Study on Neoadjuvant Chemoradiation for Elderly Patients with Local Advanced Esophageal Squamous Carcinomas
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摘要: 目的 探讨年龄≥70岁的高龄食管癌患者术前行新辅助放化疗的安全性和疗效。方法回顾性分析高龄患者高龄组(A组)术前新辅助放化疗的不良反应和手术切除率、术后并发症和病理学检查情况，将其他年龄组患者作为对照组(B组)相比较。新辅助放化疗前临床分期为cT3N0～1，病理类型为鳞癌，放疗剂量均为40 Gy，2周期顺铂联合氟尿嘧啶化疗，3～4周后手术治疗。结果全部患者均完成新辅助治疗，主要不良反应有呕吐、粒细胞减少和食管炎。其中，Grade3/4粒细胞减少25.9%(7/27)较B组8.1%(5/62)差异有统计学意义（χ2=5.144，P=0.023）。A组新辅助治疗有效率为92.6%(25/27)，B组有效率95.2%，两组比较差异无统计学意义。A组手术切除率92.6%(25/27)，完全性切除率88.9%(24/27)，B组手术切除率91.9%(57/62)，完全性切除率87.1%(54/62)，两组比较差异无统计学意义。无围手术期死亡病例，A组并发症发生率为32.0%(8/25)，B组发生率为22.0%(13/59)，两组比较差异无统计学意义(P>0.05)。其中肺炎、心率失常和喉返神经损伤为主要并发症，心率失常发生率32.0%与B组8.5%比较，差异有统计学意义（χ2=8.360，P=0.015）。结论高龄食管癌患者术前新辅助放化疗后严重粒细胞减少症和术后心律失常发生率高于其他年龄组，但总的不良反应发生率不高于对照组，手术切除率、术后病理学检查放化疗反应情况组间比较差异无统计学意义，术前新辅助放化疗安全、有效。Abstract: Objective To evaluate the safety and efficacy of neoadjuvant chemoradiation for elderly patients (age≥70) with local advanced esophageal squamous carcinomas. Methods A total 27 elder patients staged cT3N0~1(group A) were analyzed retrospectively compared with 62 cases of younger patients(group B),all of them were given 2 cycles cisplatin 75 mg/m2 plus fluorouracil 600 mg/m2 d1～5 and 40 Gy of radiation followed by surgery 3~4 weeks later in past two years. Results All patients accomplished planned neoadjuvant chemoradiations.Neoadjuvant chemoradiation caused vomiting,neutropenia and esophagitis in two arms similarly,only G3/4 neutropenia occurred in 25.9%(7/27) of group A versus 8.1%(5/62) of group B (P=0.023).The effective rate of neoadjuvant chemoradiation was 92.6%(25/27) in group A vs.95.2% in group B (P=0.621).88.9% patients （24/27）underwent complete resection of group A and 87.1%(54/62) of group B (P=0.563).No mortality was found.The overall complication rate were similar in two groups (32.0% vs.22.0%).Arrhythmia，pneumonia and injury of recurrent laryngeal nerve were the common complications after surgery.The incidence of arrhythmia in group A occurs was 32.0% contrast to 8.5% in group B (P=0.015).There was no difference of pCR between two groups (25.9% vs.22.6%). Conclusion There was no significant difference between elderly patients and younger patients with local advanced esophageal squamous carcinomas treated by neoadjuvant chemoradiation followed by surgery,though increased G3/4 neutropenias and arrhythmias.The neoadjuvant chemoradiation was safety and effective for elderly patients.
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Key words:
- Esophageal carcinoma /
- Neoadjuvant chemoradiation /
- Surgery /
- Elderly patients
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