局部中晚期食管癌术前新辅助放化疗联合食管癌根治术的临床研究

doi:10.3760/cma.j.issn.1004-4221.2017.08.006

Abstract
Figure/Table
References()
Related Citation (15)
Read Tracking
Download Tracking

Download: PDF (1031 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS) Supporting Info

Abstract Objective To evaluate the tolerance of preoperative neoadjuvant chemoradiotherapy (neoCRT) plus esophagectomy, as well as the short-term outcome, tumor resection rate, incidence of postoperative complications, and perioperative mortality, in patients with locally advanced esophageal cancer. Methods This study included 74 patients with thoracic esophageal cancer who were admitted to our hospital from May 2011 to June 2015. Chemotherapy and radiotherapy were performed concurrently. The chemotherapy consisted of vinorelbine (25 mg/m² on days 1, 8, 22, and 29) and cisplatin (25 mg/m² on days 1-4 and 22-25). The radiotherapy was conventionally fractionated with a total dose of 40 Gy (2.0 Gy/d). At 4-8 weeks after chemoradiotherapy, esophagectomy was performed (neoCRT+surgery group);definitive chemoradiotherapy (DCRT) was performed in the patients who refused surgery (DCRT group);follow-up was performed in the patients who refused any anti-cancer therapies after neoCRT (neoCRT group). Results Forty-four patients underwent neoCRT+surgery, with a radical resection (R₀) rate of 100% and a pathological complete response (pCR) rate of 43%;17 patients received DCRT;13 patients received neoCRT alone. For the neoCRT+surgery group, DCRT group, and neoCRT group, the 2-year overall survival (OS) rates were 79%, 75%, and 17%, respectively, and the 2-year disease-free survival (DSF) rates were 75%, 55%, and 17%, respectively. There were significant differences in OS between the neoCRT group and the neoCRT+surgery group (P=0.000) and between the neoCRT group and the DCRT group (P=0.001), but no significant difference was observed between the neoCRT+surgery group and the DCRT group (P=0.415). There were significant differences in DFS between the neoCRT group and the neoCRT+surgery group (P=0.000) and between the neoCRT group and the DCRT group (P=0.002), but no significant difference was observed between the neoCRT+surgery group and the DCRT group (P=0.416). The rate of clinical response to preoperative neoCRT was 87% for all patients. Fifty-six patients (76%) developed grade ≥3 myelosuppression due to preoperative neoCRT. The incidence rates of postoperative pulmonary infection, anastomotic leakage, and anastomotic stenosis were 21%, 12%, and 7%, respectively, and the perioperative mortality rate was 2%. Conclusions For patients with locally advanced esophageal cancer, preoperative neoCRT plus surgery can increase the clinical response rate and pCR rate, reduce the tumor stage, and improve the survival, but chemoradiotherapy toxicities and perioperative complications cannot be ignored.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	Ran Gang
	Zhou Lizhen
	Zhou Chao
	Kong Min
	Zhu Chengchu
	Yang Haihua

Key words： Esophageal neoplasms/surgery Esophageal neoplasms/chemoradiotherapy Prognosis

Received: 07 December 2016

Fund:Major Scientific and Technological Special Emphasis on Social Development Project of Zhejiang Province (2011C13039-2)

Corresponding Authors: :Yang Haihua,Email:yanghh@enzemed.com

Cite this article:

Ran Gang,Zhou Lizhen,Zhou Chao et al. Clinical effect of preoperative neoadjuvant chemoradiotherapy plus esophagectomy in treatment of locally advanced esophageal cancer[J]. Chinese Journal of Radiation Oncology, 2017, 26(8): 874-879.

URL:

http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2017.08.006 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2017/V26/I8/874

