化疗及序贯放疗后手术治疗局部晚期食管癌30例分析

目的探讨应用紫杉醇＋顺铂方案化疗及序贯放疗后，再行手术治疗局部晚期食管鳞癌的近期疗效。方法局部晚期食管鳞癌患者30例，应用紫杉醇＋顺铂方案化疗2个周期后，序贯常规剂量分割放疗40Oy，放疗结束4周行食管癌切除＋重建消化道术；评定术前放、化疗疗效，观察放、化疗不良反应及手术切除率、病理客观缓解率、并发症发生率、术后病死率。结果30例均完成术前放、化疗，临床有效率为83．3％；2例不接受手术者继续放、化疗，余28例手术治疗者中1例侵犯主动脉未能切除，27例行根治性切除，手术切除率96．4％；术后并发肺部感染8例，吻合口瘘2例，声音嘶哑1例，吻合口狭窄1例，围手术期死于急性呼吸窘迫综合征1例。结论局部晚期食管鳞癌患者在紫杉醇＋顺铂方案化疗及序贯放疗后行手术治疗，可提高临床有效率和手术切除率。

Surgical treatment of locally advanced esophageal cancer after chemotherapy and sequential radiotherapy in 30 patients

Objective To evaluate the short-term outcome of chemotherapy with TAX plus DDP and sequential radiotherapy followed by surgical treatment of locally advanced esophageal squamous carcinoma. Methods Thirty patients with locally advanced esophageal squamous carcinoma received chemotherapy with TAX plus DDP for 2 cycles, followed by sequence {ractionated radiotherapy in a dose of 40 Gy. Four weeks after radiotherapy, the patients were performed esophageal resection and reconstruction of digestive tract. The therapeutic effect and adverse reaction of chemotherapy and radiotherapy before operation were evaluated, and the resection rate, pathological response rate, the incidence of complications and postoperative fatality were observed. Results Thirty patients completed chemoradiotherapy with clinical response rate of 83. 3%, in which 2 patients refusing operation continued chemoradiotherapy, and 28 patients underwent surgery. In 28 patients, the carcinoma was not removed in 1 patient because of invasion of aorta by esophageal cancer, the other 27 patients completed radical surgery, with the resection rate of 96.4%. After operation, pulmonary infection occurred in 8, anastomotic leakage in 2, hoarseness in 1, and anastomotie stenosis in 1, and 1 patient died of acute respiratory distress syndrome. Conclusions Surgical treatment of locally advanced esophageal cancer after chemotherapy with TAX plus DDP and sequential radiotherapy can improve the clinical response rate and the resection rate.