术前放化疗并手术治疗局部晚期食管癌

目的 评价术前放化疗并手术治疗局部晚期食管癌的疗效.方法 2000年1月至2004年12月连续收治符合入组条件的胸段局部晚期食管鳞癌患者42例,应用胸部及腹部CT、食管超声内镜、支气管内镜等检查进行治疗前分期.术前放化疗方案:去甲长春花碱25 mg/m2,于第1、8、22、29天静脉注射,或5氟尿嘧啶(5-Fu)2.4 g/m2于第1～3、22～2,4天持续72 h静脉注射及顺铂(DDP)75 mg/m2,第1、22天静脉注射,同期采用常规分割放疗2.0 Gy/d,每周5 d,总量40 Gy.放化疗结束4～6周后,施行食管癌切除,重建消化道.结果 全组42例,其中41例完成术前放化疗,术前放化疗的临床有效率83.3%;40例进一步接受手术,根治性(R0)切除率97.5%,病理完全缓解率为23.8%.全组1、3、5年生存率分别为66.9%、54.5%、44.9%,中位生存时间为43.4个月;1、3、5年无病生存率分别为61.1%、48.7%、39.5%,中位无病生存时间为32.7个月.术前放化疗引起的骨髓抑制、肺毒性、食管毒性,多数为Ⅰ～Ⅱ度,无术前放化疗的毒副反应导致无法手术或死亡.术后肺部感染、严重心律失常、围术期死亡率分别是22.5%、20.0%、5.0%.结论 术前放化疗并手术可取得较高的临床有效率和完全病理缓解率,明显降低食管癌的分期,有望提高局部中晚期食管癌的生存率.患者对本方案耐受性良好,但放化疗的毒副反应不容忽视.

Neo-adjuvant chemoradiotherapy followed by surgery in treatment of advanced esophageal carcinoma

Objective To investigate the effects of neo-adjuvant chemoradiotherapy followed by surgery in treatment of advanced esophageal carcinoma. Methods Forty-two consecutive patients with locally advanced esophageal carcinoma underwent chemotherapy and radiotherapy concurrently. The chemotherapy consisted of intravenous infusion of vinorelbine (25 mg/m2 per day) on days 1,8,22,and 29 or 5-fluorouracil (2.4g/m2) on days 1-3 and days 22-24,and cisplatin (75 mg/m2) on days 1 and 22. Radiotherapy was delivered 5 days a week for 4 weeks with the total dose of 40 Gy divided into a daily fraction of 2.0 Gy. After the completion of chemoradiotherapy,clinical restaging was performed. Esophagectomy and lymphadenectomy were performed 4-6 weeks after the chemoradiotherapy. Results Forty-one of the 42 patients finished the preoperative chemoradiotherapy. The clinical response rate of chemoradiotherapy was 83.3%. Forty cases received esophagectomy,with a radical operation rate of 97.5% and a pathological complete response rate of 23.8%. The overall 1,3,and 5-year survival rates were 66.9%,54.5%,and 44.9% respectively with a median survival time of 43.4 months. The 1,3,and 5-year disease-free survival rates were 61.1%,48.7%,and 39.5% respectively with a median disease-free survival time of 32.7 months. The toxic responses of the chemoradiotherapy,such as myelotoxicity,pulmonary toxicity,and esophagitis were at grade 1 or 2. No death occurred during chemoradiotherapy. The incidence rates of postoperative pulmonary infection and severe arrhythmia were 22.5% and 20.0% respectively. The postoperative mortality rate was 5.0%. Conclusion The neoadjuvant chemoradiotherapy followed by surgery achieves a high clinical response rate and pathologic complete tumor regression rate,significantly downstages the esophageal cancer,and improves the survival. Although the toxicity of chemoradiotherapy is mild,the side-effects cannot be ignored still.