局部中晚期食管癌术前新辅助放化疗联合食管癌根治术的临床研究

目的 评价局部晚期食管癌患者对术前neoCRT并手术的耐受性,术前新辅助放化疗疗效以及对肿瘤切除率、术后并发症发生率、围术期死亡率的影响。 方法 2011—2015年间共收治达入组条件胸段食管癌患者 74例。术前同期放化疗方案:长春瑞滨 25 mg/m²第1、8、22、29天,顺铂 25 mg/m²第 1—4、22~25天,同期常规分割放疗2.0 Gy/d,总量40 Gy。放化疗结束后 4~8周行食管癌根治术(neoCRT+手术),拒绝手术患者行根治性放化疗(DCRT),术前放化疗后拒绝进一步治疗患者予随访(neoCRT)。 结果 44例完成术前neoCRT+手术均为R₀切除,pCR达43%;17例拒绝手术改成DCRT;13例neoCRT。neoCRT+手术、DCRT、neoCRT患者 2年OS率分别为79%、75%、17%,DFS率分别为75%、55%、17%。neoCRT与neoCRT+手术OS率不同(P=0.000),与DCRT也不同(P=0.001),neoCRT+手术组与DCRT相近(P=0.415)。neoCRT与neoCRT+手术DFS率不同(P=0.000),与DCRT也不同(P=0.002),neoCRT+手术与DCRT相近(P=0.416)。全组术前放化疗临床有效率87%,术前放化疗 56例患者出现≥3级骨髓抑制(76%),术后肺部感染、吻合口瘘、吻合口狭窄发生率及围术期死亡率分别占21%、12%、7%、2%。 结论 术前放化疗联合手术治疗局部中晚期食管癌能取得较高的临床有效率和pCR率,明显降低食管癌的分期,有望提高生存率,但放化疗不良反应、围术期并发症需重视。

Clinical effect of preoperative neoadjuvant chemoradiotherapy plus esophagectomy in treatment of locally advanced esophageal cancer

Objective To evaluate the tolerance of preoperative neoadjuvant chemoradiotherapy (neoCRT) plus esophagectomy, as well as the short-term outcome, tumor resection rate, incidence of postoperative complications, and perioperative mortality, in patients with locally advanced esophageal cancer.Methods This study included 74 patients with thoracic esophageal cancer who were admitted to our hospital from May 2011 to June 2015.Chemotherapy and radiotherapy were performed concurrently.The chemotherapy consisted of vinorelbine (25 mg/m2 on days 1, 8, 22, and 29) and cisplatin (25 mg/m2 on days 1-4 and 22-25).The radiotherapy was conventionally fractionated with a total dose of 40 Gy (2.0 Gy/d).At 4-8 weeks after chemoradiotherapy, esophagectomy was performed (neoCRT+surgery group);definitive chemoradiotherapy (DCRT) was performed in the patients who refused surgery (DCRT group);follow-up was performed in the patients who refused any anti-cancer therapies after neoCRT (neoCRT group).Results Forty-four patients underwent neoCRT+surgery, with a radical resection (R0) rate of 100% and a pathological complete response (pCR) rate of 43%;17 patients received DCRT;13 patients received neoCRT alone.For the neoCRT+surgery group, DCRT group, and neoCRT group, the 2-year overall survival (OS) rates were 79%, 75%, and 17%, respectively, and the 2-year disease-free survival (DSF) rates were 75%, 55%, and 17%, respectively.There were significant differences in OS between the neoCRT group and the neoCRT+surgery group (P=0.000) and between the neoCRT group and the DCRT group (P=0.001), but no significant difference was observed between the neoCRT+surgery group and the DCRT group (P=0.415).There were significant differences in DFS between the neoCRT group and the neoCRT+surgery group (P=0.000) and between the neoCRT group and the DCRT group (P=0.002), but no significant difference was observed between the neoCRT+surgery group and the DCRT group (P=0.416).The rate of clinical response to preoperative neoCRT was 87% for all patients.Fifty-six patients (76%) developed grade ≥3 myelosuppression due to preoperative neoCRT.The incidence rates of postoperative pulmonary infection, anastomotic leakage, and anastomotic stenosis were 21%, 12%, and 7%, respectively, and the perioperative mortality rate was 2%.Conclusions For patients with locally advanced esophageal cancer, preoperative neoCRT plus surgery can increase the clinical response rate and pCR rate, reduce the tumor stage, and improve the survival, but chemoradiotherapy toxicities and perioperative complications cannot be ignored.