调强放射治疗联合周剂量紫杉醇治疗60例食管癌的疗效观察

目的:探讨调强放疗联合紫杉醇每周给药的方法治疗食管癌的近期疗效、局部控制率、生存率及毒性反应。方法:103例食管癌患者随机分为60例放化组(调强放疗+紫杉醇组),43例单放组(单纯调强放疗组)。单放组:采用调强放疗,95%PTV:66GY/30-33次,每周5次;放化组:调强放射治疗同时化疗(紫杉醇60mg)第1、8、15、22、29、36天静滴。结果:放化疗组的食管癌病灶近期总有效率为8 3.3%,单纯放疗组为60.4%,两组差异有显著性(P<0.05)。1、2年生存率,单放组为55.8%(24/43)、32.5%(14/43),同步放化组为86.6%(52/60)、68.3%(41/60),两组差异有显著性(P<0.05)。不良反应放化组稍高于单放组,但两者差异无统计学意义。结论:调强放疗联合紫杉醇单药每周方案,同步治疗食管癌近期疗效和局部控制率较好,能提高远期生存率可能,虽毒性反应增加但能耐受。     

调强放疗同步化疗治疗食管癌的近期疗效观察

目的观察常规放疗和调强放疗联合PF方案同期放化疗治疗食管癌的近期疗效和毒副作用。方法常规组（A组）31例采用常规照射方法，6／8MV高能X线，总剂量60—70Gy；调强组（B组）31例放疗均采用6／8MV—X线。总剂量66～70Gy。两组均放疗第1天配合PF方案化疗，21天1个周期，连续2个周期。结果常规组和调强组总有效率分别为74．19％和93．55％（P〈0．05）。常规组毒副作用大于调强组，骨髓抑制、胃肠道反应及放射性食管炎发生率差异有显著性差异（P〈0．01）。结论调强放疗联合PF方案治疗食管癌较常规放疗联合PF方案有很好的近期疗效，毒副作用显著减轻，晚期并发症的发生率及远期疗效有待进一步观察。     

食管癌新辅助化疗

新辅助化疗有延长局限性食管癌生存的趋势,有效的化疗方案和时间还需要进一步探讨。评价和预测化疗疗效的方法包括影像学和分子标志物,也是目前研究的重点。     

调强放疗同步化疗治疗中晚期食管癌的疗效观察

背景与目的：调强放疗(intensity modulated radiation therapy,IMRT)是在最大限度提高肿瘤靶区照射剂量的同时明显减少周围正常组织剂量的放疗技术,化疗是防止远处转移的有效手段。本文旨在观察IMRT同步化疗治疗中晚期食管癌的临床效果。方法：将62例中晚期食管癌患者分为两组,其中同步放化疗组(IMRT+化疗)32例,单纯放疗组(单纯IMRT)30例。两组患者均采用IMRT放疗,同步放化疗组同期采用化疗方案TP(紫杉醇175 mg/m2,第1天;奈达铂,30 mg/m2,第1~3天),化疗28 d为1个周期,至少化疗2个周期。比较两组近期临床疗效及不良反应。结论：同步放化疗组有效率(CR+PR)为93.8%,高于单纯放疗组的76.7%,差异有统计学意义(P<0.05),同步放化疗组的1、2年局控率(84.4%、59.4%)高于单纯放疗组(70.0%、36.7%),差异有统计学意义(P<0.05);两组的生存率差异无统计学意义(P>0.05);同步放化疗组白细胞下降和放射性食管炎发生率以及Ⅲ、Ⅳ级不良反应发生率均明显高于单纯放疗组(P<0.05)。     

同期化疗配合后程三维适形放疗治疗食管癌的临床观察

目的：观察同期化疗配合后程三维适形放疗治疗食管癌的缓解率、局控率、生存率和毒副反应。方法：79例食管癌患者随机分为两组，放化疗组（39例）大野前后对穿常规分割照射36Gy-40Gy后，缩野三维适形照射追量26Gy，在放疗开始和放疗末期用氟脲嘧啶500mg／m^2＋顺铂20mg／m^2第1—5天全身化疗。单放组（40例）大野前后对穿常规分割照射36Gy-40Gy后，缩野照射追量26Gy。两组放疗总量62Gy-66Gy。结果：放化疗组与单放组完全缓解率分别为33％、12．5％（P〈0．05）。1、2年生存率放化疗组为79％、59％，单放组为68％、42％（P=0．13）。毒性反应放化疗组相对增加，但绝大多数患者可以耐受。结论：同期化疗配合后程三维适形放疗治疗食管癌近期疗效较好，可提高生存率。毒副反应增加，但可以耐受。     

