Prospective trial of concurrent chemoradiotherapy with protracted infusion of 5-fluorouracil and cisplatin for T4 esophageal cancer with or without fistula

PURPOSE: A prospective trial of concurrent chemoradiotherapy (CT-RT) with a protracted infusion of 5-fluorouracil and cisplatin was performed to evaluate the safety and efficacy of this protocol for T4 esophageal cancer (UICC 1997). METHODS AND MATERIALS: Between 1998 and 2000, 28 patients with T4 esophageal squamous cell carcinomas were treated with concurrent CT-RT. Of the 28 patients, 15 had Stage III, 5 Stage IVA, and 8 Stage IV disease. Five of the T4 tumors had evidence of fistula before treatment. Patients received a protracted infusion of 5-fluorouracil 300 mg/m(2)/24 h on Days 1-14, a 1-h infusion of cisplatin 10 mg/body on Days 1-5 and 8-12, and concurrent radiation at a dose of 30 Gy in 15 fractions during 3 weeks. This schedule was repeated twice, with a 1-week split, for a total RT dose of 60 Gy during 7 weeks for 25 patients. For the remaining 3 patients, 30 Gy of preoperative CT-RT was administered. RESULTS: Of the 25 patients who were treated with the full dose of CT-RT, 14 (56%) completed the two courses of the CT-RT protocol, and 8 patients (32%) received the full dose of RT but a reduced dose of chemotherapy. Eight (32%) of the 25 tumors showed complete regression. Although Grade 3 hematologic toxicities were frequently noted, Grade 4 or more hematologic toxicities were few. Of the 5 T4 fistulous tumors, 2 demonstrated the disappearance of the fistula after CT-RT. However, the worsening or development of an esophageal fistula was noted in 5 patients. The 2-year survival rate for patients with Stage III was 27%, and the median survival time for those with Stage III and Stage IVA+IV was 12 and 5 months, respectively. CONCLUSION: Despite its significant toxicity for esophageal fistula, this concurrent CT-RT protocol of protracted 5-fluorouracil infusion and cisplatin appears feasible and effective for T4 esophageal cancer with or without fistulas.     

金属食管支架治疗食管恶性狭窄22例分析

[目的]研究金属支架治疗食管恶性狭窄的价值。[方法]采用镍钛合金和Z型支架治疗食管狭窄22例 (18例恶性狭窄 ,4例吻合口狭窄 ) ,包括6例食管支气管瘘。通过胃镜在X线下确定狭窄段的上下缘 ,以及瘘管的位置 ,并在体外和体内定位 ,拔出胃镜后留置导丝 ,将支架置入器沿导丝送到狭窄部位 ,在X线透视下确定支架位置正确后 ,缓慢释放支架 ,并适当调整位置。[结果]病人置放支架后吞咽困难分级降低1.67个等级 ,食管直径由(0.4±0.2)cm扩张至(1.6±0.2)cm。带膜金属支架使瘘口完全封闭 ,术后无严重并发症发生。[结论]金属支架治疗对于不能手术切除的晚期食管癌 ,食管瘘或手术后吻合口狭窄以及吻合口复发的病人是有效的姑息治疗方法 ,带膜支架对食管支气管瘘堵瘘非常有效     

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.     

