Comparison of Neoadjuvant Chemoradiotherapy Combined with Surgery and Surgery on Local Advanced Esophageal Cancer
-
摘要: 目的 比较新辅助放化疗联合手术与单纯手术治疗局部晚期食管癌的疗效。方法 ⅡA~Ⅲ期食管癌患者80例，随机分为新辅助放化疗联合手术组及单纯手术治疗局部晚期食管癌组，每组40例。PF方案化疗，DDP （顺铂）75 mg/ (m2·d)，d1，5-Fu（氟尿嘧啶） 500 mg/ (m2 ·d)，d1~5持续滴注，第1次化疗与第1次放疗同一天实施，每3周为1疗程，放疗期间共用2疗程。放化疗结束后4周行食管癌根治术。放疗组PTV靶区给予每次2.0 Gy，5次/周，总剂量40 Gy。生存分析采用Kaplan-Meier 法，组间比较行Log rank 检验。结果 新辅助放化疗联合手术组并发症多于单纯手术组，但是两组之间差异无统计学意义。1、2、3年生存率新辅助放化组联合手术分别为87.5％、71.5％、53.7％，单放手术组的分别为85％、46.4％、34.8%，P=0.023。结论 新辅助放化疗联合手术治疗可以改善局部晚期食管癌的总生存率，且不明显增加术后并发症。Abstract: Objective To compare the efficacy of neoadjuvant chemoradiotherapy (CRT) combined with surgery and surgery alone on local advanced esophageal cancer. Methods Eighty patients with esophageal cancer at stageⅡA-Ⅲ were equally randomized into neoadjuvant CRT plus surgery group and surgery group. CRT was given as two chemotherapy courses by cisplatin 75 mg/(m2 ·d) on d1 and 5-fl uorouracil 500 mg/(m2 ·d), from d1 to d5 as continuous infusion. The first chemotherapy and the first radiotherapy were applied on the same day. One course was given every 3 weeks. Two courses were given concurrent with radiotherapy. Radical surgery for esophageal carcinoma was applied for 4 weeks after chemoradiotherapy. Planning target volume in radiotherapy was given 2.0 Gy/fraction and total dose of 40 Gy. Overall survival was analyzed by Kaplan-Meier. Log rank was applied to compare between two groups . Results There were more complications in neoadjuvant CRT plus surgery group than those in surgery group,without statistic differences. 1-, 2- and 3-year overall survival rates were 83.3％, 65.3％ and 42.8％ in neoadjuvant CRT plus surgery group, and 80％, 41.6％and 25% in surgery group, respectively(P=0.023). Conclusion Compared with surgery alone, neoadjuvant CRT plus surgery could improve overall survival rate of local advanced esophageal cancer, with no signifi cant postoperative complications.
-
Key words:
- Esophageal cancer /
- Neoadjuvant chemoradiotherapy /
- Surgery
-
-
[1] Campbell NP, Villafl or VM. Neoadjuvant treatment of esophageal cancer[J]. World J Gastroenterol,2010,16(30): 3793-803. [2] Ping YM, Zhang YD, Du XQ, et al. Experience in the treatment of esophageal and cardiac carcinoma in 20000 cases of esophageal cancer surgery[C]// China's fi rst international conference and the Seventh National Conference on esophageal cancer. Zhengzhou: China academic journal (cd-rom version) electronic magazine， 20 05: 167-71. [平育敏，张毓德，杜喜群，等. 食管癌和贲门 癌20000例外科治疗经验[C]//中国首届国际食管癌学术会议暨 第七届全国食管癌学术会议论文集. 郑州：中国学术期刊(光 盘版) 电子杂志社，2005:167-71.] [3] Trotti A,Coleves AD,Setser A, et al. CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment[J]. Semin Radiat Oncol,2003,13(3):176-81. [4] Gebski V,Burmeister B, Smithers BM, et al. Survival benefi ts from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis[J]. Lancet Oncol,2007,8(3):226-34. [5] Sjoquist KM, Burmeister BH, Smithers BM, et al. Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis[J]. Lancet Oncol, 2011,12(7):681-92. [6] An FS, Huang JQ, Xie YT, et al. A prospective study of combined chemoradiotherapy followed by surgery in the treatment of esophageal carcinoma[J]. Zhonghua Zhong Liu Za Zhi,2003,25(4):376-9. [安丰山, 黄金球, 谢映涛, 等. 食管 癌新辅助放化疗的前瞻性临床研究[ J ] . 中华肿瘤杂志, 20 03,25(4):376-9.] [7] Urschel JD, Vasan H. A meta-analysis of randomized controlled trials that compared neoadjuvant chemoradiation and surgery to surgery alone for resectable esophageal cancer[J]. Am J Surg,2003,185(6):538-43. [8] Fiorica F, Di Bona D, Schepis F, et al. Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis[J]. Gut,2004,53(7): 925-30. [9] Burmeister BH, Smithers BM, Val Gebski, et al. Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phaseⅢ trial[J]. Lancet Oncol,2005,6(9):659-68.
计量
- 文章访问数: 1222
- HTML全文浏览量: 346
- PDF下载量: 710
下载:
