식도암의 근치적 치료성적 및 예후인자

Treatment Result and Prognostic Factors in Patients with Esophageal Cancer

Purpose : To analyse clinical outcome and prognostic factors according to treatment modality, this paper report out experience of retrospective study of patients with esopahgeal cancer. Materials and Methods : One hundred and ten patients with primary esopahgeal cancer who were treated in Presbyterian Medical Center from May 1985 to December 1992. We analysed these patients retrospectively with median follow up time of 28 months, one hundred and four patients(95%) were followed up from 15 to 69 months. In methods, twenty-eight patients were treated with median radiation dose irradiated 54.3Gy only. Fifty-sex patients were treated with combined chemoradiothearpy. Sixteen cases of these patients were treated with concurrent chemoradiation and the other patients(forty cases) were treated sequential chemoradiotherapy. In concurrent chemoradiotherapy group, patients received 5-FU continuous Ⅳ infusion for 4 days. Cisplatin Ⅳ bolus, and concurrent esophageal irradiation to 30 Gy. After that patients received 5-FU continuous Ⅳ. Cisplatin bolus injection and Mitomycin-C bolus Ⅳ. Bleomycin continuous Ⅳ, and irradiation to 20 Gy. In sequential chemoradiotherapy group, the chmotherapy consisted of 5-FU 1,000mg/m² administred as a continuous 24 hour intravenous infusion during five days and Cisplatin 80-100mg/m² bolus injected, or Bleomycin. Vinblastine, Cisplatin, Methotrexate were used of 1 or 2 cycles. After preoperative concurrent chemoradiation, twenty-six patients underwent radical esopagectomy. Results : Ninety-three patients could be examined for response assessment. By treatment modality, response rates were 85.1% for radiation alone group and 86.3% for combined chemoradaition group. But in operation group, after one cycle of concurrent chemoradiation treatment, response rate was 61.9%. The pathologic complete response were 15.4% in peration group. Overall median survival was 11 months and actuarial 5-year survival rate was 8%. The median survival interval was 6 months for radiation alone group. 11 months for combined chemoradiation group and 19 months for operation group. And also median survival was 19 months for complete responder group that 8 months for noncomplete responder group. In univariative analysis, statistically significant prognostic factors were tumor size, clinical stage, tumor response, and operation. In multivariative analysis, significantly better survival was associated with clinical stage, tumor response, radiation dose, and operation. Conclusion : Compared with radiotherapy alone, combined multimodality may imporve the median survival in patients with localized carcinoma of the esopahgus and toxicity is acceptable.