210例中晚期食管癌放化疗的预后因素分析

目的 探讨放化疗联合治疗中晚期食管癌的临床疗效、毒副反应及相关预后因素。方法对210例初治接受放化疗联合治疗的中晚期食管癌患者的临床资料进行回顾性分析,其中84例行序贯化放疗,126例行同步化放疗,放疗剂量60～66 Gy（均为调强放疗）,化疗采用紫杉醇联合铂类方案,化疗2～6个周期。按照实体瘤疗效评价标准（RECIST）11评价疗效,分别采用国立癌症研究所毒性判定标准（NCI-CTC）30和放射肿瘤治疗协作组（RTOG） 制定的急慢性放射损伤分级标准评价放化疗毒性反应。同时随访其生存情况并选取可能影响预后的因素进行单因素分析和Cox多因素分析。结果 210例患者中获CR 79例,PR 99例,SD 21例,PD 11例,有效率（RR）为84.8%。全组患者的1、3年生存率分别为79.6％、52.2％,中位生存期为41.0个月,同步化放疗组较序贯化放疗组无明显的生存优势（P＞0.05）。单因素分析显示肿瘤位置、N分期、M分期、临床分期、放射性食管炎、放射性食管狭窄、白蛋白降低与食管癌患者的预后有关（P＜0.05）,经Cox多因素分析发现肿瘤位置、N分期、放射性食管狭窄、白蛋白降低是影响食管癌预后的独立因素。主要毒副反应为血红蛋白减少、放射性食管炎、放射性食管狭窄、放射性肺炎和白蛋白降低,序贯化放疗组放射性食管炎的发生率高于同步化放疗组（P=0.046）。结论 肿瘤位置、N分期、放射性食管狭窄和白蛋白降低是中晚期食管癌放化疗的独立预后因素,治疗过程中对不良反应的及时处理可以较好地改善预后。     

食管良恶性狭窄及瘘的带膜内支架介入治疗

目的：研究应用带膜的镍钛合金金属内支架治疗食管的良恶性狭窄。方法：共60例患者,不能手术晚期食管癌19例,食管癌放疗后引起的食管狭窄20例,手术后吻合口狭窄18例,手术后吻合口瘘2例,腐蚀性食管炎1例,4例合并食管-气管瘘或食管-纵隔瘘。所用器械包括：6F猎人头导管,0.035Cun长1.8m交换导丝,食管球囊导管,支架推送器和50-120mm镍钛合金属支架。全部在电视透视下进行,局部口咽部麻醉。结果：全部病例均获成功,其中一例患者因狭窄位置较高,支架置入后48小时取出,术后进食良好。结论：带膜的镍钛合金金属内支架对食管的恶性狭窄进行姑息性治疗是提高患者生存质量安全有效的方法;对手术后吻合口瘘与狭窄和食管-气管瘘或食管-纵隔瘘起到了较好的治疗作用。     

Accelerated hyperfractionated radiotherapy for cervical cancer: multi-institutional prospective study of forum for nuclear cooperation in Asia among eight Asian countries

PURPOSE: To evaluate the toxicity and efficacy of accelerated hyperfractionated radiotherapy (RT) for locally advanced cervical cancer. METHODS AND MATERIALS: A multi-institutional prospective single-arm study was conducted among eight Asian countries. Between 1999 and 2002, 120 patients (64 with Stage IIB and 56 with Stage IIIB) with squamous cell carcinoma of the cervix were treated with accelerated hyperfractionated RT. External beam RT consisted of 30 Gy to the whole pelvis, 1.5 Gy/fraction twice daily, followed by 20 Gy of pelvic RT with central shielding at a dose of 2-Gy fractions daily. A small bowel displacement device was used with the patient in the prone position. In addition to central shielding RT, intracavitary brachytherapy was started. Acute and late morbidities were graded according to the Radiation Therapy Oncology Group and Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. RESULTS: The median overall treatment time was 35 days. The median follow-up time for surviving patients was 4.7 years. The 5-year pelvic control and overall survival rate for all patients was 84% and 70%, respectively. The 5-year pelvic control and overall survival rate was 78% and 69% for tumors > or = 6 cm in diameter, respectively. No treatment-related death occurred. Grade 3-4 late toxicities of the small intestine, large intestine, and bladder were observed in 1, 1, and 2 patients, respectively. The 5-year actuarial rate of Grade 3-4 late toxicity at any site was 5%. CONCLUSION: The results of our study have shown that accelerated hyperfractionated RT achieved sufficient pelvic control and survival without increasing severe toxicity. This treatment could be feasible in those Asian countries where chemoradiotherapy is not available.     

