Lokal ileri evre özefagus kanserinde kemoradyoterapi deneyimimiz

Abstract

Amaç: Bu çalışmada lokal ileri evre özefagus kanseri tanısıyla neoadjuvan/ definitif kemoradyoterapi (KRT) uygulanan hastaların sonuçlarının bildirilmesi amaçlanmıştır. Hastalar ve Yöntem: Histolojik tanısı skuamöz hücreli 10, adenokarsinom 4, adenoskuamöz karsinom 1 olan, T3N0M0 5 veya T3N1M0/T4N0M0 10, toplam 15 hasta geriye dönük olarak incelendi. Ortanca radyoterapi dozu 50 Gy (1,8-2 Gy/gün, 5 fraksiyon/hafta) olup eş zamanlı kemoterapi radyoterapinin ilk ve son hafta sisplatin ve 5-florourasil olarak uygulandı. Bulgular: Eş zamanlı kemoterapinin kesintisiz uygulanabilirlik oranı %80 idi. Medyan takip 15 ay (aralık, 3-70 ay) idi. Neoadjuvan olarak tedavi edilen beş hastadan birinde lokal progresyon, üçünde uzak metastaz izlendi. Baştan definitif KRT planlanan hastalardan üçüne (%30) evrede küçülme izlenerek cerrahi önerildi. İki yıllık lokal kontrol (LK) %22, uzak metastazsız sağkalım (UMSK) %45 ve genel sağkalım (GSK) %31 olarak saptandı. Derece III disfaji oranı %6 idi. Sonuç: Lokal ileri evre özefagus kanserinde tedavi tartışmalıdır. Cerrahi şansını elde eden hastalarda daha uzun sağkalım ve lokal kontrol bildirilirken üçlü modalite tedavilerin yapılabilirliği merkezin deneyimi ile sınırlıdır. Bu nedenle tüm hastalar bireysel olarak ve multidisipliner yaklaşım ile değerlendirilmelidir.

Objective: In this study, we report our neoadjuvant/definitive chemoradiotherapy (CRT) experience in locally advanced esophageal cancer patients. Patients and Methods: A total of 15 patients were retrospectively evaluated. Histological diagnosis were as follows: squamous cell 10, adenocarcinoma 4, adenosquamous carcinoma1. Initial stage was T3N0M0 5 or T3N1M0/T4N0M0 10. Radiotherapy was administered at median of 50 Gy (1.8-2 Gy/day, 5 fractions/week) and cisplatin and 5-fluorouracil were given concurrently on the first and the last week of radiotherapy. Results: Continuous applicability of concurrent chemoradiotherapy was 80%. Median follow-up was 15 months (range, 3-70 months). One of the five patients who were treated with neoadjuvant approach had local progression,and three had distant metastasis. Three patients (30%) who were planned to be treated with definitive CRT had downstaging and surgery was recommended. Two-year local control rate was 22%, distant metastasis-free survival rate was 45% and overall survival rate was 31%. Grade III dysphagia was observed in 6% of patients. Conclusion: Treatment of locally advanced esophageal cancer remains controversial. Although patients who had surgery were reported to have longer survival and better local control rates, the feasibility of triple-modality treatment is limited to the center's experience. For this reason, all patients should be evaluated individually with a multidisciplinary approach.