食管癌的立体适形放疗和同步化疗

目的应用立体适形放射治疗技术并同步化学治疗食管癌,评价疗效和并发症.方法 52例食管癌给予立体适形放射治疗和同步化疗.放疗:2～2.2GY/次/天,5次/周,共计35次;5～8个共面适形固定野,总剂量70～76GY.化疗:顺氨氯铂20mg,5-氟脲嘧啶500 mg,每周一次,放疗开始即同步使用化疗,化疗在放疗前进行.结果治疗后1月～6月复查食管X片和CT,肿瘤缩小50%以上者92.31%(48/52);1年、3年和5年生存率分别为78.85%(41/52);41.46%(17/41);26.92%(7/26).结论立体适形放射治疗和同步化学治疗食管癌,疗效较好,并发症少,是不能手术患者的较好的一种治疗方式.     

Prognostic role of microRNA polymorphisms in patients with advanced esophageal squamous cell carcinoma receiving platinum-based chemotherapy

Purpose

MicroRNA (miRNA) polymorphisms contribute to cancer susceptibility and prognosis. The aim of this study was to evaluate the effects of miRNA polymorphisms on clinical outcomes in patients with advanced esophageal squamous cell carcinoma (ESCC) treated with platinum-based chemotherapy.

Methods

Five polymorphisms (miR-146a rs2910164, miR-196a2 rs11614913, miR-100 rs1834306, miR-125a rs12976445 and miR-26a1 rs7372209) were genotyped in 378 patients with advanced ESCC recruited at Zhongshan Hospital. The associations between genotypes and drug response, toxicity, and overall survival were analyzed.

Results

miR-146a rs2910164 was significantly associated with an increased risk of severe hematological toxicity [odds ratio = 0.374, 95 % confidence interval (CI) 0.171–0.819, P = 0.014]. The TT genotypes of both miR-196a2 rs11614913 and miR-125a rs12976445 were associated with worse survival [hazard ratio (HR) = 1.552, 95 % CI 1.112–2.165, P = 0.010; HR = 2.171, 95 % CI 1.173–4.017, P = 0.014, respectively]. Combined analysis revealed a 4.073-fold increased risk of death in patients carrying two unfavorable genotypes (P = 0.002).

Conclusions

Taken together, these findings indicate that miRNA polymorphisms may predict prognosis in advanced ESCC patients receiving platinum-based chemotherapy.     

临床分期对根治性放疗食管癌患者预后的影响

  目的   非手术治疗食管癌患者分别按照2004、2009年版临床分期标准分期,观察不同分期标准的各期食管癌患者的预后生存,以及大体肿瘤体积（gross tumor volume,GTV-T）对临床T分期及预后的影响,以期确定更为合理的食管癌临床分期标准。   方法   回顾性分析219例行根治性放疗的食管癌患者的临床资料。患者于放疗前行食管钡餐造影检查、定位CT扫描并于放射治疗计划系统勾画靶区计算GTV-T。所有患者分别按照2004、2009年版临床分期标准进行分期,结合GTV-T,观察患者预后。   结果   全组患者1、3、5年生存率分别为70.8%、35.6%、20.7%,中位生存期23个月。两种食管癌临床分期标准均能反映食管癌放疗预后,2009年版分期生存曲线分离度最好,生存差异具有显著性意义（χ2=29.497,P < 0.001）。临床T分期与GTV-T大小呈正相关（r=0.615,P < 0.001）。不同临床T分期中,GTV-T对患者预后有一定影响。   结论   不同食管癌临床分期标准均能反映患者预后,2009版分期标准更佳。GTV-T与临床T分期呈正相关,反映预后。      

放化疗联合治疗食管癌

目的研究放、化疗联合治疗食管癌的临床价值.方法120例食管鳞癌患者,随机分为3个组行前瞻性临床研究.化疗组40例,用5-Fu、DDP、HCPT联合方案化疗;放疗组40例,8MV-X射线常规三野等中心照射,DT60Gy、DT2Gy/次、5次/周;综合组40例联合应用放、化疗方案.结果化疗组、放疗组的1、2、3年生存率分别为52.5%、32.5%、15%;57.5%、42.5%、20%,综合组1、2、3年生存率为75%、65%、42.5%,综合组的2、3年生存率明显高于放疗组,化疗组(P<0.05)且无严重毒副作用.结论食管癌放、化疗联合治疗疗效好,提高了3年生存率,无严重副作用,值得进一步深入研究.     