老年食管鳞癌根治性放化疗疗效观察及预后分析

背景与目的：随着人口的老龄化,≥70岁老年食管癌患者越来越多,然而对这部分患者的研究资料并不多,本研究评价老年食管鳞癌患者根治性放化疗疗效及相关预后因素。方法：回顾性分析2009年3月—2011年12月在复旦大学附属肿瘤医院放疗科接受根治性放化疗的年龄≥70岁的食管鳞癌初治患者治疗疗效及相关预后因素。结果：共53例符合条件的患者,中位年龄74岁;单纯放疗患者29例,同期放化疗患者24例;1、2、3和5年生存率分别为62%、44%、33%和19%;2度及以上急性放射性食管炎及放射性肺炎发生率分别为6%和9%,无一例患者发生4度及以上放射性损伤。COX多因素分析显示,治疗方式、病变部位以及吸烟史与患者的预后明显相关。结论：放疗能为老年食管鳞癌患者所耐受,是一种安全的治疗方式,同期化疗的参与能够提高患者治疗的疗效。     

全程内镜直视下扩张置管术治疗食管狭窄

目的为提高食管狭窄病人的生存质量,延长生存期。方法采用全程内镜直视下扩张置管术治疗狭窄18例。结果晚期食管癌、贲门癌9例,合并食管-气管瘘4例;食管、贲门癌术后6例;食管痛放疗后狭窄2例;喉癌术后喉瘘1例,均置管成功。5例合并瘘管的病人置管后即刻达到阻瘘目的。术后发生支架移位1例;食物嵌顿1例。吞咽困难均得到明显改善。结论全程内镜下扩张置管术较X线下置管术具有操作简便,置管准确,扩张效果好的优势。     

Esophagectomy after concurrent chemoradiotherapy improves locoregional control in clinical stage II or III esophageal cancer patients

PURPOSE: To evaluate the effect of surgical resection on the outcome of patients with clinical Stage II or III cancer of the esophagus treated with concurrent chemoradiotherapy. METHODS AND MATERIALS: A retrospective review of 132 consecutive patients with clinical Stage II or III esophageal cancer treated with concurrent chemoradiotherapy between January 1990 and December 1998 was performed. Of the 132 patients, 60 underwent esophagectomy 6-8 weeks after chemoradiotherapy. The median radiation dose was 50 Gy (range, 30-64.8 Gy) in the definitive chemoradiation group and 45 Gy (range, 30-50.4 Gy) in the chemoradiation plus esophagectomy group. RESULTS: Statistically significant differences were found between the two groups in median age, histologic subtype, tumor location, and number of patients with T4 disease. Patients who underwent definitive chemoradiotherapy were older (p = 0.0004) and more likely to have squamous cell carcinoma than adenocarcinoma (p <0.000), upper thoracic or cervical esophageal tumors (p <0.000), and T4 tumors (p = 0.024). Patients treated with chemoradiation plus esophagectomy had statistically significant superior 5-year loco-regional control (67.1% vs. 22.1%, p <0.000), disease-free survival (40.7% vs. 9.9%, p < 0.000), and 5-year overall survival (52.6% vs. 6.5%, p < 0.000) rates and median survival time (62 vs. 12 months) compared with patients treated with chemoradiotherapy only. However, no statistically significant difference was found in the rate of distant metastasis-free survival between the two groups (67.5% vs. 65.8%, p = 0.3). Surgical resection of the tumor was an independent predictor of improved locoregional control and overall survival in both univariate and multivariate analyses. To reduce the effect of the selection bias on the outcome, 34 patients in each group with matched pretreatment characteristics were compared. The results showed statistically significant better overall survival, disease-free survival, and locoregional control in favor of the chemoradiotherapy plus esophagectomy group. No statistically significant difference in distant metastasis-free survival was found in this subgroup analysis. CONCLUSIONS: Locoregional control was better in clinical Stage II or III esophageal cancer patients treated with concurrent chemoradiation plus esophagectomy. An improvement in survival occurred in the chemoradiation plus esophagectomy group, although this observation may have reflected selection bias. The results from this study suggest the need for a randomized trial to compare chemoradiation with or without esophagectomy in the treatment of cancer of the esophagus.     

