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

目的 评价局部晚期食管癌患者对术前neoCRT并手术的耐受性,术前新辅助放化疗疗效以及对肿瘤切除率、术后并发症发生率、围术期死亡率的影响。 方法 2011—2015年间共收治达入组条件胸段食管癌患者 74例。术前同期放化疗方案:长春瑞滨 25 mg/m²第1、8、22、29天,顺铂 25 mg/m²第 1—4、22~25天,同期常规分割放疗2.0 Gy/d,总量40 Gy。放化疗结束后 4~8周行食管癌根治术(neoCRT+手术),拒绝手术患者行根治性放化疗(DCRT),术前放化疗后拒绝进一步治疗患者予随访(neoCRT)。 结果 44例完成术前neoCRT+手术均为R₀切除,pCR达43%;17例拒绝手术改成DCRT;13例neoCRT。neoCRT+手术、DCRT、neoCRT患者 2年OS率分别为79%、75%、17%,DFS率分别为75%、55%、17%。neoCRT与neoCRT+手术OS率不同(P=0.000),与DCRT也不同(P=0.001),neoCRT+手术组与DCRT相近(P=0.415)。neoCRT与neoCRT+手术DFS率不同(P=0.000),与DCRT也不同(P=0.002),neoCRT+手术与DCRT相近(P=0.416)。全组术前放化疗临床有效率87%,术前放化疗 56例患者出现≥3级骨髓抑制(76%),术后肺部感染、吻合口瘘、吻合口狭窄发生率及围术期死亡率分别占21%、12%、7%、2%。 结论 术前放化疗联合手术治疗局部中晚期食管癌能取得较高的临床有效率和pCR率,明显降低食管癌的分期,有望提高生存率,但放化疗不良反应、围术期并发症需重视。     

中晚期食管癌98例同步放化疗的疗效观察

目的探讨同期放化疗对中晚期食管癌的疗效。方法 98例食管癌中43例行单纯放射治疗（单放组）,以6 MVX常规照射,2 Gy/次,5次/周,照射总剂量为50 Gy,另55例行化放疗联合治疗（化放组）,予顺铂（DDP）联合氟尿嘧啶（5-Fu）（DDP 20 mg/m2,d1～d5;5-Fu 500 mg/m2,d1～d5）,28天为1个周期,放疗方案同单放组,观察两组的近期疗效、远期疗效和不良反应。结果化放组有效率（RR）为65.4%,高于单放组（44.1%）（P〈0.05）。KPS评分化放组较单放组显著提高（P〈0.05）,化放组3年生存率为11.9%,高于单放组（6.9%）（P〈0.05）。两组主要不良反应包括白细胞减少、消化道反应和放射性食管炎,化放组白细胞减少发生率高于单放组（P〈0.05）。结论对中晚期食管癌患者,同期放化疗较单纯放疗的近期疗效更好,可明显改善患者的生存质量,延长患者生存时间,且相对安全。     

同步放化疗联合沙利度胺治疗中晚期食管癌的临床随机对照研究

目的:评价同步放化疗联合沙利度胺治疗中晚期食管癌的临床疗效和患者的耐受性。方法:65例符合入组条件的局部中晚期不能手术的食管癌患者随机分为治疗组和对照组。治疗组33例采用同步放化疗联合沙利度胺（放疗总剂量60～70Gy,化疗方案为5- 氟尿嘧啶+ 顺铂;沙利度胺第1 周100mg/d ,晚睡前顿服,每日1 次,第2 周开始增加至200mg/d ,并以200mg/d 为维持剂量,口服至放疗结束）,对照组32例仅接受同步放化疗。结果:治疗组和对照组的有效率分别为87.9% 和68.7% ,两组差异无统计学意义（P>0.05）;局部控制率分别为93.0% 和91.0% ,两组差异无统计学意义（P>0.05）;1 年的生存率分别为74.0% 和63.0% ,两组差异无统计学意义（P>0.05）。 治疗组KPS 评分的改善率为57.6% ,对照组KPS 评分的改善率为31.3% ,两组比较差异有统计学意义（P<0.05）;治疗组的恶心、呕吐发生率较对照组低,差异有统计学意义（P<0.05）,但治疗组的便秘、嗜睡以及乏力的发生率较对照组高,差异有统计学意义（P<0.05）。 结论:同步放化疗联合沙利度胺治疗食管癌可改善患者的生活质量,提高对放化疗的顺应性,有提高远期生存率可能,值得进一步研究。      

