- 期刊
Surgery Followed by Concurrent Chemoradiation with Weekly Cisplatin and Adjuvant Systemic Chemotherapy for Locally Advanced Esophageal Cancer-A Pilot Study
術後週期性及低劑量的同步化學放射治療合併輔助全身性化學治療對於食道癌治療結果之先期研究
摘要
目的：食道癌是一種非常惡性及常常在疾病後期才診斷出來的疾病。即使經過積極的外科手術治療，存活率仍然不盡理想。一些研究機構已經證實同步化學放射線治療可以增加存活率及局部控制。鑑於國外設計的化學藥物劑量對於本國人來說可能副作用太大而不適合，我們設計了一套術後週期性及低劑量的同步化學放射線治療來治療局部進展性的食道癌。除此之外，遠端轉移常是治療失敗的主因之一。因此，除了同步化學放射線治療之外，我們再加上全身性的化學治療當作我們治療食道癌的計畫。 材料與方法：從1999年6月到2003年2月共有36位局部進展性的病人。經過手術之後，其中18位病人接受同步化學放射線治療及全身性的化學治療，其餘18位病人只單獨接受放射線治療。放射線治療對於兩組的設計劑量相同，為60 Gy。同步化學治療為每週一次低劑量的cisplatin (30 mg/(平方公尺))，共6次。間隔3到4週後，給於全身性的化學治療。設計劑量為每月一次，每次cisplatin (20 mg/(平方公尺)) D1~D5，共4次。 結果：治療結果在這兩個組別對於中值存活(17.5 months vs. 10 months)及2年存活率(77% vs. 44%, p=0.02)。血液及非血液性副作用在這兩個組別是相當的。 結論：在這個研究設計之下，術後週期性及低劑量的同步化學放射線治療合併全身性的化學治療，對於局部進展性的食道癌，不但在副作用上是可以接受的，而且在存活率及局部控制上是有幫助的。
並列摘要
Purpose: Carcinoma of the esophagus is a virulent malignancy with poor survival despite aggression resection. This pilot study was conducted to evaluate the efficacy and toxicity of a three-step combination therapy for locally advanced esophageal cancer. Material and Methods: We retrospectively reviewed patients with esophageal carcinoma treated at our institution from July 1999 to February 2003. Patients were included in the study if they had T3 to T4, N0/N1, and M0 stage disease. All patients underwent a curative resection with a margin negative for malignant cells. There were i8 patients who then had adjuvant concurrent chemoradiation (CCRT group) and systemic adjuvant chemotherapy and i8 had surgery followed by radiation alone (RT group). Total doses of 60 Gy for both groups were given. In addition to RT, the CCRT group received concurrent chemotherapy consisting of 6 weekly doses of cisplatin (CDDP) (30 mg/m^2). CCRT was followed by adjuvant chemotherapy consisting of 4 monthly cycles of CDDP (20 mg/m^2/day) plus 5-fluorouracil (1000 mg/m^2/day) for 5 consecutive days. This study looked at survival, toxicity, and patterns of failure. Results: The CCRT group had significantly better median survival (17.5 months vs. 10 months) and 2-year survival (77% vs. 44%, p=0.02). Hematologic and non-hematologic toxicities were generally comparable in both groups. Conclusion: In this preliminary study, we have demonstrated that surgery followed by CCRT improves survival and locoregional control and decreases distant metastasis in local advanced esophageal cancer with acceptable toxicity. A large-scale, prospective randomized trial of this regimen is warranted.
延伸閱讀
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