Postoperative Chemoradiotherapy in Locally Advanced Esophageal Carcinoma: Low-Dose and Standard-Dose Radiotherapy Compared

局部性食道癌手術後合併化療放射治療之放射劑量比較

林宜賢(Yi-Hsien Lin) ； 季匡華(Kwan-Hwa Chi) ； 蕭正英(Cheng-Ying Shiau) ； 王令瑋(Ling-Wei Wang) ； 陳盛鈺(Sheng-Yu Chen) ； 梁棉榮(Mien-Jung Liang) ； 劉裕明(Yu-Ming Liu) ； 顏上惠(Sang-Hue Yen)

《放射治療與腫瘤學》 11卷2期 (2004/06) Pp. 91-97

https://doi.org/10.6316/TRO/200411(2)91

摘要

目的：本研究欲探討不同放射劑量對於食道癌手術後施行輔助性同步化療放射治療之療效。 材料與方法：我們回溯分析自1990年1月至1998年12月78位接受手術後化療放射治療之食道癌患者，其病理分期為TxN1, T3-4Nx。病患均接受食道切除術為首要治療。手術後四週開始，病患接受輔助性化療放射治療，放射治療每次 1.8 Gy，期間並進行同步化療一至二次，每次以cisplatin 20 mg/m2, 5-Fu 500 mg/m2, leucovorin 90 mg/m2，連續滴注96小時。所有病患依放射劑量分成二組，低劑量組25人為40至49.99 Gy，標準劑量組53人為50 Gy以上。 結果：低劑量組、標準劑量組之五年存活率分別為40.00%、28.30%（p = 0.43），五年無病存活率分別為28.00%、24.53%（p = 0.36），五年無復發存活率分別為36.00%、28.30%（p = 0.44），五年無轉移存活率分別為38.77%、24.53%（p = 0.61）。 結論：局部性食道癌患者接受手術後同步化療放射治療，較高劑量放射治療並未達到顯著延長控制及存活率。低劑量放射治療可能對較早期的食道癌是足夠的，然而較高劑量對較晚期食道癌的效果仍未明。我們建議進行隨機實驗，以探討放射劑量在手術後同步化療放射治療之影響。

關鍵字

食道癌 ； 手術 ； 輔助性化療放射治療

並列摘要

Purpose : To compare overall survival rate, disease-free survival rate, local recurrence-free survival rate, distant metastasis-free survival rate of adjuvant chemoradiotherapy (CRT) after curative en-bloc esophagectomy using different doses of radiotherapy for locally advanced esophageal cancer (LAEC). Materials and Methods : We conducted a retrospective analysis of 78 patients with pathologically staged LAEC (TxN1, T3-4Nx) with adjuvant CRT after surgery between January 1990 and December 1998. Patients received curative esophagectomy as the primary treatment. Four weeks later, patients received adjuvant CRT at 1.8 Gy/fraction and infusional chemotherapy (1-2 cycles) with regimens of cisplatin 20 mg/m2, fluorouracil 500 mg/m2, leucovorin 90 mg/m2 during radiotherapy. The patients were divided into two groups with the total doses of 40-49.99 Gy (low-dose) for AJCC stage II and over 50 Gy (standard-dose) for stage III. Results : Twenty-five patients received low-dose radiotherapy and 53 patients received standard-dose radiotherapy. Five-year overall survival rate was 40.00% and 28.30% for the low- and standard- dose group (p = 0.43). Five-year disease-free survival rate was 28.00% (low-dose) and 24.53% (standard-dose) (p = 0.36). Five-year local recurrence-free survival rate was 40.00% and 28.30 % (p = 0.44). Five-year distal metastasis-free survival rate was 38.77% and 24.53 % (p = 0.61). There was no significant difference between the two treatment groups. Conclusion : The higher radiation dose did not increase survival or local control in LAEC. Low-dose radiotherapy was sufficient whereas standard-dose radiotherapy was controversial for CCRT in LAEC. Randomized trails are recommended to further determine the effects of radiation dose in postoperative chemoradiotherapy in LAEC.

並列關鍵字

Esophageal cancer ； Surgery ； Adjuvant chemoradiotherapy