New England Journal of Medicine· 2012Q1· Klinik çalışma
Özafagus veya Birleşme Kanseri için Preoperatif Kemoradyoterapi
Preoperative Chemoradiotherapy for Esophageal or Junctional Cancer
- 5.511atıf
- Q1SCImago
- 2012yıl
Kısa özet
Ameliyat öncesi kemoradyoterapiyi takiben yapılan cerrahi, potansiyel olarak kür edilebilir özofagus veya özofagogastrik bileşke kanseri hastalarında, yalnızca cerrahiye kıyasla ortalama genel sağkalımı 25 aydan fazla önemli ölçüde iyileştirmiştir.
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Ana noktalar
- Ameliyat öncesi kemoradyoterapi artı cerrahi, ortalama genel sağkalımı 24,0 aydan 49,4 aya çıkarmıştır.
- Preoperatif tedavi eklenmesiyle tam tümör rezeksiyonu (R0) oranları %69'dan %92'ye yükselmiştir.
- Kemoradyoterapi sonrası rezeksiyon yapılan hastaların %29'unda patolojik tam yanıt gözlenmiştir.
- Major hematolojik toksisiteler düşük (%6 löykeni, %2 nötropeni) ve hematolojik olmayan toksisiteler de yönetilebilirdi (%5 anoreksi, %3 yorgunluk).
- Ameliyat sonrası komplikasyonlar ve hastane içi mortalite, kemoradyoterapi-cerrahi ve yalnızca cerrahi grupları arasında benzerdi.
Yapay zekâ ile başlık ve abstract'tan üretildi; tam metin okunmaz.
Özet (abstract)
BACKGROUND: The role of neoadjuvant chemoradiotherapy in the treatment of patients with esophageal or esophagogastric-junction cancer is not well established. We compared chemoradiotherapy followed by surgery with surgery alone in this patient population. METHODS: We randomly assigned patients with resectable tumors to receive surgery alone or weekly administration of carboplatin (doses titrated to achieve an area under the curve of 2 mg per milliliter per minute) and paclitaxel (50 mg per square meter of body-surface area) for 5 weeks and concurrent radiotherapy (41.4 Gy in 23 fractions, 5 days per week), followed by surgery. RESULTS: From March 2004 through December 2008, we enrolled 368 patients, 366 of whom were included in the analysis: 275 (75%) had adenocarcinoma, 84 (23%) had squamous-cell carcinoma, and 7 (2%) had large-cell undifferentiated carcinoma. Of the 366 patients, 178 were randomly assigned to chemoradiotherapy followed by surgery, and 188 to surgery alone. The most common major hematologic toxic effects in the chemoradiotherapy-surgery group were leukopenia (6%) and neutropenia (2%); the most common major nonhematologic toxic effects were anorexia (5%) and fatigue (3%). 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% in the surgery group (P<0.001). A pathological complete response was achieved in 47 of 161 patients (29%) who underwent resection after chemoradiotherapy. Postoperative complications were similar in the two treatment groups, and in-hospital mortality was 4% in both. Median overall survival was 49.4 months in the chemoradiotherapy-surgery group versus 24.0 months in the surgery group. Overall survival was significantly better in the chemoradiotherapy-surgery group (hazard ratio, 0.657; 95% confidence interval, 0.495 to 0.871; P=0.003). CONCLUSIONS: Preoperative chemoradiotherapy improved survival among patients with potentially curable esophageal or esophagogastric-junction cancer. The regimen was associated with acceptable adverse-event rates. (Funded by the Dutch Cancer Foundation [KWF Kankerbestrijding]; Netherlands Trial Register number, NTR487.).
Yazarların özeti; kaynağından alınmıştır. New England Journal of Medicine, 2012 · DOI ↗
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