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PRELIMINARY RESULTS OF PREOPERATIVE CHEMORADIATION THERAPY FOR CERVICAL ESOPHAGEAL SQUAMOUS CELL CARCINOMA WITH LARYNX PRESERVATION

頸部食道鱗狀細胞癌接受術前同步化學放射治療與喉部保留手術之初步結果

摘要


Purpose : Preoperative concurrent chemoradiotherapy (CCRT) followed by surgery has been widely accepted for treating locally advanced esophageal cancer except cervical esophageal cancer. This study aimed to evaluate the feasibility of preoperative CCRT followed by surgery for cervical esophageal squamous cell carcinoma (SCC) with intent to preserve the larynx. Materials & Methods : From August 2013 to August 2015, 11 patients with cervical esophageal SCC scheduled to receive preoperative CCRT with surgery were retrospectively analyzed. The gross tumor and involved lymphadenopathies were delivered with 48 Gy and 43.2 Gy to subclinical mucosal/submucosal disease and regional lymphatic basin in 24 fractions by simultaneously integrated boost (SIB) planning through intensity modulated radiation therapy (IMRT) or Tomotherapy. Chemotherapy with weekly cisplatin 30 mg/m^2 was administered during radiation therapy (RT) course. Side effects grading was according to the Common Terminology Criteria for Adverse Events (CTCAE version 4.0). The image assessment and pathological responses were recorded and graded. Results : Among all 11 patients, ten of them had received the planned CCRT completely and one was dead due to aspiration pneumonia and sepsis during CCRT course. Of the 10 patients who completed preoperative CCRT, 8 patients of them have received esophagectomy. The pathological T down-staging was noted in 4 patients (50%) and pathological complete response (pCR) was achieved in 1 patient (12.5%). Seven of these 8 patients (87.5%) preserved the larynx and 6 patients (75%) achieved negative surgical margins (R0 resection). The most severe acute toxicities from CCRT were grade 3 cough (n=1, 10%) and grade 3 anemia (n=1, 10%). According to chest surgeons’ consensus, the cut-off point for larynx-preserving surgery after CCRT for cervical esophageal cancer could be 2-cm distance from esophageal tumor to larynx. Conclusion : Preoperative CCRT followed by larynx-sparing surgery is feasible in cervical esophageal SCC. The preliminary results can be used as a reference for further clinical validation of multimodality therapy in cervical esophageal SCC with intent to improve tumor control and quality of life.

並列摘要


目的:術前同步化學放射治療合併手術已被廣泛運用於治療局部晚期非頸部食道癌。本研究目的在於針對頸部食道鱗狀細胞癌,評估術前同步化學放射治療合併喉部保留手術之可行性。材料與方法:本研究分析 11 名接受術前同步化學放射治療合併喉部保留手術之頸部食道鱗狀細胞癌患者。以同步整合加強照射技術給予 48 Gy 至腫瘤靶區,43.2 Gy 至潛在高風險區,同時給予 cisplatin 化學治療。藉由評估副作用,影像變化與病理反應來評估其初步療效。結果:共計 10 名病患完成術前同步化學放射治療,而有 1 名病患於同步化學放射治療中因為吸入性肺炎及敗血症導致死亡。完成術前同步化學放射治療的病患中,8 名接受食道腫瘤切除手術。手術後,4 名患者(50%)病理 T 分期改善,1 名患者(12.5%) 達到病理完全緩解。7 名患者(87.5%)保留喉部,且 6 名患者(75%)達到手術切口邊緣陰性。因化學放射治療導致的嚴重急性副作用,分別為分期 3 級咳嗽(1 名,10%)及分期 3 級貧血(1 名,10%)。根據外科醫師共識,能接受喉部保留手術的分界點為食道腫瘤距離喉部大於 2 公分。結論:頸部食道鱗狀細胞癌患者接受術前同步化學放射治療後進行喉部保留手術是可行的。未來是否能將多重模式治療運用於頸部食道鱗狀細胞癌病患以改善腫瘤控制率及生活品質,可將本研究的初步結果作為臨床驗證之參考。

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