新辅助化疗提高食管癌手术R0切除率的研究

目的 探讨新辅助化疗提高食管癌手术R0切除率的可能性.方法 30例食管癌患者,其中鳞癌18例,腺癌10例,小细胞癌2例.术前新辅助化疗采用以紫杉醇联合铂类为主的方案,化疗后予以手术治疗.结果 化疗有效率(CR+PR)56.7%(17/30),R0切除率100%,吻合口瘘发生率3.3% (1/30),无死亡病例.结论 新辅助化疗对提高食管癌手术R0切除率具有重要意义,对术后长期生存的影响有待进一步随访观察.     

新辅助化疗提高食管癌手术R0切除率的研究

目的 探讨新辅助化疗提高食管癌手术R0切除率的可能性.方法 30例食管癌患者,其中鳞癌18例,腺癌10例,小细胞癌2例.术前新辅助化疗采用以紫杉醇联合铂类为主的方案,化疗后予以手术治疗.结果 化疗有效率(CR+PR)56.7%(17/30),R0切除率100%,吻合口瘘发生率3.3% (1/30),无死亡病例.结论 新辅助化疗对提高食管癌手术R0切除率具有重要意义,对术后长期生存的影响有待进一步随访观察.     

多西他赛联合顺铂行食管癌新辅助化疗的疗效观察

背景与目的：单一采用手术治疗进展期食管癌的效果较差,通过新辅助治疗能否改善进展期食管癌患者的预后是近年来食管癌治疗研究的热点,但仍存在争议。本研究旨在探讨多西他赛联合顺铂在食管癌新辅助化疗中的价值。方法：以多西他赛联合顺铂行食管癌新辅助化疗患者49例为研究组,观察化疗的有效率;以同期行单纯手术患者50例为对照组,比较2组手术切除率及术后1年生存率。结果：研究组49例患者均完成2个疗程的化疗,有48例行手术治疗,客观缓解率ORR（CR＋PR）为59.2%（29例）,术前分期明显降低。对照组50例均顺利完成手术。研究组和对照组行根治性手术切除率差异存在统计学意义（P〈0.05）。新辅助化疗后获得客观缓解患者的术后1年生存率与对照组比较差异有统计学意义（P〈0.05）。结论：多西他赛联合顺铂行食管癌新辅助化疗有助于降低术前分期,提高根治性手术切除率和新辅助化疗后获得客观缓解患者的1年生存率。     

紫杉醇联合顺铂新辅助化疗对Ⅲ期食管癌手术风险及预后的影响

目的 探讨紫杉醇联合顺铂新辅助化疗对Ⅲ期食管癌患者实施手术的风险及对预后的影响。方法 回顾分析2009年1月至2012年6月收治的140例Ⅲ期食管癌患者,根据治疗情况分为单纯手术组（n=78）和新辅助化疗组（n=62）。单纯手术组仅接受手术治疗。新辅助化疗组于术前给予紫杉醇联合顺铂化疗,具体方案为：紫杉醇135 mg／m2静滴,d1;顺铂30 mg／m2静滴,d1～d3,21天为1周期,化疗2个周期。化疗结束后4周行手术治疗。比较两组的手术切除根治率、术后并发症和总生存期（OS）。结果 62例接受新辅助化疗患者中,获CR 4例、PR 34例、SD 21例、PD 3例,有效率为61.3％。化疗的主要不良反应为白细胞减少、肝肾功能损伤、消化道反应和脱发,均为1～2级。新辅助化疗组的根治性切除率为91.9％（57／62）,高于单纯手术组的69.2％（54／78）,差异有统计学意义（P=0.001）;两组围手术期均无1例死亡,新辅助化疗组的术后并发症发生率为30.6％,单纯手术组为25.6％,两组差异无统计学意义（P=0.512）。新辅助化疗组的中位OS为17.8个月（95％CI：14.5～21.1个月）,单纯手术组为14.2个月（95％CI：11.6～16.8个月）,两组差异有统计学意义（P=0.016）。结论 针对Ⅲ期食管癌患者,术前采用新辅助化疗有助于提高肿瘤切除率,且不增加并发症发生率,有效提高患者的OS,值得临床推广应用。     