[1] Chen WQ,Zheng RS,Baade PD,et al. Cancer Statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.DOI:10.3322/caac.21338.
[2] Reeh M,Nentwich MF,Asani S,et al. Locally advanced esophageal carcinoma:is there still a role of surgery alone without neoadjuvant treatment?[J].J Gastrointest Surg,2015,19(4):587-593.DOI:10.1007/s11605-015-2762-y.
[3] Allum WH,Stenning SP,Bancewicz J,et al. Long-term results of a randomized trial of surgery with or without preoperative chemotherapy in esophageal cancer[J].J Clin Oncol,2009,27(30):5062-5067.DOI:10.1200/JCO.2009.22.2083
[4] 周超,杨海华,周丽珍,等.局部晚期食管癌术前放化疗加联合胸腹腔镜下根治术术前放疗靶区的临床研究[J].肿瘤学杂志,2015,21(12):961-967.DOI:10.11735/j.issn.1671-170X. 2015.12.B004.
Zhou C,Yang HH,Zhou LZ,et al. Clinical research of radiotherapy target for neo-adjuvant chemoradiotherapy followed by combined thoracoscopic and laparoscopic minimal invasive esophagectomy in locally advanced esophageal cancer[J].J Oncol,2015,21(12):961-967.DOI:10.11735/j.issn.1671-170X.2015.12.B004.
[5] Zhang DW,Cheng GY,Huang GJ,et al. Operable squamous esophageal cancer:current results from the East[J].World J Surg,1994,18(3):347-354.
[6] 傅剑华,戎铁华,李小东,等.术前放化疗并手术治疗局部晚期食管癌Ⅱ期临床试验[J].癌症杂志,2004,23(Suupl 11):1473-1476.
Fu JH,Rong TH,Li XD,et al. Chemoradiotherapy followed by surgery in treatment of locally advanced esophageal carcinoma:a phase Ⅱ trial[J].Chin J Cancer,2004,23(Suupl 11):1473-1476.
[7] 杨弘,傅剑华,刘孟忠,等.术前放化疗并手术与单纯手术治疗局部晚期食管鳞癌的多中心随机对照临床研究[J].中华医学杂志,2012,92(15):1028-1033.DOI:10.3760/cma.j.issn.0376-2491.2012.15.005.
Yang H,Fu JH,Liu MZ,et al. A multi-centered randomized controlled study of neo-adjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced squamous cell carcinoma of esophagus:an interim analysis[J].Chin J Med,2012,92(15):1028-1033.DOI:10.3760/cma.j.issn.0376-2491.2012.15.005.
[8] Bollschweiler EH,Lscher AH,Metzger R.Histologic tumor type and the rate of complete response after neoadjuvant therapy foresophageal cancer[J].Future Oncol,2010,6(1):25-35.DOI:10.2217/fon.09.133.
[9] Hofstetter W,Swisher SG,Correa AM,et al. Treatment outcomes of resected esophageal cancer[J].Ann Surg,2002,236(3):376-385.
[10] Kleinberg L,Knisely JP,Heitmiller R,et al. Mature survival results with preoperative cisplatin,protracted infusion 5-fluorouraeil,and 44-Gy radiotherapy for esophageal cancer[J].Int J Radiat Oncol Biol Fhys,2003,56(2):328-334.
[11] Bidoli P,Slani S,Candis D,et al. Single-agent chemotherapy with vinorelbine for pretreated or metastatic squamous cell carcinoma of the esophagus[J].Tumori,2001,87(5):299-302.
[12] Conroy T,Etienne PL,Adenis A,et al. Vinorelbine and cisplatin in metastatic squamous cell carcinoma of the esophagus:response,toxility,quality of life and survival[J].Ann Oncol,2002,13(5):721-729.
[13] 郎锦义,李志琳,马家宝,等,长春瑞滨对中晚期食管癌放疗增敏作用的疗效观察[J].四川医药,2008,29(11),1485-1487.DOI:10.3969/j.issn.1004-0501.2008.11.013.
Lang JY,Li ZL,Ma JB,et.al. Observations of low-dose navelbine in sensitization of radiotherapy on intermediate and advanced esophageal carcinoma[J].Sichuan Med J,2008,29(11):1485-1487.DOI:10.3969/j.issn.1004-0501.2008.11.013.
[14] 樊青霞,李鑫,吴欣爱,等.诺维本联合顺铂治疗食管癌的临床观察[J].癌症进展,2004,2(2),109-111.
Fan QX,Li X,Wu XA,et al. Clinical study of vinorelbine combined with cisplatin in the treatment of esophageal cancer[J].Oncol Prog,2004,2(2):109-111.
[15] Mulligan ED,Dunne B,Griffin M,et al. Margin involvement and outcome in oesophageal carcinoma:a 10-year experience in a specialist unit[J].Eur J Surg Oncol,2004,30(3):313-317.DOI:10.1016/j.ejso.2003.11.009
[16] 金海林,韩树堂,李文杰,等.术前联合放化疗与单纯手术治疗食管癌疗效Meta分析[J].世界华人消化杂志,2011,19(27):2869-2875.DOI:?.
Jin HL,Han ST,Li WJ,et al. Efficacy of preopetative chemoradiotherapy plus surgery versus alone for resectable esophageal carcinoma:a meta-analysis[J].World Chin J Digestol,2011,19(27):2869-2875.DOI:?.
[17] 朱成楚,陈保富,孔敏,等.术前放化疗加胸腹腔镜联合手术在局部中晚期食管癌中的应用体会[J].中华胃肠外科杂志,2012,15(9):943-946.DOI:10.3760/cma.j.issn.1671-0274. 2012.09.019.
Zhu CC,Chen BF,Kong M,et al. Neoadjuvant chemoradiotherapy followed by combined thoracoscopic and laparoscopic esophagectomy in the treatment of locally advanced esophageal carcinoma[J].China J Gastrointest Surg,2012,15(9):943-946.DOI:10.3760/cma.j.issn.1671-0274. 2012.09.019.
[18] Fiofica F,DiBona D,Schepis F,et al. Preoperative chemoradiotherapy for oesophageal cancer:a systematic review and meta-analysis[J].Gut,2004,53(7):925-930.
[19] Gebski V,Burmeister B,Smithers BM,et al. Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma:a meta-analysis[J].Lancet Oncol,2007,8(3):226-234.
[20] Bedenne L,Michel P,Bouche O,et al. Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus:FFCD 9102[J].J Clin Oncol,2007,25(10):1160-1168.