在食道癌症中进行外科化疗或外科前期化疗或放射治疗
Jens Hoeppner1, Thomas Brunner1, Claudia Schmoor1
1From Bielefeld University, Medical School and University Medical Center Ostwestfalen-Lippe, Campus Hospital Lippe, Detmold, Germany (J.H.); the Department of Radiation Oncology, Medical University of Graz, Graz, Austria (T.B.); the Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany (C.S.); the Institute of Surgical Pathology, University Medical Center Freiburg, Germany (P.B.); the Department of Surgery, University Medical Center Schleswig-Holstein-Campus Lübeck, Lübeck, Germany (B.K., T.K.); Comprehensive Cancer Center Augsburg, Faculty of Medicine, University of Augsburg, Augsburg, Germany (R.C.); the Department of General and Visceral Surgery, University Medical Center Freiburg, Freiburg, Germany (S.U.); the Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.R.I.); the Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute and San Raffaele Vita-Salute University, Milan (I.G.); the Department of General, Visceral, Thoracic, and Endocrine Surgery, Johannes Wesling University Hospital Minden, Ruhr University Bochum, Minden, Germany (B.G.); the Department of General, Visceral, and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany (M.G.); the Department of General, Visceral, Thoracic, Transplantation, and Pediatric Surgery, University Medical Center Schleswig-Holstein-Campus Kiel, Kiel, Germany (B.R.); the Department of General, Visceral, Transplantation, Vascular, and Pediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany (J.F.L.); the Department of General, Visceral, Cancer, and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany (C.B.); the Department of Hematology and Oncology, Sana Klinikum Offenbach, Offenbach am Main, Germany (E.R.); the Department of Surgery, Klinikum Dortmund, Klinikum der Universität Witten-Herdecke, Dortmund, Germany (M.S.); the Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany (F.B.); the Department of Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany (G.F.); the Department of Hematology, Oncology, and Cancer Immunology, Charité-University Medicine Berlin, Campus Virchow-Klinikum, Berlin (P.T.-P.); the Department of General, Visceral, Cancer, and Transplantation Surgery, University Hospital Essen, Essen, Germany (U.P.N.); the Department of General, Visceral, and Transplantation Surgery, University Hospital Muenster, Muenster, Germany (A.P.); the Department of Radiotherapy and Oncology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany (D.I.); the Division of Gastroenterology, Rheumatology, and Infectology, Department of Medicine, Charité-Universitätsmedizin Berlin, Berlin (S.D.); the Department of Surgery, Robert Bosch Hospital, Stuttgart, Germany (T.S.); the Department of Surgery, University Medical Center Erlangen, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany (C.K.); the Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany (S.Z.); the Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University Hospital, Munich, Germany (J.W.); the Department of Internal Medicine I, Klinikum Mutterhaus der Borromaerinnen, Trier, Germany (R.M.); the Departments of Hematology, Oncology, and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany (G.I.); the Department of General, Visceral, and Transplant Surgery, University Medical Center Mainz, Mainz, Germany (P.G.); and the Department of Medicine II, University Cancer Center Leipzig, Cancer Center Central Germany, University Medical Center Leipzig, Leipzig, Germany (F.L.).
与化学辐射疗法相比,用FLOT进行的外科化疗改善了可切除食道腺癌的存活率. 这种方法为患有这种具有挑战性的癌症的患者提供了更好的选择.
科学领域:
- 在瘤学瘤学.
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
背景情况:
- 可切除,局部晚期食道腺癌的最佳多模式治疗策略仍然是临床不确定性的领域.
- 在治疗规划中的一个关键辩论涉及比较术后化疗与术前化疗和放射治疗的疗效.
研究的目的:
- 为了确定FLOT (甲,莱可沃林,氧沙利和多塞塔克塞尔) 的术前化疗是否优于术前化疗放射治疗,以改善切除食道腺癌患者的整体存活率.
主要方法:
- 一个3期,多中心,随机试验,比较术前FLOT化疗加手术与术前化疗加手术.
- 纳入了没有转移性疾病的可切除食道腺癌 (cT1 cN+,cT2-4a cN+或cT2-4a cN0) 的患者.
- 疗效评估的主要终点是整体存活率.
主要成果:
- 与手术前化学放射治疗 (50.7%) 相比,术后FLOT显示了3年整体生存率 (57.4%) 的显著改善,危险比率为0.70 (P=0.01).
- 在FLOT组 (51.6%) 与化学辐射疗法组 (35.0%) 相比,在3年内无进展的生存率也明显更好.
- 3级或更高的不良事件在FLOT组 (58.0%) 比化学放射治疗组 (50.0%) 更频繁,但FLOT组的90天术后死亡率较低 (3.1%对5.6%).
结论:
- 使用FLOT疗法进行的术后化疗,与术前化疗和放射治疗相比,可切除食道腺癌患者的存活率更高.
- 这些发现支持FLOT作为这种患者群体首选的新辅助治疗策略.
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