进展期胃癌新辅助化疗31例临床疗效分析

目的观察新辅助化疗治疗进展期胃癌的疗效，分析其与组织病理学、多药耐药相关标志物表达的关系。方法采用前瞻性开放式、病例平行对照研究方法，新辅助化疗组（31例）采用亚叶酸钙＋5-氟尿嘧啶＋奥沙利铂方案化疗2个周期后行根治性手术或姑息性手术；术后2～3周开始辅助化疗。对照组（30例）确诊后即行根治性手术或姑息性手术，术后接受辅助化疗。观察两组疗效及新辅助化疗组疗效与病理学特征和多药耐药相关标志物表达的关系。结果新辅助化疗组有效率71．0％（22／31），手术切除率93．9％（31／33），组织病理学有效率58．1％（18／31），手术并发症发生率22．6％（7／31），p53阴性者有效率78．6％（11／14）、阳性者有效率41．2％（7／17），1、3年生存率分别为90．3％（28／31）和63．2％（12／19）；对照组手术并发症发生率23．3％（7／30），1、3年生存率分别为70．0％（21／30）和31．6％（6／19）。结论进展期胃癌新辅助化疗通过临床及组织病理学降期可使手术切除率提高，尤其对于p53阴性者疗效更佳，手术不良反应发生率未增高。     

术前新辅助治疗Ⅲ期食管胃结合部腺癌近期疗效分析

目的:通过术前应用紫杉醇联合卡铂（paclitaxel plus carboplatin,TC）单周新辅助化疗方案、术前应用TC单周新辅助化疗同步联合放疗方案和直接手术治疗在Ⅲ期食管胃结合部腺癌（adenocarcinoma of esophagogastric junction,AEG）诊疗中的应用分析,评价术前新辅助治疗在Ⅲ期AEG治疗中的影像学改变及近期疗效。方法:Ⅲ期AEG患者90例,随机分成直接手术组、TC方案新辅助化疗组（新辅助化疗组）及TC方案新辅助化疗同步联合放疗组（新辅助放化疗组）,各30例。评价新辅助化疗组与新辅助放化疗组影像学变化,比较新辅助化疗组与新辅助放化疗组临床分期及病理分期变化情况,另比较三组患者手术R0切除率。结果:新辅助治疗后影像学变化:电子胃镜:新辅助化疗组与放化疗组出现肿瘤较前缩小或消失,部分原发灶处黏膜较前平整,轻微充血变红。CT检查可见原发肿瘤灶显著缩小,浸润的胃壁较前变薄、结构层次较前清楚,周围淋巴结较前缩小和/或数量减少。影像学提示新辅助治疗对AEG治疗效果显著。新辅助治疗后分期变化:新辅助放化疗组较新辅助化疗组患者分期改变明显,差异具有统计学意义（P＜0.05）。三组R0切除率情况:新辅助化疗组与新辅助放化疗组R0切除率均高于直接手术组（Pa=0.004,Pb=0.000）,且新辅助放化疗组R0切除率高于新辅助化疗组（Pc=0.045）。结论:TC单周方案新辅助化疗和新辅助同步放化疗均能使Ⅲ期AEG患者病灶影像学出现明显改变,肿瘤病灶降期,提高R0切除率,且新辅助同步放化疗组效果要优于新辅助化疗组。TC单周新辅助化疗联合同步放疗方案可推广用于Ⅲ期AEG的新辅助治疗。     

新辅助化疗在进展期食管癌中的疗效分析

目的 :探讨新辅助化疗在进展期食管癌治疗中的意义。方法:回顾性研究272例进展期食管癌患者,其中112例行新辅助化疗+手术治疗,160例行单纯手术治疗,比较围手术期并发症发生率、手术切除率及术后生存期。 结果 :新辅助化疗组术后并发症发生率为34.8%（39/112）,单纯手术组术为29.4%（47/160）,P=0.50;两组5年生存率分别为:35.7%和29.4%,P < 0.05。化疗效果PR组和SD/PD组5年生存率分别为38.5%和30.1%,P < 0.01。 结论 :新辅助化疗未增加食管癌患者围手术期并发症的发生率,是安全可行的;新辅助化疗能提高进展期食管癌患者的生存率;化疗有效组患者预后好于化疗无效组。      

