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。

A prospective study of combined chemoradiotherapy followed by surgery in the treatment of esophageal carcinoma

OBJECTIVE: To evaluate the effect of combined chemoradiotherapy followed by surgery for patients with esophageal carcinoma. METHODS: Ninety-seven patients with stage II or III esophageal carcinoma without contraindication against operation and chemoradiotherapy, were randomly divided into two groups: combined group (Group A) 48 and control group (Group B) 49. Patients in group A were given neoadjuvant treatment consisted of chemotherapy with 5-fluorouracil and cisplatin for 2 cycles and radiotherapy of DT36 Gy/12 f/17 d. Three weeks later, operation was performed. Patients in group B were given operation alone. Survival rate was calculated with Kaplan-Meier method. Chi and Log-rank test was used to assess the difference between the two groups. RESULTS: The radical resectability of group A and group B were 85.4% and 65.3% (P = 0.018 1). The lymph node metastasis rate of the two groups were 21.7% and 45.7% (P = 0.019 4). The T stage of group A was significantly lowered (P = 0.003 6). The local and regional recurrence rate of two groups were 34.8% and 58.7% (P = 0.023 6), while there was no significant difference in operative complications between the two groups. Significant improvement in the long-term survival rate was observed in group A, especially in patients who achieved partial and complete response with high 5-year survival rate of 56.5%. CONCLUSION: Preoperative neoadjuvant chemoradiotherapy is able to reduce the tumor and tumor stage, lower the lymph node metastasis rate and local or regional recurrence rate, also it can improve radical resectability and long-term survival without increasing the operative complications.