食管癌术前同步多西他赛联合顺铂化放疗的临床观察

目的:探讨多西他赛联合顺铂术前同步放化疗治疗食管癌的疗效.方法:对22例食管癌初治患者采用术前同步放化疗.放疗采用三维适形放疗技术(3DCRT),处方剂量46 Gy/23次,在放疗的第1和4周均给予多西他赛和顺铂化疗2个周期.放化疗结束后休息4～6周,行食管癌根治术.结果:22例患者完成术前放化疗,术前放化疗的临床有效率为81.8％(18/22).21例患者进一步接受手术,根治性切除率为95.2％,病理完全缓解率为38.1％(8/21).与治疗前分期比较,T与N分期均明显提前,P值均＜0.05.放化疗导致的Ⅲ级以上不良反应主要为白细胞下降、呕吐及放射性食管炎.肺部感染、吻合口瘘、伤口延迟愈合及乳麋胸均为4.8％(1/21).中位随访时间45个月,3和5年生存率分别为61.9％和47.6％,中位生存时间49个月.3和5年无病生存率分别为50.2％和40.5％,中位无病生存时间为35个月.结论:多西他赛联合顺铂术前同步放化疗并手术治疗食管癌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.本治疗方案,患者耐受性良好,无治疗相关性的死亡.

Cinical study of docetaxol combined with cisplatin in neo-adjuvant chemo-radiotherapy for esophageal carcinoma

OBJECTIVE:To investigate the prognosis of esophageal carcinoma receiving docetaxol combined with cisplatin in neo-adjuvant chemo-radiotherapy followed by surgery.METHODS:Twenty-two patients with primary diagnosis of esophageal carcinoma were into this study.The radiotherapy used three dimensional conformal radiotherapy and the prescribed dose was 46 Gy/23 F.The chemotherapy consisted of docetaxol and cisplatin.The chemotherapy was administered in continuous infusion for the first week and the fourth week.After completion of chemo-radiotherapy,clinical restaging was performed.Esophagectomy and lymphadenectomies were performed 4-6 weeks after chemo-radiotherapy.RESULTS:Twenty-two patients finished the preoperative chemo-radiotherapy.The clinical response rate of chemo-radiotherapy was 81.8%(18/22).Twenty-one cases continued to received esophagectomy,the rate of radical resection was 95.2% and the pathological complete response rate was 38.1%(8/21).The T and N were downstaged compared to the pre-treatment,.Toxicity grade 3-4 included leucopenia,vomiting and radiation esophagitis.Surgery-related complications included pulmonary infection(4.8%,1/21),anastomotic leakage(4.8%,1/21),wound delay healing(4.8%,1/21),and chylothorax(4.8%,1/21).Overall survival at 3,5 years were 61.9%,47.6%,respectively and the median survival was 49 months.Disease-free survival at 3,5 years were 50.2%,40.5%,respectively and the median disease-free survival was 35 months.CONCLUSIONS:This neoadjuvant chemo-radiation(docetaxol combined cisplatin with radiotherapy) followed by surgery can achieve a high clinical response rate and pathologic complete tumor remission rate and significantly downstage the esophageal cancer.This multidiscipline therapy may hopefully improve the survival.In this treatment no death occured during chemo-radiotherapy.