新辅助化疗对提高ⅢA期非小细胞肺癌手术切除率的作用

目的　探讨新辅助化疗对ⅢA 期非小细胞肺癌 (NSCLC)手术切除率的影响。方法　 3 8例ⅢA 期NSCLC患者随机分为新辅助化疗组 (19例 )和单独手术组 (19例 )。新辅助化疗组患者确诊后即接受 2个周期的全身化疗 ,然后手术。单独手术组患者确诊后直接手术治疗。结果　新辅助化疗的有效率为 42 .1% ,化疗的毒副作用较轻 ,患者可以耐受。新辅助化疗组的手术切除率 94.7% ,手术完全性切除率 5 7.9% ,明显高于单独手术组患者 (P <0 .0 5 ) ,其手术切除率和完全性切除率分别为 78.9%和 3 6.8%。新辅助化疗并未增加手术并发症。结论　新辅助化疗可明显提高Ⅲ A 期NSCLC患者的手术切除率和完全性切除率。对于延长患者生存期的远期疗效尚需进一步观察。     

潜在可切除胃癌新辅助化疗的临床疗效观察

目的探讨潜在可切除胃癌新辅助化疗的临床疗效。方法收集本科收治的进展期及局部晚期潜在可切除胃癌患者31例，予以改良DCF方案（mDCF）化疗2～4个周期，观察其临床疗效及不良反应。结果全组获CR1例，PR15例，SD10例，PD5例，临床有效率为51．61％，疾病控制率为83．86％。手术切除率为64．52％（20／31），其中R0切除率为45．16％（14／31），R1切除率为12．90％（4／31），R2切除率为6．45％（2／31）。姑息性手术7例（22．58％）。2例术后出现并发症，并发症发生率为10％（2／20）。主要不良反应为骨髓抑制、恶心呕吐及轻度肝功能损害，经对症处理后均可缓解及恢复。结论改良DCF方案应用于潜在可切除胃癌的新辅助化疗的临床疗效较好，该疗法可使肿瘤降期，增加手术切除的机会，化疗相关不良反应可耐受，安全性较高。     

新辅助化疗BPF方案对食管癌微血管密度及血管内皮生长因子的影响

[目的]评价新辅助化疗（NACT）对食管癌微血管密度（MVD）及血管内皮生长因子（VEGF）的影响。[方法]67例Ⅱb～Ⅲb期经胃镜病理证实的食管鳞状细胞癌患者，随机分两组，新辅助化疗组（NACT组）：42例患者行术前新辅助化疗（BPF方案：氟尿嘧啶500mg／m^2，d1-5,iv；顺铂20mg／m^2，d1-5,iv；平阳霉素8mg，d1、3、5、7、9，im）；25例患者行单纯手术作为对照。应用免疫组化方法检测胃镜活检标本和手术后大体切除标本中MVD及VEGF的表达。[结果]NACT组总有效率（CR＋PR）为69．04％，手术切除率为95，23％。NACT组化疗前与对照组的VEGF阳性率分别为73．80％、68．00％，MVD值分别为46．82±19．07、47．12±16．15（x^2=0．260，P=0．610）；化疗后两者（33.33％，29．06±13．05）与化疗前比较均呈显著下降趋势（P〈0．05）。临床有效病例中，新辅助化疗前21例VEGF表达阳性者，新辅助化疗后仅余8例阳性（x^2=4．461，P=0．035）；MVD值化疗前后比较也有显著性差异。[结论]BPF术前化疗方案可有效提高中晚期食管癌的手术切除率，MVD值和VEGF可作为NACT疗效的评价指标。     

食管癌外科治疗近期疗效的影响因素分析

目的探讨食管癌患者年龄、吻合位置与术后并发症发生率和死亡率的关系,以及新辅助化疗对食管癌手术切除率的影响。方法回顾性分析西安交通大学医学院第一医院肿瘤外科自1997年~2003年首诊收治、资料完整587例食管癌患者资料。结果不同年龄组手术切除率分别为91.2%、95.9%和97.7%(P>0.05);>70岁年龄组术后吻合口瘘发生率和术后死亡率均较其它组高(P<0.05)。胸膜顶部吻合口瘘发生率为16.67%,较其它位置吻合口瘘发生率明显高(颈部2.17%、弓上1.09%、弓后2.60%、弓下0),具有显著性差异(P=0.019)。III期食管癌患者行术前新辅助化疗组与未化疗组的手术切除率分别为96.92%和78.85%,具有显著差异(P<0.05),而术后吻合口瘘发生率和术后死亡率无明显差异(P=1.000)。结论术前新辅助化疗可提高食管癌手术的切除率并不增加术后并发症。年龄大并不完全是手术禁忌,高龄患者的手术应充分考虑患者的生理年龄。     