术前放疗提高中晚期食管癌生存率随访结果报道

目的:研究随机化60Co γ线术前放疗提高食管癌远期生存率的效果.方法:运用生存分析的寿命表法和Kaplan-Meier法对比分析了本院1972～1986年经随机抽签决定的336例术前放疗和1 680例单纯手术患者随访15～30年的资料.结果:发现术前放疗能显著提高中晚期食管癌5、10、15年生存率;术后15年内术前放疗与单纯手术者相比生存曲线位置显著提高(P=0.001);分组分析发现Ⅱa期食管癌术前放疗后分期下降者比分期不变者生存曲线位置显著提高(P＜0.04);术前放疗对中段食管癌、根治切除者提高远期生存率效果显著.结论:60Co γ线术前放疗能提高中晚期食管癌的远期生存率,应该在临床上推广应用.     

不同剂量TP方案化疗联合同步放疗治疗局部晚期食管癌的疗效观察

目的 探讨不同剂量TP方案化疗联合同步放疗治疗局部晚期食管癌疗效及毒副反应。方法 53例局部晚期食管癌患者分成三组:大剂量紫杉醇+顺铂联合放疗组(以下简称大剂量组:DDP 100 mg/m²,d1;PTX 175 mg/m² ,d1)18例;小剂量紫杉醇+顺铂联合放疗组(以下简称小剂量组:DDP 20 mg/m² ,d1-5;PTX 20 mg/m² ,d1、3、5)16例;单纯放疗组19例。化疗21天为1个周期;放疗采用三维适形放疗,常规分割,总剂量60 Gy/6 W。结果 大剂量组、小剂量组、单纯放疗组完全缓解(CR)率、有效率(CR+PR)及1年生存率分别为58.8%、81.3%、26.3%;88.2%、93.8%、57.9%及94.1%、100%、73.7%。三组比较,大、小剂量组CR率、CR+PR率均较单纯放疗组有统计学差异,P＜0.05;小剂量组与单纯放疗组在1年生存率上差异有统计学意义,P＜0.05。毒副反应大剂量组在骨髓抑制、胃肠道反应、脱发,较小剂量组、单纯放疗组差异有统计学意义,P＜0.05。结论 小剂量TP方案化疗联合同步放疗治疗局部晚期食管癌,疗效较好,毒副反应可以耐受。     

放化疗联合治疗中晚期食管癌的疗效观察

目的 观察放化疗联合治疗中晚期食管癌的疗效及预后的相关因素.方法 回顾性分析60例中晚期食管癌患者,根据治疗方法 不同分为单纯放疗组(简称单放组)32例和放疗加化疗组(简称放化组)28例.放射治疗均采用6MV-X线常规照射,常规分割2 Gy/次,总量DT60～70 Gy,放化组在放射治疗同时或者放疗后给予顺铂(DDP)加亚叶酸钙(CF)加5-氟尿嘧啶(5-Fu)方案化疗.结果 放化组与单放组1、2、3年生存率分别为73.30%、46.70%、16.67%和60.30%、16.67%、6.67%;其中2年生存率放化组明显高于单放组,差异有统计学意义(P＜0.05).同期放化组与序贯放化组1、2、3年生存率分别为88.89%、55.55%、22.22%和84.21%、47.37%、15.79%.患者近期不良反应,放化组较单放组有所加重,差异有统计学意义(P＜0.05).治疗方式和临床分期是食管癌预后的影响因素(P＜0.05),放化联合较单纯放疗预后好,分期越晚预后越差.结论 放化疗联合能提高中晚期食管癌患者的2年生存率,患者近期不良反应可以耐受,是治疗中晚期食管癌有效的方法 之一.     

