常规剂量紫杉醇联合顺铂术前同步放化疗治疗胸段食管癌的临床研究

Concurrent standard dose of cisplatin, paclitaxel, and radiotherapy followed by surgery in treatment of thoracic esophageal carcinoma

目的探讨常规剂量紫杉醇联合顺铂术前同步放化疗治疗胸段食管癌的疗效。方法对26例食管癌初治患者采用术前同步放化疔，Ⅱ期17例，Ⅲ期9例，常规分割放疗2Gy／d，每周5d，总量40Gy，在放疗的第1周和第4周给予化疗，紫杉醇135mg／m^2，静脉滴注3h。第1天，顺铂20mg／m^2，静脉滴注，第1～3天；放化疗结束后休息4—6周，行食管癌根治术。用Kaplan—Meier法进行生存率和无病生存率分析，Logrank检查评估组间生存差异。结果患者均采用左进胸，食管胃颈部吻合，根治性切除率96．15％。术后组织病理反应：Ⅰ级9例，Ⅱ级6例，Ⅲ级11例。完全病理缓解率为42．31％（11／26）。放化疗导致的Ⅲ级以上毒性反应主要为白细胞下降7．69％（2／26），血小板下降7．69％（2／26），放射性食管炎11．54％（3／26）。手术并发症为：吻合口瘘3．85％（1／26）、喉返神经损伤7．69％（2／26）、乳糜胸3．85％（1／26）。中位随访时间42．28个月，3、5年生存率分别为62．96％、54．56％，3、5年无病生存率分别为59．94％、55．65％，术后原发灶不同病理反应的患者3年生存率分别为25．4％（Ⅰ级），60．00％（Ⅱ级），90．91％（Ⅲ级），5年生存率分别为0（Ⅰ级），60．00％（Ⅱ级），81．82％（Ⅲ级）（P〈0．05）。结论常规剂量紫杉醇和顺铂术前同步放化疗可能提高诱导放化疗后病理反应达到Ⅱ级以上食管鳞癌患者的5年生存率，没有增加治疗相关并发症。

Objective To investigate the curative effect of incorporation of the regimen of standard dose of paclitaxel combined with cisplatin into concurrent radiotherapy as pre-operative treatment for patients with esophageal carcinoma. Methods Twenty-six patients with primary diagnosis of esophageal carcinoma, 17 in stage Ⅱ and 9 in stage Ⅲ, underwent conventional fractionated radiotherapy with a total dosage of 40 Gy （ 2 Gy per day, 5 doses per week ）. Paclitaxel were given intravenously at a close of 135 mg/m^2 for 3 h on dayl and day 22. Cisplatin was given intravenously at a close of 20 mg/m^2 on D1 - D3 and IY22 - 24.4 - 6 weeks after the completion of chemo-radiotherapy, left thoracic incision and transhiatal esophagectomy with anastomosis in the neck was performed. The patients were followed up for 42. 28 months. Kaplan-Meier method was used to analyze the overall survival （OS） and disease-free survival （DFS） , and Log-rank test was performed to assess the survival rates statistical significance among groups. Results The radical resection rate was 96.15%. The pathologic response to chemoradiotherapy were grade Ⅰ in 9 patients, grade Ⅱ in 6 patients , and grade Ⅲ in Ⅱ patients. The pathological complete remission （PCR） rate was 42. 31% （ 11/26 ）. Toxicity grade 3 - 4 included leucopenia （ 7.69%, 2/26 ）, thrombocytopenia （7.69%, 2/26）, and radiation esophagitis （11.54%, 3/26）. Surgery-related complications included anastomotic leakage （ 3.85% , 1/26） , recurrent laryngeal nerve injury （7.69% , 2/26） , and chylothorax （ 3.85% , 1/ 26）. The 3- and 5-year overall survival rates were 62.96% and 54. 56% respectively. The 3- and 5-year disease-free survival rates were 59.94% and 55.65% respectively . The 3-year overall survival rates of the patients with different pathologic responses were 25.40% （ for those of grade Ⅰ ）, 60% （for grade Ⅱ ） ,and 90. 91% （for grade Ⅲ） respectively （ P 〈0.05）. The 5-year overall survival rates were 0 （for grade Ⅰ ） , 60% （for grade Ⅱ ）, and 81.82% （for grade Ⅲ ） respectively （ P 〈0.05）. Conclusion Preoperative chemoradiotherapy containing full dose of paclitaxel and cisplatin increases the 5-year overall survival for the patients with postoperative pathologic response grade Ⅱ and above, and does not increase the treatmentrelated complications.