PATHOLOGIC COMPLETE RESPONSE (YPT0 YPN0) AFTER CHEMOTHERAPY AND RADIOTHERAPY NEOADJUVANT FOLLOWED BY ESOPHAGECTOMY IN THE SQUAMOUS CELL CARCINOMA OF THE ESOPHAGUS

ABSTRACT Background: Esophageal squamous cell carcinoma is an aggressive neoplasia that requires a multidisciplinary treatment in which survival and prognosis are still not satisfactory. The complete pathologic response to neoadjuvant chemotherapy and radiotherapy is considered a good prognosis factor, and esophagectomy is indicated. Aim: Survival analysis of cases with pathologic complete response (ypT0 ypN0) to neoadjuvant chemotherapy and/or radiotherapy, submmitted to esophagectomy. Methods: Between 1983-2014, 222 esophagectomies were performed, and 177 were conducted to neoadjuvant treatment. In 34 patients the pathologic response was considered complete. Medical records of the patients were retrospectively reviewed regarding type of chemotherapy applied, amount of radiotherapy, interval between the neoadjuvant therapy and the surgery, body mass index; postoperative complications; hospital admission time and survival. Results: The average age was 55.8 years. Twenty-five patients were subjected to chemotherapy and radiotherapy, and nine to neoadjuvant radiotherapy. The total radiation dose ranged from 4400 until 5400 cGy. The chemotherapy was performed with 5FU, cisplatin, and carbotaxol, concomitantly with the radiotherapy. The esophagectomy was transmediastinal, followed by the cervical esophagogastroplasty performed on a average of 49.4 days after the neoadjuvant therapy. The hospital admission time was an average of 14.8 days. During the follow-up period, 52% of the patients submitted to radiotherapy and chemotherapy were disease-free, with 23.6% of them presenting more than five years survival. Conclusions: The neoadjuvant treatment followed by esophagectomy in patients with pathologic complete response is beneficial for the survival of patients with esophageal squamous cell carcinoma.

摘要 背景：食管鳞状细胞癌（Esophageal squamous cell carcinoma）是一种侵袭性肿瘤，需采用多学科综合治疗，但其患者的生存与预后仍未达到理想水平。新辅助化疗（neoadjuvant chemotherapy）和/或放疗（radiotherapy）后的完全病理缓解（pathologic complete response）被视作良好的预后因素，此类患者可考虑施行食管切除术（esophagectomy）。目的：本研究旨在对接受新辅助化疗和/或放疗后达到病理完全缓解（ypT0 ypN0）并接受食管切除术的患者开展生存分析。方法：1983年至2014年间，共完成222例食管切除术，其中177例患者术前接受了新辅助治疗，34例被判定为病理完全缓解。本研究回顾性分析了患者的病历资料，涵盖所使用的化疗方案、放疗剂量、新辅助治疗至手术的间隔时间、体重指数、术后并发症、住院时长及生存情况。结果：患者平均年龄为55.8岁。其中25例接受了化疗联合放疗，9例仅接受新辅助放疗。总放射剂量范围为4400至5400 cGy。化疗方案采用5FU、顺铂（cisplatin）及卡紫杉醇（carbotaxol），与放疗同步实施。手术方式为经纵隔食管切除术，术后平均在新辅助治疗后49.4天行颈部食管胃成形术（cervical esophagogastroplasty）。患者平均住院时长为14.8天。随访期间，接受放化疗的患者中52%达到无病生存，其中23.6%的患者生存期超过5年。结论：对于食管鳞状细胞癌患者，术前接受新辅助治疗并达到病理完全缓解后行食管切除术，可显著改善患者的生存预后。