紫杉醇联合顺铂新辅助化疗方案治疗中晚期食管癌的临床观察

食管癌是我国最常见的消化道肿瘤之一,手术仍然是首选的治疗方式。但是临床中发现的多是进展期食管癌,单纯手术治疗效果不理想,术后5年生存率一直徘徊于10％～35％,平均20％。为了提高食管癌的术后生存期,我们对44例中晚期食管癌患者进行紫杉醇（PTX）联合顺铂（DDP）新辅助化疗,与同期45例单纯手术组患者比较,结果总结报道如下。     

放化疗联合治疗食管癌患者的临床疗效及预后分析

目的探讨并分析同步放化疗联合治疗食管癌患者的疗效和预后。方法选取2009年3月至2011年3月收治的78例晚期食管癌患者,按照治疗方式分为观察组和对照组,每组39例。对照组患者给予序贯放化疗治疗,观察组患者给予同步放化疗治疗。比较两组患者的近期疗效,并对患者预后进行分析。结果观察组患者治疗总有效率为74.4%（29/39）,对照组患者为51.3%（20/39）,观察组总有效率高于对照组（P〈0.05）。观察组患者白细胞减少和放射性食管炎发生率分别为64.1%和74.4%,高于对照组（P〈0.05）。两组患者的1年生存率差异无统计学意义（P〉0.05）,而观察组的2年生存率显著高于对照组（P〈0.05）。观察组复发率和转移率均低于对照组（P〈0.05）。结论同步放化疗显著提高了患者的治疗效果和2年生存率,抑制了肿瘤的转移和复发,且无严重不良反应出现,有助于患者完成治疗。     

DVPm方案治疗中晚期食管癌31例近期疗效分析

我们在DVP（DDP，VCR，PYm)方案的基础上，增加mmc组成DVPm方案 ，自1986年1月-1990年12月，治疗中晚期食管癌31例，CR8例（25.8%)，PR12例（38.7%),RR64.5%,RRR83.3%。取得较满意疗效，且毒性并不比DVP方案大，进一步分析了术后，放疗后复发转移病人与初治，复治病人的疗效，以及不同类型食管癌病人的疗效。     

雷替曲塞联合奈达铂同步调强放疗治疗局部晚期食管癌的临床疗效

目的探讨雷替曲塞联合奈达铂同步调强放疗治疗局部晚期食管癌的临床疗效。方法将局部晚期食管癌80例根据治疗方法分为采用雷替曲塞联合奈达铂同步调强放疗组(观察组)38例,采用顺铂联合5-FU同步调强放疗治疗组(对照组)42例,比较2组患者实体瘤的疗效指标,比较2组的不良反应。结果观察组CR为57.9%、PR为39.5%、DCR为97.4%,而对照组CR为47.6%、PR为45.2%、DCR为92.9%。观察组的DCR与对照组相比,差异无统计学意义(χ^2=0.731,P=0.621)。2组患者各项不良反应对比差异均无统计学意义(P>0.05)。结论雷替曲塞联合奈达铂同步调强放疗治疗局部晚期食管癌是有效的及安全的临床治疗方案,其临床应用方便,耐受性良好。     

食管癌的新辅助治疗

Because the conflicting data currently available from the performed randomized trials it is very difficult to provide strict guidelines for the treatment of patients with locoregional advanced esophageal cancers. Surgery however, remains the standard of care for potentially resectable disease. Preoperative chemotherapy is still controversial with two large randomized trials resulting in two different conclusions regarding the survival benefit. Preoperative chemoradiation is also controversial since only one randomized trial showed a clear survival benefit however, the patients treated with surgery alone in this trial had an unusually poor outcome. And the study by Urba et al was not powered enough to show a clear survival benefit for patients treated with neoadjuvant chemoradiation. The results of three metaanalysis of these randomized studies show lower rate of resection, higher rate of R0-resection, more often postoperative mortality and better prognosis for patients with neoadjuvant radiochemotherapy. As a consequence one may consider offering neoadjuvant chemotherapy or neoadjuvant radiochemotherapy to patients with locallyadvanced disease under the premise that patients have a good performance status and understand the controversies about this therapeutic option. Larger trials with sufficient power to clearly detect survival benefits for patients treated with neoadjuvant chemotherapy or radiochemotherapy are necessary before this therapeutic option will be the standard of care.     

