Comparative Study of Preoperative Chemoradiation for Surgical Treatment of Esophageal Cancer

術前化學放射治療應用於食道癌手術之成效：歷史上之比較

李元麒(Yung-Chie Lee) ； 吳振都(Chen-Tu Wu) ； 黃培銘(Pei-Ming Huang) ； 徐紹勛(Hsao-Hsun Hsu) ； 張逸良(Yih-Leong Chang)

《Formosan Journal of Surgery》 37卷1期 (2004/02) Pp. 1-7

https://doi.org/10.29833/FJS.200402.0001

摘要

食道癌病人單獨以外科手術治療之成效一向不佳。台大醫院從1995年開始嘗試以術前化學放射治療合併手術切除來治療具局部侵犯性之食道癌，其做法為針對袍2 or N1之病人先每日投予cisplatin (6 mg/m2/day) 加flurouracil (225 mg/m2/day)靜脈注射，同時作放射治療每日200 cGy，每星期作5次，直到總劑量為3600 cGy，做完3至4週後經評估可行後作手術切除，其成果與1995年以前只作手術切除病人作比較。
此回溯性研究，研究1987至1999之食道癌接受手術病人共169位，其中化學放射加手術組有67位病人，腫瘤接受化學放射治療之部分反應率為29.95%，完全反應率為25.4%，手術後5年存活率為52.3%，相對於局部侵犯性食道癌病人1995年以前只作手術切除病人5年存活率只有19.5%。作化學放射治療組之手術死亡率20.9%，稍高於單獨手術組(13.7%)，整個食道癌病人手術後影響預後之因子包括腫瘤大小、病理分期、有無淋巴腺轉移以及對化學放射治療之反應等。

並列摘要

Background and purpose: The result of surgical resection alone for patients with locally advanced esophageal cancer had been unsatisfactory before in our hospital. A treatment protocol was started in 1995 to test the effect of preoperative concurrent chemoradiation (CCRT) followed by surgery on patient survival, compared with surgery alone.
Methods: Patients with locally advanced esophageal carcinoma (袍2 or N1) received preoperative concurrent CCRT, which included daily cisplatin (6 mg/m2/day) plus flurouracil (5-Fu) (225 mg/m2/day) with concurrent radiation at a daily fraction dosage of 200 cGy, 5 days per week, for a total dose of 3,600 cGy. Surgical resection was performed 3 to 4 weeks after CCRT.
Results: During the period from January 1987 through December 1999, a total of 169 patients with esophageal carcinoma were treated in our department. Sixty-seven patients had received complete course of preoperative CCRT. After CCRT, tumor response rate was 55.3% (partial response, 29.9% and complete response, 25.4%). After surgery, the in-hospital operative mortality was 20.9% in CCRT plus surgery group, which was slightly higher than surgery alone group (13.7%), but the difference was statistically insignificant. CCRT plus surgery group had a better 5-year survival rate (52.3%) than surgery alone group (19.5%). In this series, tumor size, pathological stage, status of lymph node metastasis and tumor response to CCRT are significant prognostic factors.
Conclusions: Utilization of preoperative CCRT followed by surgical resection for locally advanced esophageal cancer provides a better patient survival compared with surgery alone.

並列關鍵字

esophageal cancer ； preoperative chemoradiation ； surgery