Author/Editor		Šeruga, Boštjan; Sok, Miha; Eržen, Janez; Jerman, Jože; Jančar, Boris; Zakotnik, Branko
Title		Preoperative concomitant chemoradiotherapy in esophageal cancer
Translated title		Preoperativna sočasna kemoradioterapija pri raku požiralnika
Type		članek
Source		Radiol Oncol
Vol. and No.		Letnik 40, št. 4
Publication year		2006
Volume		str. 231-7
Language		eng
Abstract		Background. Currently primary treatment options for esophageal cancer are surgery only or concomitant chemoradiotherapy (CRT) and the long-term survival of patients with locally advanced disease is rare. Preoperative concomitant CRT seems to be beneficial, mostly in patients who achieve a complete pathologic response (pCR) after CRT. In this retrospective analysis the efficiency and toxicity of preoperative CRT in patients with locally advanced esophageal cancer was analysed as well as the influence of pCR on the suraival. Patients and metkods From 1996 to 2002 41 patients with locoregionally confined esophageal cancerwere treated with cisplatin 75 mg/m2 and 5-FU 1000 mg/m2 as 4 day contonuous infusion starting on days 1. and 22. with concorrtitant radiotherapy 4500 cGy, 200-300 cGy/day. Esophagectomy followed 4-5 weeks after radiotherapy. After the surgery patients were followed-up regularly at 3-6 months intervals. Results. The pCR was achieved in 26.8% of patients. The overall median survival time was 18 months for all patients, 21.2 months for patients who achieved pCR and 16 months in those with residual disease (p= 0,79). Postoperative mortality rate was 22%. The median dose intensity for cisplatin was 92% and for 5-FU 71.5 of the planned dose. Disease recurred most often locoregionally (31.7%) and the overall recurrence rate was 43.9. Conclusion. Modern radiation techniques and the adequate dose intensity could further improve the locoregional control. The selection of patients without comorbid conditions and without already present distant metastases is essential for this combined treatment approach.
Summary		Izhodišča. Kirurško zdravljenje in zdravljenje s sočasno kemoradioterapijo (KRT) sta danes možna načina primarnega zdravljenja raka požiralnika. Dolgotrajno preživetje bolnikov z lokalno napredovalo boleznijo je redko. Zdravljenje teh bolnikov s preoperativno KRT bi lahko bilo koristno, zlasti pri dosegu patološkega popolnega odgovora (pP0) po KRT. V retrospektivni analizi smo analizirali učinkovitost in toksičnost preoperativne KRT pri bolnikih z lokalno napredovalim rakom požiralnika ter vpliv pP0 na preživetje. Bolniki in metode. Od leta 1996 do 2002 smo zdravili 41 bolnikov z lokalno napredovalim rakom požiralnika s cisplatinom 75 mg/m2 in 5-FU 1000 mg/m2 v štiridnevni kontinuirani infuziji s pričetkom 1. in 22. dan. Sočasno so prejeli 4500 cGy, 200-300 cGy/dan. Ezofagektomija je sledila 4-5 tednov po zaključeni radioterapiji. Po operaciji smo jih redno sledili na 3-6 mesecev. Rezultati. Pri 26,8% bolnikov je bil dosežen pPO. Čas srednjega preživetja je bil 18 mesecev za vse bolnike, 21,2 meseca za bolnike s pP0 in 16 mesecev za bolnike z rezidualno boleznijo (p = 0,79). Postoperativna smrtnost je bila 22%. Srednja intenziteta odmerka za cispiatin je bila 92% in za 5-FU 71,5% predvidenega celokupnega odmerka. Bolezen se je najpogosteje ponovila lokoregionalno (31,7%), celokupno se je bolezen ponovila v 43,9%. Zaključek. Sodobnejši načini radioterapije in zadostna intenziteta odmerka bi lahko prispevali k izboljšanju lokoregionalne kontrole. Za to kombiniran način zdravljenja je potrebna skrbna izbira bolnikov brez pridruženih sočasnih obolenj in oddaljenih zasevkov.
Descriptors		ESOPHAGEAL NEOPLASMS DISEASE-FREE SURVIVAL SURVIVAL ANALYSIS