Combined modality of radiation and chemotherapy for the treatment of gastric carcinoma. A review

The results of combined radiation and chemotherapy for the treatment of gastric carcinoma are reviewed. A small amount of postoperative adjuvant combined treatments of the curatively resected gastric carcinoma was performed which do not suggest any advantage of treatment compared to observation. For locally advanced and unresectable gastric carcinoma 5-fluorouracil or ftorafur was administered simultaneously to local irradiation in several phase-II studies. The response rates of 37%-58% and one year survival of 45%-72% do not suggest an advantage of combined modality compared to the one way treatment. The FAM, FAMe or FAB regimen was also used and obviously do not improve the results of combined modality treatment. A small but well conducted prospective randomized trials compared radiotherapy with and without chemotherapy or chemotherapy with and without radiotherapy. Recent results from different cooperative groups failed to improve the treatment results in terms of response and survival.     

胃癌新辅助化疗

胃癌新辅助化疗曾因效果差而遭受废弃。近年来有关新辅助化疗的很多大型Ⅲ期临床试验成功开展,新型化疗药物如多西紫杉醇、奥沙利铂、伊立替康的出现,为胃癌新辅助化疗研究的进一步开展提供了平台。     

食管癌新辅助化疗研究进展

食管癌的治疗原则系以外科手术为主的综合治疗.近年来临床前瞻性研究证实新辅助化疗可降低肿瘤期别及延长患者生存期.现综述新辅助化疗的适应证、与单纯手术的比较、化疗药物及化疗方案、疗效监测的研究进展.     

食管癌新辅助化疗研究进展

食管癌的治疗原则系以外科手术为主的综合治疗.近年来临床前瞻性研究证实新辅助化疗可降低肿瘤期别及延长患者生存期.现综述新辅助化疗的适应证、与单纯手术的比较、化疗药物及化疗方案、疗效监测的研究进展.     

An associated concomitant early multiple esophageal carcinoma and gastric carcinoma

Presented is the case of a 71-year-old female with an associated, concomitant early multiple esophageal carcinoma and a gastric carcinoma. An esophageal endoscopy revealed a reddish region in the upper and middle esophagus. This lesion, in part, remained unstained by lugol. Further, three lesions were observed at the upper and middle portions of the esophagus in a resected specimen, and the macroscopic diagnosis was 0-II c, These lesions were histologically diagnosed as being moderately differentiated squamous cell carcinomas, 5 x 15 mm, 2 x 5 mm, and, 3 x 5 mm in size. Furthermore, a lesion in the cardia was found superimposed on the esophageal cancer, and diagnosed as being an adenocarcinoma (II b), 10 x 15 mm in size. In the literature, reports of a concomitant association of an early esophageal carcinoma and a gastric carcinoma amount to 19 cases in Japan, our case being the twentieth case. In formatively, our case was found to display a multiple carcinoma in the esophagus.     

Preoperative chemotherapy and radiation for advanced esophageal carcinoma: comparison between once a day radiation and hyperfractionation,a single-institution experience

