Trimodality Treatment for Locally Advanced, Resectable Esophageal Squamous Cell Carcinoma

術前化學放射治療合併手術使用於局部晚期可切除之食道鱗狀細胞癌的成效

陳彥豪(Yen-Hao Chen) ； 呂宏益(Hung-I Lu) ； 黃承華(Cheng-Hua Huang) ； 饒坤銘(Kun-Ming Rau) ； 邱逸群(Yi-Chun Chiu) ； 王友明(You-Ming Wan) ； 陳彥仰(Yen-Yang Chen) ； 劉建廷(Chien-Ting Liu) ； 李劭軒(Shau-Hsuan Li)

《台灣癌症醫學雜誌》 27卷5期 (2011/10) Pp. 200-210

https://doi.org/10.6323/JoCRP.2011.27.5.2

摘要

Background: Patients with esophageal squamous cell carcinoma have a poor prognosis. An esophagectomy with lymph node dissection was the standard treatment in the past, but preoperative chemoradiotherapy followed by surgery (trimodality) has become more common in clinical practice recently. The aim of this study is to report the treatment outcome and postoperative mortality/morbidities of these two treatment modalities in patients with locally advanced, resectable esophageal squamous cell carcinoma.Methods: Between January 1991 and December 2010, 102 patients with locally advanced, resectable stage (T3N0-1) esophageal squamous cell carcinoma who received trimodality treatment or surgery alone were identified. There were 41 patients in the trimodality group, and 61 patients in the group of surgery alone. The outcome and postoperative complications were compared between the trimodality group and the surgery-alone group. Results: The median follow-up from the time of diagnosis of the esophageal cancer was 15.0 months. A univariate analysis showed that treatment after 2003 (P＜0.001), trimodality therapy (P=0.006), and female sex (P=0.017) were predictive of better disease-free survival and overall survival. In multivariate comparison, trimodality therapy (P=0.006) and female sex (P=0.040) represented the independent predictive factors of longer survival. Postoperative mortality and morbidities were similar between these two groups. In 41 patients receiving trimodality therapy, 8 (20%) patients achieved a complete pathologic response after preoperative chemoradiotherapy and had significantly superior overall survival (P=0.034) and disease-free survival (P=0.022).Conclusions: Retrospective and nonrandomized nature of this study did not allow comparison of trimodality therapy with surgery alone, the similar postoperative complications between surgery alone and trimodality groups, together with the improved survival in patients receiving trimodality therapy would support the need for additional prospective randomized controlled trial.

關鍵字

化學放射治療 ； 手術 ； 食道癌 ； 鱗狀細胞癌

並列摘要

Background: Patients with esophageal squamous cell carcinoma have a poor prognosis. An esophagectomy with lymph node dissection was the standard treatment in the past, but preoperative chemoradiotherapy followed by surgery (trimodality) has become more common in clinical practice recently. The aim of this study is to report the treatment outcome and postoperative mortality/morbidities of these two treatment modalities in patients with locally advanced, resectable esophageal squamous cell carcinoma.Methods: Between January 1991 and December 2010, 102 patients with locally advanced, resectable stage (T3N0-1) esophageal squamous cell carcinoma who received trimodality treatment or surgery alone were identified. There were 41 patients in the trimodality group, and 61 patients in the group of surgery alone. The outcome and postoperative complications were compared between the trimodality group and the surgery-alone group. Results: The median follow-up from the time of diagnosis of the esophageal cancer was 15.0 months. A univariate analysis showed that treatment after 2003 (P＜0.001), trimodality therapy (P=0.006), and female sex (P=0.017) were predictive of better disease-free survival and overall survival. In multivariate comparison, trimodality therapy (P=0.006) and female sex (P=0.040) represented the independent predictive factors of longer survival. Postoperative mortality and morbidities were similar between these two groups. In 41 patients receiving trimodality therapy, 8 (20%) patients achieved a complete pathologic response after preoperative chemoradiotherapy and had significantly superior overall survival (P=0.034) and disease-free survival (P=0.022).Conclusions: Retrospective and nonrandomized nature of this study did not allow comparison of trimodality therapy with surgery alone, the similar postoperative complications between surgery alone and trimodality groups, together with the improved survival in patients receiving trimodality therapy would support the need for additional prospective randomized controlled trial.

並列關鍵字

concurrent chemoradiotherapy ； surgery ； esophageal cancer ； squamous cell carcinoma