Neoadjuvant Therapy and Surgery for Clinical Unresectable Esophageal Cancer

臨床無法進行手術的食道癌病患於術前合併放射與化學治療

許宏基(Hon-Ki Hsu) ； 周宜平(Yi-Pin Chou) ； 白倩穎(Chien-Ying Pai)

《Mid-Taiwan Journal of Medicine》 9卷3期 (2004/09) Pp. 174-178

https://doi.org/10.6558/MTJM.2004.9(3).6

摘要

目的 多數的食道癌患者初診時，均呈現癌症末期及嚴重的營養不良。局部器官的侵犯及遠處轉移使得食道癌手術治療的機會不高，手術時還得面對高齡、營養不良、及癌症侵犯等高風險。儘管手術風險高，外科切除仍是目前治療食道癌最主要的方法；因為其他的姑息性療法成功率低，且無法長期性解決吞嚥困難的問題。本研究目的是以手術前合併放射化學療法以治療食道癌，其用意是想將腫瘤縮小以利手術切除。
方法 從1990年元月到2002年12月本院共有617位食道鱗狀上皮細胞癌患者。其中有272位（44.1%）成功地切除癌病且以胃重建。從1999年元月到2002年12月我們挑選多31位晚期食道癌患者進入術前合併放射化學療法的研究。這31位患者的腫瘤依食道鏡檢，胸部電腦斷層及臨床診斷判定成無法手術切除。於第 1至4, 29至32日接受5-FU 800 mg/m^2 day，第1及29日輔以cisplatin 60 mg/m^2 day 及放射36 Gy後，合併放射化學療法有7位因遠處轉移或身體虛弱無法手術。剩下的24位接受手術，其中5位無法切除，19位接受食道癌切除及胃食道重建。院內死亡率為15.8%（3/19），有5位病理腫瘤完全反應（5/19，26.3%），有8位有白血球過少（8/31，25.8%）。手術組內有7位發生放射性肺炎導致呼吸器過長使用，2位吻合處洩漏，2位心包積水，1位肋膜積水及1位敗血症。
結果 存活時間中位數於切除者為10.60+1.52月，無切除者為7.87+1.97月，於統計學上兩者差異沒有顯著意義。
結論 術前合併放射化學療法可以使腫瘤縮小，增加手術切除率。但此種方法有相當高的併發症及死亡率，且無法有效地延長病人的生命。

關鍵字

合併放射化學療法 ； 食道癌

並列摘要

Objectives. We applied neoadjuvant therapy to our advanced esophageal carcinoma patients who were clinically unresecatable. The primary goal of this study was to increase the resection rate and the secondary goal was to increase the survival time.
Methods. From January 1990 to December 2002, 617 patients with squamous cell carcinoma of the esophagus were treated in our hospital. Resection with reconstruction was done in 272patients (44.1%). From January 1999 to December 2002, 31 patients with advanced esophageal carcinoma were enrolled for CCRT study. The tumors were diagnosed as unresectable by clinical experience and examinations including esophagography, esophageal endoscopy and thoracic CT scan. In this study, all of the 31 patients received CCRT (5-FU 800 mg/m2day 1 to 4, 29 to 32,cisplatin 60 mg/m2day 1 and 29, and radiation 36 Gy).
Results. Among the 24 patients who completed CCRT and underwent surgical intervention, 5 patients had unresectable tumors and 19 patients received esophagectomy and reconstruction. Hospital mortality in the surgically respectable group was 15.8% (3/19). The pathological complete response rate (CR) in the resected esophageal specimens was 15.8% (3/19). Grade III to IV leukopenia was noted in 25.8% (8/31) of all patients. Among the surgical group, complications included radiation pneumonitis in 7 patients which resulted in prolonged ventilator usage; anastomotic leakage in 2 patients; pericardial effusion in 2 patients; pleural effusion in 1 patient and sepsis in 1 patient. The median survival time in the resection group was 10.60+1.52 months and 7.87+1.97 months in the non-resection group. There was no significant difference between the two groups (p = 0.3716).
Conclusions. CCRT and surgery in selected patients with advanced esophageal carcinoma downgraded the tumor and increased the opportunity for surgical resection. However, it also carried high surgical morbidity and mortality rates and provided no survival benefit.

並列關鍵字

concurrent chemoradiation therapy ； Esophageal carcinoma