Response,toxicity, failure patterns,and survival in five radiation therapy oncology group (RTOG) trials of sequential and/or concurrent chemotherapy and radiotherapy for locally advanced non–small-cell carcinoma of the lung

Purpose: The purpose of this study was to assess response, toxicity, failure patterns, and survival differences in three chemotherapy (ChT)/radiation therapy (RT) sequencing strategies for locally advanced non-small cell lung cancer (NSCLC).Methods and Materials: Five completed Radiation Therapy Oncology Group (RTOG) trials for Stage II-IIIA/B inoperable NSCLC patients employed one of the three following strategy groupings: 1) sequential ChT followed by standard RT (60 Gy in 6 weeks); 2) combined sequential and concurrent ChT and standard RT (60 Gy in 6 weeks); or 3) concurrent ChT and hyperfractionated RT (69.6 Gy in 6 weeks). All five trials required KPS ≥ 70; two trials (314 patients) required <5% weight loss and three trials (147 patients) had no minimum weight loss requirement. In all five trials the ChT used cisplatin with either vinblastine or oral etoposide. Combining data for the five trials yielded an evaluable group of 461 patients. The three methods of sequencing ChT and RT were evaluated for differences in response, acute and late toxicity, patterns of failure, and survival. Acute toxicity was defined as that occurring within 90 days from the start of RT. Late toxicity was defined as that occurring after 90 days from the start of RT. Acute or late toxicity ≥ grade 3 was defined as severe. Site of first failure was recorded by date. In-field failure excluded distant metastasis as a failure and included only tissue in the RT treatment field. Overall progression-free survival (PFS) was defined as survival without evidence of intra- or extrathoracic tumor or death from any cause.Results: Group 1 had a lower overall response rate (63%) compared to either Group 2 (77%) or Group 3 (79%), p = 0.03 and 0.003, respectively. Overall grade 4/5 acute toxicities were nearly equal between groups. The severe nonhematologic acute toxicities were significantly different by strategy group (p < 0.0001). Group 1 and 2 were not statistically different. Group 3 had significantly more patients with severe acute nonhematologic toxicity (55%) than either Group 1 (27%) or 2 (34%) with p < 0.0001 and p = 0.0005, respectively. This was due to a severe acute esophagitis rate of 34% for Group 3 versus 1.3% for Group 1 and 6% for Group 2 (p < 0.0001 for both comparisons). Overall grade 4/5 late toxicities did not differ by group. Severe late nonhematologic toxicities were different by group (p = 0.0098). Group 1 patients had significantly fewer severe late nonhematologic toxicities (14%) compared to patients in Groups 2 (26%) or 3 (28%) (p = 0.046 and 0.038, respectively). Severe late lung toxicity was 10% for Group 1 compared to 21% and 20% for Groups 2 and 3, respectively. Severe late lung toxicities differed by group (p = 0.033), but not severe late esophagitis (p = 0.077). There were no differences between the three strategy groups for patterns of first failure. The in-field failures were higher in Group 2 (71%) compared to Groups 1 (56%) and 3 (55%), p = 0.0478. Pairwise comparisons yielded p-values of 0.068 and 0.015 for Group 2 versus 1 and Group 2 versus 3, respectively. Three-year PFS was better in Group 2 (15%) and 3 (15%) compared to Group 1 (7%), but not statistically significant (p = 0.454). Similarly, in-field PFS was better in Group 2 (17%) and 3 (20%) than Group 1 (9%), but not significant (p = 0.167). There were improvements in 3-year survival for Group 2 (17%) and Group 3 (25%) compared to Group 1 (15%), but the differences were not statistically significant (p = 0.47). The same results were present for patients with less than 5% weight loss and patients with stage IIIA tumors.Conclusion: Thus, concurrent ChT and hyperfractionated RT had a higher incidence of severe acute esophageal toxicity. Severe late lung toxicity with concurrent ChT/hyperfractionated RT, as well as with induction ChT followed by concurrent ChT/standard RT, may be greater compared to sequential ChT/RT. Also, concurrent ChT/hyperfractionated RT, and induction ChT followed by concurrent ChT/standard RT, appear to have a benefit in terms of increased tumor response compared to sequential ChT/RT, but not in failure pattern. The latter may reflect the presence of pretherapy micrometastases that are delayed from progression by the combined therapy, but not prevented.     

