinoma were comparable or superior after CRT (with salvage therapy if needed) to outcomes after surgery alone. (C) 2009 Elsevier Inc.