Neoadjuvant Treatment for Esophageal Cancer

Because the conflicting data currently available from the performed randomized trials it is verydifficult to provide strict guidelines for the treatment of patients with locoregional advanced esophagealcancers.Surgery however,remains the standard of care for potentially resectable disease.Preoperativechemotherapy is still controversial with two large randomized trials resulting in two different conclusionsregarding the survival benefit.Preoperative chemoradiation is also controversial since only one randomizedtrial showed a clear survival benefit however,the patients treated with surgery alone in this trial had anunusually poor outcome.And the study by Urba et al was not powered enough to show a clear survivalbenefit for patients treated with neoadjuvant chemoradiation.The results of three metaanalysis of theserandomized studies show lower rate of resection,higher rate of RO-resection,more often postoperativemortality and better prognosis for patients with neoadjuvant radiochemotherapy.As a consequence one mayconsider offering neoadjuvant chemotherapy or neoadjuvant radiochemotherapy to patients with locally-advanced disease under the premise that patients have a good performance status and understand thecontroversies about this therapeutic option.Larger trials with sufficient power to clearly detect survivalbenefits for patients treated with neoadjuvant chemotherapy or radiochemotherapy are necessary beforethis therapeutic option will be the standard of care.     

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比较

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。     

低频超声联合手术在食管癌治疗中的应用

目的探讨低频超声联合手术治疗对食管癌患者生存的影响。方法 80例食管癌患者随机分为2组,每组40例。研究组40例接受低频超声联合手术治疗,对照组40例仅进行手术治疗。结果研究组1、2、3 a生存率分别为80.3%、62.5%、40.9%,对照组分别为75.3%、55.1%、36.8%,2组比较差异均有统计学意义(P<0.05)。2组并发症发生率比较差异无统计学意义(P<0.05)。研究组淋巴结肿瘤细胞存活率为21.5%,低于对照组的37.3%,差异有统计学意义(P<0.05)。结论低频超声联合手术治疗能够改善食管癌患者的生存状况,且不增加患者的术后并发症,值得在临床推广应用。     

同步放化疗治疗局部晚期食管癌临床观察

目的 探讨同步放化疗治疗局部晚期食管癌的疗效及毒副反应.方法 80例经组织学或细胞学证实的局部晚期食管癌随机分为两组,同步放化疗组40例接受同步放化疗,单纯放疗组40例仅接受放疗,化疗采用DF方案,放疗剂量为60-64 Gy,治疗结束后分别观察疗效及毒副反应.结果 同步放化疗组和单纯放疗组有效率分别为95.0%、82....     

DF方案化疗和放疗综合治疗局部晚期食管癌

目的　评价DF方案化疗和放疗综合治疗局部晚期食管癌的疗效。方法　DF方案 (DDP + 5 -Fu)化疗和放疗综合治疗 98例 ,单纯放射治疗 92例。结果　化放组和单放组 1、2、3年生存率分别为 60 2 %、43 9%、3 1 6%和 44 6%、2 9 3 %、16 3 % ,3年局控率分别为 45 9%和 3 1 5 % ,3年远处转移率分别为 11 2 %和 2 2 8% ,化放组明显优于单放组 (P <0 0 5 )。化放组无严重的毒副反应。结论　DF方案化疗和放疗综合治疗能提高局部晚期食管癌的局控率 ,减少远处转移和提高生存率 ,且不增加严重的毒副反应     

Systematic Analysis of Pemetrexed-based Chemoradiotherapy for Patients with Locally Advanced or Metastatic Esophageal Cancer