Comparisons of curative and side effects of chemoradiotherapy among Xinjiang Han, Uigur and Kazakh esophageal carcinoma patients

Objective: This study aimed to explore the differences in the curative and side effects of chemoradiotherapyon esophageal cancer (EC) among Xinjiang Han, Uigur and Kazakh patients. Methods: 170 patients with IIAstage-IV of esophageal squamous cell carcinoma were analyzed retrospectively. Based on different nationalities,they were divided into the Han, Uigur and Kazakh groups. The 1-, 2- and 3-year survival rates, incidence ofthe side effects (including hematological toxicities, radioactive esophagitis and percutaneous reactions) andapplication of antibiotics and harmonics were compared among the groups. There was no significant differencein the short-term curative effects among the Han, Uigur and Kazakh groups. The 1- 2- and 3-year survivalrates of the three groups were 84%, 40%, 26%; 78%, 27%, 18%; and 60%, 21%, 12% (x2=14.497, P<0.05). Theincidence rate of hamatological toxicity ≥Grade 2 in the Kazakh group was significantly lower than that in theHan or Uigur group. Results: The incidence rates of radioactive esophagitis and percutaneous reactions Grade2 in the Han group were significantly higher than those in the Uigur or Kazakh group. There was no significantdifference in the types of applied antibiotics among the groups, but there were significant differences in the daysof antibiotic application and proportion of patients receiving harmonics between the Hans and either of othergroups. Conclusion: Chemoradiotherapy shows a better effect in the long-term survival rate among Han ECpatients compared with Uigur or Kazakh EC patients. Uigur and Kazakh patients show a better tolerance tothe side effects of chemoradiotherapy compared with Hans.     

营养干预对食管癌同步放化疗疗效研究

目的 探讨营养干预治疗对食管癌同步放化疗患者疗效的影响。方法 前瞻性纳入2016-2017年安徽省肿瘤医院确诊为食管癌行放疗的患者46例,随机分为常规治疗组与营养干预组(各23例),观察两组患者放疗前后体重指数(BMI)、主观整体评估(PG-SGA)、血清白蛋白(ALB)、血红蛋白(HB)、白细胞(WBC)等客观营养指标的变化及放疗不良反应发生率。结果 放疗前两组年龄、性别、BMI、ALB、PLT、临床分期等具有可比性(P>0.05);营养干预组放疗后BMI较放疗前改善(21.52±2.67、21.13±2.73,P=0.000);干预组放疗后PG-SGA评分较放疗前明显降低(P=0.000);常规组放疗后BMI、HB、ALB、PLT、WBC水平较放疗前明显下降,且PG-SGA评分较放疗前更差(P<0.05);此外,干预组患者出现3级骨髓抑制发生率显著降低(4.34%∶8.68%,P=0.000)。结论 食管癌放疗患者存在较高的营养风险,营养干预治疗可改善患者营养状况,降低放疗不良反应发生率,有可能提高患者生活质量,改善生存预后。     

