紫杉醇联合铂类双周方案在食管鳞癌术前化疗中的应用探索

Biweekly paclitaxel and platinum chemotherapy followed by surgery for esophageal squamous cell carcinoma

目的探讨紫杉醇联合铂类双周方案应用于食管鳞癌术前化疗的可行性和疗效。方法回顾性分析2012年1月至2016年3月在中国医学科学院肿瘤医院行紫杉醇联合铂类双周方案术前化疗的20例食管鳞癌患者的临床病理资料。结果20例患者在术前完成3-8个周期全身化疗，平均化疗4个周期。紫杉醇联合铂类双周方案术前化疗的主要不良反应包括白细胞下降（90.0%）、中性粒细胞下降（75.0%）、恶心呕吐（50.0%）等，其中Ⅲ、Ⅳ级不良反应主要为白细胞下降（20.0%）和中性粒细胞下降（65.0%），经对症处理及调整化疗药物后均好转。20例患者化疗后均接受了手术治疗，术后出现轻度病理反应13例，中度病理反应7例，无重度病理反应者，无治疗后进展患者。有5例（25.0%）患者化疗后出现了T分期的降期，其中4例为中度病理反应，1例为轻度病理反应。全组患者术后并发症的发生率为25.0%（5/20），围手术期并发症经对症处理后均好转。全组无治疗相关性死亡。结论紫杉醇联合铂类双周方案在食管鳞癌患者术前化疗中安全有效，值得进一步开展随机对照研究以探索紫杉醇联合铂类双周方案在食管癌术前化疗中的应用价值。

Objective To evaluate the feasibility and efficacy of biweekly paclitaxel and platinum chemotherapy followed by surgery for esophageal squamous cell carcinoma. Methods We retrospectively analyzed the elinieopathological data of 20 patients with esophageal squamous cell carcinoma treated in our hospital between January 2012 and March 2016. All patients received biweekly paclitaxel and platinum chemotherapy followed by surgery. Results 20 cases received preoperative chemotherapy for 3-8 cycles with an average of 4 cycles. The main chemotherapy-related adverse events were bone marrow suppression （ 18/ 20,90.0%）, followed by vomiting and nausea （10/20, 50.0%）. Five patients （25.0%） had grade 4 neutropenia and all toxicities were torlerable and manageable. After chemotherapy, all patients received surgery. The histological responses in the primary tumors were grade 1 in 13 （65.0%） patients, grade 2 in 7 （35.0%） patients, and grade 3 in 0 （0%） patient. None had disease progression. Downstaging of T-stage was observed in 5 cases （25.0%） after chemotherapy. Among them, 4 eases were with moderate histologicl responses and one case with mild histological response. The incidence of postoperative complications was 25.0%（5/20）, and the complications were improved following symptomatic treatments. There was no treatment-related death. Conclusions Biweekly paclitaxel and platinum chemotherapy followed by surgery for esophageal squamous cell carcinoma is safe and effective. Further randomized clinical trial should be conducted to assess the value of this therapeutic regimen in the preoperative chemotherapy for esophageal cancer.