食管癌放化疗面临的挑战与对策教材.pptVIP

1 食管癌放化疗面临的挑战与对策 蚌医一附院放疗科 李多杰 2 6 7 Definitive chemoradiotherapy for T4 and/or M1 lymph node squamous cell carcinoma of the esophagus T4M0 21例，T2M1a1例，T3M1a17例，T4M1a15例。 49例 (91%) 按规定完成同步放化疗。 18例 (33%) 临床完全缓解，其中36例T4期患者有9例 (25%) 、18例非T4期有9例 (50%) 临床完全缓解。 主要毒副作用为血液学毒性和放射性食管炎，4例 (7%) 治疗相关死亡 。 中位随访43个月，中位生存时间 9个月， 3年生存率 23%。 J Clin Oncol. 1999 Sep;17(9):2915-21. 8 2005.1-2006.12，共153例鳞癌，不能手术 3D-CRT 35%同步铂类化疗 中位剂量64GY（50-74GY） 5Y-OS 26.3% 预后因素：GTV和病灶长度 9 Preoperative Chemoradiotherapy for Esophageal or Junctional Cancer CROSS研究 Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study N Engl J Med 2012;366:2074-84. March 2004 through December 2008 carboplatin (doses titrated to achieve an area under the curve of 2 mg per milliliter per minute) paclitaxel (50 mg per square meter of body-surface area) for 5 weeks concurrent radiotherapy (41.4 Gy in 23 fractions,5 days per week), followed by surgery. 10 CROSS研究 11 CROSS研究 12 CROSS研究 16 Complete resection with no tumor within 1 mm of the resection margins (R0) was achieved in 92% of patients in the chemoradiotherapy–surgery group versus 69% inthe surgery group (P0.001) A pathological complete response was achieved in 47 of 161 patients (29%) who underwent resection after chemoradiotherapy CROSS研究 N Engl J Med 2012;366:2074-84. 17 Quantifying the benefit of pathologic complete response after neoadjuvant chemoradiotherapyin the treatment of esophageal cancer 荟萃分析了2 2篇文献研究结果，进展期术前行新辅助放化疗 结果：pCR者3年总生存为75.0％，5年总生存率为50.0％ ； 未达pCR者3、5年生存率分别为29.0％和22.6％( P 0.025 ) 。 研究结论：综合多项研究结果发现行术前放化疗治疗进展期食管癌，术后达pCR患者3、5总生存率均明显提高。因此，行术前新辅助放化疗治疗进展期食管癌，评价术后pCR对判 断患者预后有重要的意义 。 Scheer R,et al. Int J Radiat Oncol Biol Phys，2011， 80 (4) ：996-1001 18 同步放化疗后达PET-CR者手术和非手术预后相似 19 Annals of Oncology 24: 1262–1266, 2013 Association between clinical complete response and pathological complete response after preoperative chemoradiation in patients with gastroesophageal cancer: analysis in