Study on Multimodality treatment for Locally Advanced Esophageal Cancer

目的：探讨提高局部晚期食道癌患者生存率的最佳综合治疗方案。材料与方法：对1994年至1998年在库鲁姆大学医院接受放化疗(CRTX)加或不加食道切除术的48例T4期食管癌患者进行研究。ARM-1：术前、术后放化疗(每日小剂量CDDP/5FU配合超分割放射治疗，60GY)ARM-2：术后放化疗(单次大剂量CDDP/5FU配合序贯标准RTX，50GY)ARM-3：单纯放化疗(单次大剂量CDDP/5FU配合标准RTX，60GY)结果：患者分布于ARM-1组26例，ARM-2组16例，ARM-3组6例。小剂量CTX每日2个疗程加超分割RTX后有效率为88%(CR：63%，PR：25%)，标准RTX单次大剂量CTX治疗2个疗程后有效率为50%(CR：17%，PR：33%)。ARM-1手术切除率54%(治愈率35%，姑息率19%)。ARM-2组81%(治愈：6%，缓解：75%)。1、2、3年生存率ARM-1组分别为56%、27%、27%，ARM-2组分别为41%、21%、0%，ARM-3组分别为21%、21%、0%。尤其是在ARM-1行食道切除术的患者，生存率分别为79%、31%和31%。结论：局部晚期(T4)食管癌患者每日小剂量顺铂/5-氟尿嘧啶(CDDP/5FU)配合超分割放射治疗较大剂量顺铂(CDDP)和5-氟尿嘧啶(5FU)一次放疗组疗效更好。T4食道癌患者术前每日小剂量CTX+超分割RTX可提高根治性切除率。手术前和术后联合使用这种药物可以提高此类癌症患者的存活率。

Purpose :To determine the optimal multimodality treatment to improve survival in patients with a locally advanced esophageal cancerMaterial and Methods :The subject were 48 patients with a T4 esophageal cancer who underwent chemoradiotherapy (CRTx) with or without esophagectomy in Kurume University Hospital from 1994 to 1998. Based on informed consent, patients chose one arm among the following three arms of treatment.Arm-1 : Pre- and post-operative chemoradiotherapy (daily low-dosage CDDP/5Fu with hyperfraction radiotherapy, 6OGy)Arm-2 : Postoperative chemoradiotherapy (one-shot high-dosage CDDP/5Fu with sequential standard RTx, 5OGy)Arm-3 : Chemoradiotherapy alone (one-shot high-dosage CDDP/5Fu with concurrent standard RTx, 6OGy)Results :The patients' distribution was 26 in Arm-1, 16 in Arm-2, and 6 in Arm-3. The effective rates after CRTx were 88% (CR : 63%, PR : 25%) after two courses of daily low-dosage CTx with hyperfraction RTx, and 50% (CR : 17%, PR : 33%) after two courses of one-shot high-dosage CTx with standard RTx. The resectable rates were 54% (curative : 35%, palliative 19%) in Arm-1. and 81% (curative : 6%, palliative : 75%) in Arm-2. The 1-, 2-, and 3-year survival rates were 56%, 27%, and 27% in Arm-1, 41%, 21%, and 0% in Arm-2, and 21%, 21%, and 0% in Arm-3. In particular, these survival rates were 79%, 31%, and 31% for patients who underwent esophagectomy in Arm-1.Conclusion :Daily low-dosage CDDP/ 5Fu administration with hyperfraction radiotherapy was more effective for a locally advanced (T4) esophageal cancer than one-shot high-dosage CDDP and 5Fu administration with standard radiotherapy. Preoperative use of the daily low-dosage CTx + hyperfraction RTx increased the rate of curative resection in patients with a T4 esophageal cancer. Pre and post-operative uses of this combination can improve the survival of patients with such a cancer.