The purpose of this study was to determine the toxicity and efficacy of single daily fractionation as compared with twice-a-day radiation therapy in combination with chemotherapy for preoperative locally advanced thoracic esophageal carcinoma. A retrospective survey was done of 42 patients undergoing concurrent chemotherapy and radiation for preoperative locally advanced thoracic esophageal carcinoma. Twenty-five patients had 5-fluorouracil ([5-FU]), 1,000 mg/m2/d by continuous infusion, days 1-5, and days 22-26), cisplatin (100 mg/m2 intravenously, days 2 and 22), and radiation to a total dose of 4,500 to 5,040 cGy in 180 cGy/fraction every day. Seventeen patients received 5-FU (300 mg/m2/d by continuous infusion, days 1 and 21), cisplatin (20 mg/m2/d for 1 hour, days 1-5 and days 17-20), vinblastine (1 mg/m2 intravenously, days 1-5 and days 17-21) and accelerated hyperfractionated radiation 150 cGy twice a day to a total dose of 4,500 cGy. Response rate, survival, local regional failure rates, and treatment toxicity of the two groups were compared. Surgery was aborted in one patient and another patient refused surgery in the single daily-fractionation group. All patients underwent surgery in the twice-daily group. Complete response (CR) was noted in 12 patients (52%) in the single daily-fractionation group as compared with 9 patients (52%) in the twice-daily group. The median and 3-year survival were 20 months and 35%, respectively, in the single daily-fractionation group. Corresponding figures were 18 months and 32%, respectively, in the twice-daily group. For the 2 groups combined, a statistically significant improvement in survival was observed among blacks who achieved a CR (31 months) as compared with the ones with residual disease (13.5 months). Local and regional failures were 28% and 17%, respectively, for the single daily-fractionation and twice-daily groups. Distant metastases remained significant in both groups and were 36% (single daily-fractionation) and 41% (twice-daily), respectively. Grades III to IV esophagitis and hematologic toxicity developed in 36% and 64% of patients of the single daily-fractionation and twice-daily groups, respectively. The incidence of late complications was 16% (single daily-fractionation) and 11.7% (twice-daily). Preoperative chemotherapy and radiation is effective to achieve a high pathologic CR. Both radiation therapy fractionation schedules are comparable in efficacy and toxicity. Further investigations should be done to assess whether ethnicity may play a role in the prognosis of esophageal carcinoma.     

放化疗同时治疗食管癌

目的　探讨放化疗同时治疗食管癌的价值。方法　将 6 8例食管癌患者随机分为 2组 ,一组 35例放疗同时合并 5 Fu、PDD方案化疗 (放化组 )。另一组 33例单纯放疗 (单放组 )。放疗采用 6MV或 15MV X线照射 ,中平面DT 5 5～6 5GY ;化疗共 4个周期 ,与放疗同时进行 2个周期 ,放疗结束后 2个周期。结果　随访 3年 ,放化组和单放组近期疗效CR分别为 80 %和 5 1.5 %(P <0 .0 5 )、1、2、3年生存率分别为 74.3%、5 1.4%、34.3%和 48.5 %、30 .3%、2 1.2 %。放化组生存率明显高于单放组 (P <0 .0 5 )。但骨髓抑制及胃肠道反应放化组高于单放组 (P <0 .0 5 )。结论　放化疗同时对食管癌治疗有协同作用 ,值得临床进一步探讨。     

Influence of incomplete neoadjuvant chemotherapy on esophageal carcinoma

Background

Neoadjuvant chemotherapy (NAC) involving two cycles of cisplatin plus fluorouracil is recommended in Japan as a standard treatment for resectable, locally advanced esophageal squamous cell carcinoma (ESCC). We have encountered patients who were administered incomplete chemotherapy because of adverse events or the patient’s refusal of treatment. Here, we retrospectively investigated the influence on perioperative outcomes and long-term prognosis of patients with ESCC who underwent complete (two cycles) or incomplete (one cycle) NAC.

Methods

We retrospectively investigated 133 patients with locally advanced ESCC of the thoracic esophagus who underwent NAC. We compared the perioperative results and prognoses of patients who underwent complete or incomplete NAC because of adverse events or the patient’s refusal of treatment.

Results

Of 133 patients, 37 patients did not receive the second cycle of NAC; the remaining 96 patients received the second cycle of NAC as scheduled. There were no significant differences in the clinical backgrounds, surgical results, or operative morbidity rates between the groups. Patients in both groups were similarly administered postoperative chemotherapy regimens. There was no significant difference in disease-free survival or overall survival.

Conclusions

We suggest that perioperative outcomes and long-term prognosis of patients with locally advanced ESCC were not significantly influenced, even if the patients did not receive a complete cycle of NAC. When certain adverse events occur after the first cycle of NAC, we believe that it is nevertheless possible to discontinue chemotherapy.