Results of Neoadjuvant Chemoradiotherapy With Docetaxel and 5-Fluorouracil Followed by Esophagectomy to Treat Locally Advanced Esophageal Cancer
Results of Neoadjuvant Chemoradiotherapy With Docetaxel and 5-Fluorouracil Followed by Esophagectomy to Treat Locally Advanced Esophageal Cancer
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DOI：
10.1016/j.athoracsur.2015.02.042
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发表时间：
2015-06-01
影响因子：
4.6
通讯作者：
Okada, Morihito
中科院分区：
文献类型：
--
作者：
Hamai, Yoichi;Hihara, Jun;Okada, Morihito
背景资料。食道癌最常采用以铂为基础的放化疗(CRT)。我们先前描述了在晚期食道癌患者中使用多西他赛(DOC)和5-氟尿嘧啶(5FU)的确定性CRT的I期研究。该方案毒性低，不含铂类药物，疗效确切。本研究旨在确定DOC和5FU组成的新辅助CRT的抗肿瘤效果和手术结果。我们回顾了2003-2008年间38例局部晚期食道癌或食管胃交界部癌患者的资料，这些患者接受了新辅助CRT联合DOC和5FU的三联疗法，然后行食道切除术。食管炎是与新辅助CRT相关的最常见的毒性(3级；26.3%)，血液毒性轻微。36例(94.7%)行经胸食道切除术，2例(5.3%)行咽喉食道切除术，35例(92.1%)行R0切除术。5例(13.2%)原发灶完全病理反应(PCR)，23例(60.5%)原发灶2/3以上病变缩小。26例(68.4%)患者的T或N状态也被下调。21例(55.3%)患者发生了总体术后并发症，术后并发症死亡率为零。5年无复发生存率为39.5%，总生存率为44.7%。新辅助CRT毒副反应及术后并发症发生率均可接受，手术完全切除率及生存率良好。该方案有望成为食道癌CRT的新辅助治疗方案，也可作为治疗不耐受顺铂的食道癌患者的替代方案。(C)2015年，由胸外科医生学会主办
Background. Esophageal cancer is most frequently treated with platinum-based chemoradiotherapy (CRT). We previously described a phase I study of definitive CRT with docetaxel (DOC) and 5-fluorouracil (5FU) in patients with advanced esophageal cancer. This regimen had low toxicity and was effective without platinating agents. The present study aims to determine the antitumor effects of neoadjuvant CRT with DOC and 5FU and surgical outcomes.Methods. We reviewed data from 38 patients with locally advanced cancer of the esophagus or esophagogastric junction who underwent trimodality therapy comprising neoadjuvant CRT with DOC and 5FU followed by esophagectomy between 2003 and 2008.Results. Esophagitis was the most common toxicity associated with neoadjuvant CRT (grade 3; 26.3%), and hematologic toxicity was mild. Transthoracic esophagectomy and pharyngolaryngoesophagectomy proceeded in 36 (94.7%) and 2 (5.3%) patients, respectively, and 35 (92.1%) underwent R0 resection. Five (13.2%) patients had complete pathologic responses (pCR) of the primary tumor, and 23 (60.5%) had pathologic reductions of over two-thirds of the primary tumor. The T or N status was also down-staged in 26 (68.4%) patients. Overall postoperative morbidity developed in 21 (55.3%) patients, and mortality due to postoperative morbidity was zero. The 5-year recurrence-free and overall survival rates were 39.5% and 44.7%, respectively.Conclusions. The rates of neoadjuvant CRT toxicity and postoperative complications were acceptable, and the complete resection rate and survival data were favorable. This regimen is promising as neoadjuvant CRT for esophageal cancer and very useful as an alternative regimen for treating patients with esophageal cancer who cannot tolerate cisplatin. (C) 2015 by The Society of Thoracic Surgeons