术前新辅助化疗联合手术切除治疗局部晚期食管癌的疗效观察

【摘要】目的:研究术前紫杉醇+顺铂新辅助化疗联合手术切除在局部晚期食管癌治疗中的临床效果。方法:选取2014 年 1 月 ～2016 年 12 月我院治疗局部晚期食管癌患者 60 例,进行随机分组,对照组 30 例仅在术后给予化疗治疗,观察组 30 例在手术前应用紫杉醇+顺铂新辅助化疗方案治疗,再进行手术治疗,比较两组患者食管癌完全切除率、1年复发率。结果:观察组食管癌完全切除率明显高于对照组,1年复发率低于对照组,差异均有统计学意义(P ＜0. 05)。结论:术前应用紫杉醇+顺铂新辅助化疗联合手术切除治疗局部晚期食管癌临床效果理想。     

Prospective Phase II Study of Neoadjuvant Therapy with Cisplatin, 5-Fluorouracil, and Bevacizumab for Locally Advanced Resectable Esophageal Cancer

Background: We investigated the efficacy and tolerability of cisplatin and 5-fluorouracil (5-FU) plus bevacizumab as neoadjuvant therapy for patients with locally advanced resectable esophageal cancer. Patients and Methods: In this prospective phase II study, 22 patients with adenocarcinoma and 6 with squamous cell carcinoma received 2 4-day cycles of bevacizumab 7.5 mg/kg followed by cisplatin 80 mg/m(2) infusion on day 1 followed by 5-FU 1,000 mg/m(2) as a 96-h continuous infusion on days 1-4, separated by a 3-week interval. Results: The response rate was 39%, the R0 resection rate was 43%, and the median overall survival (OS) was 17 months. The regimen was well tolerated, with the most common severe toxicities being venous thromboembolism (10%), nausea, and gastrointestinal bleeding (7% each). In 37 patients previously treated with cisplatin and 5-FU alone at our institution and thus serving as historical controls, the response rate was 30%, the R0 resection rate was 44%, and the median OS was 23 months. There was no statistically significant difference between the 2 groups of patients. Conclusion: Adding bevacizumab to cisplatin and 5-FU neoadjuvant chemotherapy was active and well tolerated but did not seem to improve the resection rate or OS compared with prior regimens, including the historical controls at our institution.     

Detection of interval distant metastases: clinical utility of integrated CT-PET imaging in patients with esophageal carcinoma after neoadjuvant therapy

BACKGROUND: The objective of the study was to determine the utility of integrated computed tomography / positron emission tomography (CT-PET) imaging for detecting interval distant metastases and assessing therapeutic response in patients with locally advanced, potentially resectable esophageal carcinoma after neoadjuvant therapy. METHODS: A retrospective study was performed of 88 patients with potentially resectable esophageal carcinoma who received neoadjuvant therapy before planned surgical resection. CT-PET before and after completion of neoadjuvant was used for evaluating therapeutic response; response criteria were based on qualitative and semiquantitative analyses. RESULTS: Neoadjuvant therapy comprised chemoradiotherapy in 85 patients, with prior induction chemotherapy in 39 patients. Fifty-five patients proceeded to esophagectomy. Repeat CT-PET was performed after induction chemotherapy (n = 23) and after completing chemoradiotherapy (n = 85). CT-PET identified the interval appearance of metastatic disease in 7 (8%) patients. For assessment of locoregional therapeutic response, CT-PET was unable to predict pathological response to neoadjuvant therapy in the primary tumor or locoregional lymph nodes. CT-PET had sensitivity, specificity, and positive and negative predictive values of 57%, 46%, 39%, and 64%, respectively, for detection of residual macroscopic malignancy within the primary tumor; and sensitivity, specificity, and positive and negative predictive values of 0%, 90%, 0%, and 69% for detection of residual malignancy within resected lymph nodes. CONCLUSIONS: CT-PET performed after neoadjuvant therapy in patients with potentially resectable esophageal carcinoma is important for detecting interval metastases that preclude surgical resection, but is of limited utility for assessing locoregional therapeutic response.     