国产食管金属内支架的临床应用

目的探讨国产食管金属内支架治疗食管癌性狭窄、食管—气管瘘及食管—纵隔瘘临床应用价值。方法先用导丝通过狭窄段,经球囊扩张,置入带膜食管金属内支架。结果48例食管狭窄者内支架置入后吞咽困难完全消除的7例（14．6％）,41例（85．4％）明显缓解。6例食管—气管瘘口封闭。结论国产食管金属内支架置入是治疗食管恶性狭窄安全可靠的方法,术后应继续进行抗癌治疗。     

Treatment results of chemoradiotherapy for clinical stage I (T1N0M0) esophageal carcinoma

PURPOSE: In 1991, we started a clinical prospective trial for operable esophageal carcinoma, foreseeing organ preservation, to assess the treatment results after definitive chemoradiotherapy (CRT) for clinical Stage I (T1N0M0) esophageal cancer. PATIENTS AND METHODS: Between 1992 and 2003, 63 patients were enrolled in this study. Tumor depth was mucosal cancer (T1a) in 23 and submucosal cancer (T1b) in 40. CRT consisted of 55-66 Gy/50-60 fractions (median, 59.4 Gy); from 1 to 3 cycles (median, 2) of concurrent chemotherapy (Cisplatin and 5-fluorouracil), followed by high-dose-rate intraluminal brachytherapy 10-12 Gy/2-3 fractions. RESULTS: The 5-year overall and cause-specific and disease-free survival rates were 66.4%, 76.3%, and 63.7%, respectively. The 5-year cause-specific survival rates for T1a and T1b cancer patients were 85.2% and 70.0%, respectively (p = 0.06). The 5-year disease-free survival rates for T1a and T1b were 84.4% and 50.5%, respectively (p < 0.01). Esophageal fistula as a late toxicity occurred in 2 patients (G4: 1; G5: 1), and esophageal stricture requiring a liquid diet occurred in 2 patients. Pericardial effusion was observed in 3 patients. CONCLUSION: We confirmed that patients with T1N0M0 esophageal carcinoma had their esophagus preserved in 89.2% of cases after definitive CRT, and the survival rates were equivalent to those of previous reports of surgery.     

扩张置管治疗癌性复杂性食管狭窄和瘘51例分析

 目的 探讨内镜下覆膜支架治疗癌性难治性食管狭窄和瘘的临床疗效。方法 选择失去手术机会的复杂性食管狭窄和（或）瘘的患者51例进行内镜下扩张及支架置入术，根据病情的不同情况选择不同的治疗方式，并观察治疗后1个月及1年的临床疗效。结果 经过治疗，全部患者症状得到缓解，生活质量提高，51例患者共放置支架66个，置管后狭窄处直径由（4.05±1.34）mm增至（13.03±3.99）mm（P＜0.01），吞咽困难由（3.29±0.44）级改善为（0.95±0.73）级（P＜0.01），食管瘘患者瘘口全部闭合。随访1个月及1年有效率分别为100 %，78.38 %，1年失访共3例，复发共8例，经重复治疗缓解。6 个月、1，2，3年生存率分别为86.3 %，72.6 %，33.3 %，6.3 %。结论 内镜直视扩张置管治疗难治性食管狭窄和瘘，操作直观简便，定位准确，成功率较高，近、远期效果较好。     

食管癌放疗后食管狭窄的相关因素分析

目的：研究食管癌放疗后食管狭窄形成的影响因素。方法：62例原发性食管癌患者在2005年10月至2008年6 月间接受了放疗或放化疗联合治疗。治疗后定期随访患者的食管钡餐造影,评价食管狭窄情况,计算狭窄率,观察食管狭窄峰值出现的时间。并对患者年龄、肿瘤的位置、T 分期、肿瘤侵犯食管全周的比例（周在性）、纵轴长度、放疗剂量、化疗参与等因素与放疗后发生食管狭窄进行相关性分析。结果：在16个月的中位随访时间内,共有27例（43.5%）患者出现了中度以上（狭窄率>50%）的食管狭窄。食管狭窄出现的高峰时间在放疗后5～8 个月之间。单因素分析提示T 分期、肿瘤侵犯管壁的周在性及无化疗参与为狭窄发生的相关因素（P 值分别为0.017 7、<0.000 1 和0.003 4）。 多因素分析的结论是周在性与无化疗参与对放疗后食管狭窄有显著影响意义（P 值分别为<0.001 和0.001 1）。 结论：在放疗剂量为60Gy左右的前提下,肿瘤在管腔内的周在性与放疗后狭窄的形成呈正相关,化疗的参与可能会降低食管狭窄的形成,放疗剂量与狭窄形成的关系在本研究中未得到确切证实。     