Purpose: This systematic analysis was conducted to evaluate the efficacy and safety of pemetrexed-basedchemoradiotherapy in treating patients with locally advanced or metastatic esophageal cancer. Methods: Clinicalstudies evaluating the efficacy and safety of pemetrexed based regimens on response and safety for relevant patientswere identified using a predefined search strategy. Pooled response rates (RRs) were calculated. Results: Forpemetrexed-based regimens, 4 clinical studies including 47 patients with locally advanced or metastatic esophagealcancer were considered eligible for inclusion. Systematic analysis showed that, in all patients, the pooled RR was51% (24/47) . Major adverse effects of grade III/IV were esophagitis, neutropenia, thrombocytopenia, anemiaanorexia, fatigue, diarrhea, dysphagia and vomiting. No treatment related death occurred with pemetrexed-basedtreatment. Conclusion: This systematic analysis suggests that pemetrexed based radiotherapy is associated withreasonable activity and good tolerability in treating patients with locally advanced or metastatic esophagealcancer.     

周剂量紫杉醇对局部晚期食管癌的放疗增敏作用

目的探讨周剂量紫杉醇对局部晚期食管癌的放疗增敏作用。方法将44例不宜手术的局部晚期食管癌患者随机分为放疗增敏组和单纯放疗组,每组22例。2组放疗方法相同,均采用常规设野,常规分割外照射,总剂量60—66Gy。放疗增敏组在放疗同期每周接受1次紫杉醇（40mg·m-2）化疗,连用6周。结果44例患者均可评价疗效,放疗增敏组与单纯放疗组有效率分别为86．4％和63．6％（P〈0．05）;1a局部控制率分别为77．3％和50．0％（P〈0．05）;1a无复发生存率分别为72．7％和45．5％（P〈0．05）;1a生存率分别为81．8％和54．5％（P〈0．05）。2组毒副反应相似,患者均可耐受。结论周剂量紫杉醇对局部晚期食管癌放疗具有明显的增敏作用,能提高患者的局部控制率和生存率,且毒副反应未明显增加。     

The Impact of Radiotherapy Dose in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma Receiving Preoperative Chemoradiotherapy

Objective: For patients with esophageal squamous cell carcinoma, preoperative chemoradiotherapy followed by planned esophagectomy is used as a curative treatment modality. However, the impact of radiotherapy dose remains undefined. Method: A total of 141 patients with stage III esophageal squamous cell carcinoma (ESCC; as defined by the 7th American Joint Committee on Cancer), receiving preoperative chemoradiotherapy followed by esophagectomy between 2000 and 2015 at Kaohsiung Chang Gung Memorial Hospital, Taiwan, were retrospectively reviewed. The radiotherapy dose of preoperative chemoradiotherapy (36 Gy before 2009 and 50–50.4 Gy after 2009) and other clinicopathological parameters were collected and correlated with the response to chemoradiotherapy and treatment outcome. Result: Of these 141 patients, the radiotherapy dose was 36 Gy in 59 (42%) patients and 50 Gy in 82 (58%) patients. A complete pathological response was noted in 12 (20%) of 59 patients receiving 36 Gy radiotherapy, and 37 (45%) of 82 patients receiving 50 Gy radiotherapy (p = 0.002). The three-year overall survival and disease-free survival rates were 31% and 25% in patients receiving 36 Gy radiotherapy, and 54% and 46% in patients receiving 50–50.4 Gy radiotherapy, respectively (p = 0.023 for overall survival; p = 0.047 for disease-free survival). Multivariate analysis showed that a higher radiotherapy dose was associated with increased pathological complete response (p = 0.003, hazard ratio: 3.215), better overall survival (p = 0.024, hazard ratio: 1.585), and superior disease-free survival (p = 0.049, hazard ratio: 1.493). However, higher radiotherapy doses revealed more surgical complications, including acute respiratory distress syndrome (p = 0.048) and anastomosis leaks (p = 0.004). Conclusion: For patients with locally advanced ESCC, preoperative chemoradiotherapy with higher radiotherapy doses led to increased pathologic complete response rates and improved survival.