European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2019
Feasibility of extended chemoradiotherapy plus surgery for patients with cT4b esophageal carcinoma.
Клиническое исследование II фазыСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Anderegg Martinus C J, Ruurda Jelle P, Gisbertz Suzanne S, Blom Rachel L G M, Sosef Meindert N, Wijnhoven Bas P L, Hulshof Maarten C C M, Bergman Jacques J G H M, van Laarhoven Hanneke W M, van Berge Henegouwen Mark I
Аннотация
BACKGROUND: Treatment of cT4b esophageal carcinoma usually consists of definitive chemoradiotherapy (dCRT). However, outcome after dCRT in these patients is poor. Whether surgery should have a place in the treatment of cT4b esophageal cancer is still subject to debate. Goal of this study was to evaluate the feasibility of esophagectomy after extended chemoradiotherapy in patients with cT4b esophageal cancer.
METHODS: Patients with cT4b esophageal carcinoma, as determined by endoscopic ultrasound and (PET-)CT, were eligible for this phase-2 study. Patients were treated with weekly carboplatin + paclitaxel with 50.4 Gy radiotherapy in 28 fractions for 5.5 weeks followed by an explorative thoracotomy and esophagectomy if deemed feasible.
RESULTS: From July 2011 through March 2013, 16 patients were enrolled. Five patients did not undergo surgery because of detection of distant metastases during/after CRT (n = 3), unwillingness to undergo surgery (n = 1) or death before start of CRT (n = 1). Of the 13 patients who completed CRT, 3 patients experienced major hematologic toxicity (grade 3). A radical (R0) resection was achieved in 9 of 11 patients. Postoperative complications occurred in 9 patients. A reoperation was performed in 2 patients and 2 patients died in hospital after surgery. Three patients developed recurrent disease (1 locoregional and 2 systemic) after a mean interval of 17 months. Median overall survival of all included patients was 14.3 months.
CONCLUSIONS: In certain patients with cT4b esophageal carcinoma a radical resection can be accomplished after chemoradiotherapy. However, this treatment is associated with considerable complications and should therefore be reserved for physically fit patients.
NETHERLANDS TRIAL REGISTER NUMBER: NTR3060.
METHODS: Patients with cT4b esophageal carcinoma, as determined by endoscopic ultrasound and (PET-)CT, were eligible for this phase-2 study. Patients were treated with weekly carboplatin + paclitaxel with 50.4 Gy radiotherapy in 28 fractions for 5.5 weeks followed by an explorative thoracotomy and esophagectomy if deemed feasible.
RESULTS: From July 2011 through March 2013, 16 patients were enrolled. Five patients did not undergo surgery because of detection of distant metastases during/after CRT (n = 3), unwillingness to undergo surgery (n = 1) or death before start of CRT (n = 1). Of the 13 patients who completed CRT, 3 patients experienced major hematologic toxicity (grade 3). A radical (R0) resection was achieved in 9 of 11 patients. Postoperative complications occurred in 9 patients. A reoperation was performed in 2 patients and 2 patients died in hospital after surgery. Three patients developed recurrent disease (1 locoregional and 2 systemic) after a mean interval of 17 months. Median overall survival of all included patients was 14.3 months.
CONCLUSIONS: In certain patients with cT4b esophageal carcinoma a radical resection can be accomplished after chemoradiotherapy. However, this treatment is associated with considerable complications and should therefore be reserved for physically fit patients.
NETHERLANDS TRIAL REGISTER NUMBER: NTR3060.
Предметные рубрики MeSH
AdenocarcinomaAdultAgedAnastomotic LeakCarcinoma, Squamous CellChemoradiotherapyDisease-Free SurvivalEsophageal NeoplasmsEsophagectomyEsophagitisFeasibility StudiesFemaleHospital MortalityHumansLeukopeniaMaleMargins of ExcisionMiddle AgedNauseaNeoplasm StagingPneumoniaPostoperative ComplicationsPostoperative HemorrhageSurvival RateThrombocytopeniaTumor BurdenVocal Cord Paralysis