Phase III trial comparing chemotherapy plus once-daily or twice-daily radiotherapy in Stage III non-small-cell lung cancer

PURPOSE: This Phase III study was performed to determine whether chemotherapy plus b.i.d. or q.d. radiotherapy (RT) resulted in superior survival for patients with Stage III non-small-cell lung cancer (NSCLC). METHODS AND MATERIALS: Patients with Stage III NSCLC and an Eastern Cooperative Oncology Group performance status of 相似文献   

Clinical outcomes of definitive radiotherapy for patients with cT1aN0M0 esophageal cancer unsuitable for endoscopic resection and surgery

BackgroundStudies on the clinical outcomes of radiotherapy for clinical (c)T1aN0M0 (UICC-TNM Classification, Eighth Edition) esophageal cancer (EC) are limited. Therefore, this retrospective study aimed to clarify the clinical outcomes of definitive radiotherapy (RT) or chemoradiotherapy (CRT) for cT1aN0M0 EC unsuitable for endoscopic resection and surgery.MethodsPatients with cT1aN0M0 esophageal squamous cell carcinoma who underwent definitive RT or CRT between January 2009 and December 2020 were retrospectively reviewed. The initial response, toxicities, survival rates, recurrence patterns, and salvage treatments of the patients were evaluated. Initial response was measured using the Response Evaluation Criteria in Solid Tumors guideline. Toxicity was assessed and documented following the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Survival rates from the date of initiation of treatment were measured using the Kaplan–Meier method.ResultsTwenty patients treated with definitive RT or CRT were included in the study. The median follow-up duration was 55 months (range, 13–131 months). All patients achieved complete response to the initial treatment. Grade 3 acute toxicities observed esophagitis (10%), pneumonitis (5%), and leukopenia (5%). Late toxicities higher than grade 3 were not observed. The 1-, 3-, and 5-year overall and disease-specific survival rates were 100% and 100%, 83% and 100%, and 67% and 100%, respectively. No treatment-related deaths occurred. Among the 20 patients, 6 showed local recurrence and 2 showed metachronous recurrence. Seven patients underwent salvage endoscopic submucosal dissection (ESD), and one underwent argon plasma coagulation treatment. After the endoscopic treatment, no recurrences were observed.ConclusionsDefinitive RT or CRT was considered an alternative initial treatment for patients with cT1aN0M0 EC who were unsuitable for endoscopic resection and surgery.     

食管癌新辅助放化疗的前瞻性临床研究

目的 评价术前辅助性放化疗在食管癌治疗中的价值。方法 对术前临床分期为Ⅱ、Ⅲ期,无外科手术和放化疗禁忌证的97例食管癌患者进行随机对照分组：综合治疗组48例,对照组49例。综合治疗组患者采用5-氟脲嘧啶 顺铂(5-Fu DDP)化疗2个周期后,再进行放射治疗,放疗使用直线加速器分三野照射放疗12次,剂量36Gy;治疗结束后3周进行手术。对照组采用单纯手术治疗。采用Kaplan-Meier法计算两组生存率,χ^2和Logrank方法检验两组中各项观察指标的差异。结果 综合治疗组和对照组根治性切除率分别为85．4％和65．3％(P=0．0181);病理淋巴结转移率分别为21．7％和45．7％(P=0．0194),综合治疗组T分期比对照组亦显著降低(P=0．0036);局部区域复发率分别为34．8％和58．70%(P=0．0236),而手术后的并发症发生率两组无明显差异。综合治疗组生存率明显优于对照组,尤其以辅助治疗后获得缓解的患者5年生存率最高达56．5％。结论 术前放化疗能降低术后病理淋巴结转移率、缩小肿瘤和有明显降期作用;能降低局部和区域复发率及明显提高患者长期生存率：能提高根治性手术切除率,并不增加手术并发症。     