术前介入化疗治疗宫颈癌56例疗效分析

目的:探讨宫颈癌术前介入化疗的近期疗效。方法:对56例宫颈癌患者实施术前介入化疗,抗癌药物选择顺铂、丝裂霉素、阿霉素或表阿霉素;部分病例在灌注化疗(2/3量抗癌药物)后用携带有抗癌药物(1/3量)的明胶海绵颗粒栓塞肿瘤供血动脉,观察近期临床及组织学疗效及不良反应,并对有手术指征者及时实行宫颈癌根治术。结果:56例介入化疗患者临床症状缓解率为100%,肿瘤消退情况8例完全缓解(CR),35例部分缓解(PR),13例无变化(NC),无疾病进展(PD),总有效率为76%,与化疗前相比肿瘤体积显著缩小(P<0.05)。56例标本严格按规定进行组织学评定,组织学有效率为82.1%(46/56),组织学完全缓解率为10.7%(6/56)。51例患者介入化疗后顺利完成根治手术,手术切除率达91%。仅有5例中、晚期宫颈癌病人无法手术,改用放疗。结论:宫颈癌术前介入化疗可以改善临床症状,缩减肿瘤体积和范围,降低肿瘤分期、提高手术切除率及减少术中出血,是一种安全、有效的局部治疗方法。     

Neoadjuvant chemotherapy for resectable esophageal carcinoma: a meta-analysis of randomized clinical trials

Neoadjuvant chemotherapy for resectable esophageal carcinoma has been a focus of study, but no agreement has been reached on clinical randomized controlled trials and relevant systematic evaluation. The purpose of this study was to perform a meta-analysis on published randomized controlled trials (RCTs) that compared neoadjuvant chemotherapy and surgery with surgery alone for resectable esophageal carcinoma. Medline and manual searches was conducted in PubMed, ASCO (American Society of Clinical Oncology) meeting summary, Embase, the Cochrane Library (up to October 2010), Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Database, Wanfang Database. The selection contents were to identify all published and unpublished RCTs that compared neoadjuvant chemotherapy and surgery with surgery alone for resectable esophageal carcinoma. Sixteen RCTs which included 2,594 patients were selected. The risk ratio (RR) (95% confidence interval [CI]; P value), expressed as neoadjuvant chemotherapy and surgery versus surgery alone (treatment versus control), was 1.02 (0.95, 1.10; P=0.54) for 1-year survival, 1.29 (1.13, 1.47; P=0.0001) for 3-year survival, 1.31 (1.13, 1.51; P=0.0003) for 5-year survival, 1.00 (0.95, 1.04; P= 0.85) for rate of resection and 0.89 (0.64, 1.23; P=0.48) for operative mortality. The results showed that neoadjuvant chemotherapy for resectable esophageal carcinoma can raise the overall survival rate of patients with esophageal carcinoma, but it does not affect treatment-related mortality.     

Treatment of thoracic esophageal carcinoma invading adjacent structures

T4 esophageal cancer is defined as the tumor invading adjacent structures, using tumor-node-metastasis (TNM) staging. For clinically T4 thoracic esophageal carcinoma, multimodality therapy, that is, neoadjuvant chemoradiotherapy (CRT) followed by surgery or definitive CRT, has generally been performed. However, the prognosis of patients with these tumors remains poor. Another strategy is needed to achieve curative treatment. In the present article, the treatment strategies employed to date are reviewed. Furthermore, the strategies for these malignancies are reassessed, based on our experiences. R1/2 and R0 resections are regarded as those with residual and no tumor after surgery. The present data show that patients who underwent R1/2 resection after neoadjuvant CRT experienced little survival benefit, while complete response (CR) cases after definitive CRT had comparatively better results. Therefore, curative surgery should not be attempted without down-staging, and definitive CRT should be the initial treatment. Then surgery is indicated for the eradication of residual cancer cells. Close surveillance is essential for early detection of relapse even after CR, because the operation will gradually become increasingly difficult due to post-CRT fibrosis. In conclusion, multimodality therapy consists of definitive CRT followed by R0 resection, which can be the treatment of choice for T4 esophageal carcinoma. These challenging treatments have the potential to constitute the most effective therapeutic strategy.