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National Taiwan University Hospital Pilot Study of Chemoradiotherapy for Esophageal Carcinoma



對於食道癌,併用化學與放射治療的方法已顯示有其效果,但少見治癒性的結果。為促進食道扁平細胞癌的局部控制和減少遠處轉移,我們的領航研究是使用低劑量連續注輸5-FU和每日低劑量cisplatin (CDDP)注輸併用放射治療再加上手術切除,其間療程共4周。治療計劃包括:在4周內給予總劑量5000 cGy 的放射治療;連續28天注輸5-FU(225mg/平方公尺/day):在開始放射治療前的30分鐘靜脈注輸CDDP (6mg/平方公尺/day)。病患在完成四周的療程之後,將接受食道攝影、電腦斷層攝影和內視鏡檢查以便重新分期。在完成放療與化療的3到5周後,我們為病患進行食道切除手術。結果:從1993年10月到1994年8月,有13位男性及3位女性病患接受此治療計劃。我們詳細的記錄病患的治療效果與毒性。病患年齡的中間值為62歲,治療前體重減輕的中間值是6公斤,血液中白蛋白的中間值是3.7mg%。發生第三級白血球過少症的有7人而第四級的有2人:發生第四級血小板過少症的有3人。在重新分期檢查時,有7人(44%)原腫瘤已消除。全部病患的二年存活率是37%。結論:此種治療計劃對於局部腫瘤控制的效果很好,但是治療所產生的毒性很高,超出了我們可以接受的範圍。

Parallel abstracts

Introduction: Chemoradiotherapy has demonstrated efficacy in esophageal cancer but with poor result. Combined ehemo-radiotherapy and surgery may further increase the local control rate. A pilot study was initiated by using low dose continuous infusion (CI) of 5-FU and daily low dose cisplatin (CDDP) injection with radiotherapy (RT) followed by surgery in patients with locoregional squamous cell carcinoma of the esophagus. Methods: The treatment consisted of RT to the esophagus 5000 cGy in 4 weeks, CI of 5-FU (225 mg/m^2/day) over 28 days and CDDP (6mg/m^2/day) iv injection 30 minutes before RT. Patients were then restaged by esophagogram, panendoscopy and CT scan. Esophagectomy will be performed on approximately three to five weeks after completion of concurrent chemoradiotherapy. Results: From October 1993 to August 1994, 13 men and 3 women were en rolled. All were evaluated for toxicity and response. The median age was 62 years old, the median pretreatment weight loss was 6 kilograms, and the median serum albumin level was 3.7 gm/dl. Grade III and IV leukopenia were noted in 7 patients and 2 patients, respectively. Three patients had Grade IV thrombocytopenia. Seven patients (44%) showed complete remission on restaging. The 2-year survival rate is 37%. Conclusion: This treatment regimen provides a high local tumor control. However, the toxicity of the treatment was unacceptably high.

Parallel keywords

Esophageal cancer Chemoradiotherapy Toxicity