Multimodality treatment for esophageal cancer - Surgery, is it necessary?

目的：比较食管切除术后与放化疗后的结局，（T2-3，NO-1，MO）食管癌材料：1）胸段食管鳞状细胞癌2）潜在可识别的癌症，cT 2 -3，cNO-1，cMO，cII-III期3）食管切除术和确定性放化疗风险低的患者4）无双原发癌5）获得知情同意方法：患者在知情同意后从以下三个治疗组中选择一个治疗组。1）食管切除术（S）2）确定性放化疗（CRT）3）新辅助放化疗（NA）;患者在获知对新辅助放化疗的反应后选择手术或非手术治疗。结果：2003年至2006年102例患者参加了本试验。食管切除术（S）组76例，确定性放化疗（CRT）组18例，新辅助放化疗（NA）组8例。1）S组： ...更多信息 59名患者接受Ro切除术，16名患者接受R1 R2切除术，1名患者仅接受开胸探查术。S组1、2、3年生存率分别为81%、56%、49%。2）CRT组：完全缓解14例，不完全缓解4例。无患者接受挽救手术。CRT组的1年、2年和3年生存率分别为89%、68%和46%。3）NA组：有3名患者接受了食管切除术，5名患者未接受食管切除术。NA组1、2、3年生存率分别为50%、50%，初次手术组1、2、3年生存率分别为81%、56%、49%，初次手术组1、2、3年生存率分别为74%、60%、40%。在最初选择非手术治疗的患者中，（CRT组+NA组）结论：对于可能值得考虑的（T2-3，NO-1，MO）食管癌，放化疗后的结局可能与手术后相似。少

Purpose : To compare the outcomes after esophagectomy versus those after chemoradiotherapy for potentially respectable (T2-3,NO-1,MO) esophageal cancerMaterials:1) squamous cell carcinoma in the thoracic esophagus2) potentially respectable cancer, cT2-3, cNO-1, cMO, cStage II-III3) patients at a low risk for both esophagectomy and definitive chemoradiotherapy4) no double primary cancers5) obtaining informed consentMethods : Patients choose one arm among the following three treatment arms after informed consent.1) esophagectomy (S)2) definitive chemoradiotherapy (CRT)3) neoadjuvant chemoradiotherapy (NA) ; Patients choose surgery or non-surgical treatment after being informing of the response to the neoadjuvant chemoradiotherapyResults : A hundred and two patients participated in this trial, from 2003 to 2006. There were 76 patients in the esophagectomy (S) group, 18 in the definitive chemoradiotherapy (CRT) group, and 8 in the neoadjuvant chemoradiotherapy (NA) group.1) S Group : There … More were 59 patients who underwent Ro resection, 16 who underwent R1R2 resection, and one who underwent only exploratory thoracotomy. The 1-, 2-, and 3-year-survival rate was 81%, 56%, and 49%, respectively in the S Group.2) CRT Group : There were 14 patients with complete response, and 4 with incomplete response. There was no patient who underwent salvage surgery. The 1-, 2-, and 3-year-survival rate was 89%, 68%, and 46%, respectively in the CRT Group.3) NA Group : There were three patients who underwent esophagectomy, and five who did not. The 1-, and 2-year-survival rate was 50% and 50%, respectively in the NA Group.The 1-, 2-, and 3-year-survival rate was 81%, 56%, and 49%, respectively in those patients who chose the surgical treatment at first, and was 74%, 60%, and 40%, respectively in those patients who chose the non-surgical treatment at first (the CRT Group + the NA Group)Conclusions : The outcomes after chemoradiotherapy for potentially respectable (T2-3,NO-1,MO) esophageal cancer may be similar to those after surgery. Less