Neoadjuvant Concurrent Chemoradiotherapy Followed by Definitive High-Dose Radiotherapy or Surgery for Operable Thoracic Esophageal Carcinoma

Purpose: A prospective clinical trial was undertaken to investigate the feasibility of concurrent chemoradiotherapy for esophageal carcinomas.

Materials and Methods: Between June 1989 and May 1996, forty patients with operable squamous cell carcinoma of the thoracic esophagus (Stage 0 to III: UICC 1987), ages 45 to 78 years (mean: 64), were enrolled in a study of neoadjuvant concurrent chemoradiotherapy followed by definitive high-dose radiotherapy (CRT group) or surgery (CRT-S group). Neoadjuvant chemoradiotherapy consisted of 44 Gy in 40 fractions for 4 weeks (2.2 Gy/2 Fr/day) through 10-MVX rays, with 2 courses of cisplatin (80–100 mg/body, mean: 60 mg/m2, Day 1, bolus injection) and 5-fluorouracil (500–1000 mg/body/day, mean: 400 mg/m2, Days 1–4, continuous infusion). After completion of neoadjuvant chemoradiotherapy, an intermediate clinical response was assessed by barium swallow, esophagoscopy with/without biopsy, EUS in most cases, thoracic and upper abdominal CT scan, and cervical US. Definitive chemoradiotherapy was performed in patients when regression of more than 75% was evident (CRT Group), and esophageal resection was indicated in those who remained at less than 75% (CRT-S Group). In CRT Group, a cumulative dose of 60–70 Gy for Tis, T1 and 65–75 Gy for T2–T4 tumor with high-dose–rate intraluminal brachytherapy and a total of 3 courses of chemotherapy were planned. In CRT-S Group, intraoperative radiotherapy for abdominal lymphatic system and postoperative supraclavicular irradiation were added.

Results: At the time of intermediate assessment, complete response (CR) was observed in 16 patients, a partial response (PR) in 22, and no change (NC) in 2. Thirty responding patients (CR, 16; PR, 14) entered the CRT Group, and 10 nonresponding patients (PR, 8; NC, 2) were followed by surgery (CRT-S Group). Radiotherapy was completed satisfactorily, but chemotherapy was suspended in 26 patients (65%) because of acute toxicity. Clinical CR rate at the completion of treatment showed 90% in CRT Group, and pathologic CR rate 10% in CRT-S Group. The overall median survival was 45 months, survival at 1, 2, and 3 years being 100%, 72%, and 56%, respectively. Local-regional failure was observed in 7 patients (all in CRT Group), distant failure in 6 (3 in CRT Group, 3 in CRT-S Group) and local-regional with distant failure in 1 (CRT Group). Four patients with local-regional recurrence in the CRT Group were salvaged by surgery. Overall survival at 2 and 3 years for CRT vs. CRT-S Group was 72%, 64% vs. 75%, 38%, respectively. No treatment-related mortality was observed. The rate of the ’esophagus conservation’ was 65% (Stage 0: 1 of 1, 100%; Stage I: 11 of 12, 92%; Stage II: 8 of 17, 47%; Stage III: 6 of 10, 60%).

Conclusion: Our results demonstrated that almost all early disease (Stage 0–I) and about half of advanced disease (Stage II–III) could be conserved, their esophagus treated by the multidisciplinary approach centering on high-dose radiotherapy and concurrent chemotherapy.