手術前放化療延長晚期局部食道癌病人生存期近3年

10-17

來自專欄基於基因組學診斷的癌症靶向治療8 人贊了文章

今天說的是中國研究團隊從2007年開始的3期臨床試驗研究，看看手術前的放化療是否可以延長局部晚期食道癌病人的生存期，結果果真如此，發表在Journal of Clinical Oncology上，實在是可喜可賀。

Patients and Methods

From June 2007 to December 2014, 451 patients with potentially resectable thoracic ESCC, clinically staged as T1-4N1M0/T4N0M0, were randomly allocated to NCRT plus surgery (group CRT; n = 224) and surgery alone (group S; n = 227). In group CRT, patients received vinorelbine 25 mg/m2 intravenously (IV) on days 1 and 8 and cisplatin 75 mg/m2 IV day 1, or 25 mg/m2 IV on days 1 to 4 every 3 weeks for two cycles, with a total concurrent radiation dose of 40.0 Gy administered in 20 fractions of 2.0 Gy on 5 days per week. In both groups, patients underwent McKeown or Ivor Lewis esophagectomy. The primary end point was overall survival.

Results

The pathologic complete response rate was 43.2% in group CRT. Compared with group S, group CRT had a higher R0 resection rate (98.4% v 91.2%; P = .002), a better median overall survival (100.1 months v 66.5 months; hazard ratio, 0.71; 95% CI, 0.53 to 0.96; P = .025), and a prolonged disease-free survival (100.1 months v 41.7 months; hazard ratio, 0.58; 95% CI, 0.43 to 0.78; P < .001). Leukopenia (48.9%) and neutropenia (45.7%) were the most common grade 3 or 4 adverse events during chemoradiotherapy. Incidences of postoperative complications were similar between groups, with the exception of arrhythmia (group CRT: 13% v group S: 4.0%; P = .001). Peritreatment mortality was 2.2% in group CRT versus 0.4% in group S (P = .212).

結果簡述：總體生存期單獨手術是66.5個月，先放化療再手術是100.1個月，相差33.6個月，接近3年時間。無疾病生存期單獨手術是41.7個月，先放化療再手術是100.1個月，相差58.3個月，接近5年時間。