Long-term results of RTOG trial 8911 (USA intergroup 113): A random assignment trial comparison of chemotherapy followed by surgery compared with surgery alone for esophageal cancer
Long-term results of RTOG trial 8911 (USA intergroup 113): A random assignment trial comparison of chemotherapy followed by surgery compared with surgery alone for esophageal cancer
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DOI：
10.1200/jco.2006.10.4760
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发表时间：
2007-08-20
影响因子：
45.3
通讯作者：
Willett, Christopher G.
中科院分区：
文献类型：
--
作者：
Kelsen, David P.;Winter, Katryn A.;Willett, Christopher G.
目的我们更新放射治疗肿瘤学组试验 8911（美国组间 113），该试验对局限性食管癌患者化疗加手术与单独手术进行比较。还分析了切除类型与肿瘤反应与结局之间的关系。患者和方法化疗组术前接受顺铂加氟尿嘧啶。根据切除类型（R0、R1、R2 或不切除）评估结果。主要终点是总生存期。还评估了无病生存率、复发模式、术后治疗的影响以及术前化疗反应与结局之间的关系。结果 216 例患者接受了术前化疗，227 例立即手术。 59% 的仅手术患者和 63% 的化疗加手术患者接受了 R0 切除术 (P = .5137)。接受低于 R0 切除的患者预后不佳； 32% 的 R0 切除患者在 5 年后仍然存活且无病，只有 5% 的 R1 切除患者存活时间超过 5 年。 R1、R2 或未切除患者的中位生存率没有显着差异。然而，正如最初报道的那样，接受围手术期化疗的患者与仅手术组相比，总体生存率没有差异，但术前化疗后肿瘤客观消退的患者的生存率有所提高。结论对于局限性食管癌患者，无论是否进行术前化疗，仅进行R0切除即可获得相当长的长期生存率。即使显微镜下切缘阳性也是一个不祥的预后因素。 R1切除后，术后放化疗为一小部分患者提供了长期无病生存的可能性。
PurposeWe update Radiation Therapy Oncology Group trial 8911 ( USA Intergroup 113), a comparison of chemotherapy plus surgery versus surgery alone for patients with localized esophageal cancer. The relationship between resection type and between tumor response and outcome were also analyzed.Patients and MethodsThe chemotherapy group received preoperative cisplatin plus fluorouracil. Outcome based on the type of resection ( R0, R1, R2, or no resection) was evaluated. The main end point was overall survival. Disease-free survival, relapse pattern, the influence of postoperative treatment, and the relationship between response to preoperative chemotherapy and outcome were also evaluated.ResultsTwo hundred sixteen patients received preoperative chemotherapy, 227 underwent immediate surgery. Fifty-nine percent of surgery only and 63% of chemotherapy plus surgery patients underwent R0 resections ( P = .5137). Patients undergoing less than an R0 resection had an ominous prognosis; 32% of patients with R0 resections were alive and free of disease at 5 years, only 5% of patients undergoing an R1 resection survived for longer than 5 years. The median survival rates for patients with R1, R2, or no resections were not significantly different. While, as initially reported, there was no difference in overall survival for patients receiving perioperative chemotherapy compared with the surgery only group, patients with objective tumor regression after preoperative chemotherapy had improved survival.ConclusionFor patients with localized esophageal cancer, whether or not preoperative chemotherapy is administered, only an R0 resection results in substantial long-term survival. Even microscopically positive margins are an ominous prognostic factor. After a R1 resection, postoperative chemoradiotherapy therapy offers the possibility of long-term disease-free survival to a small percentage of patients.