RESUMEN
In the open, comparative, non-randomized and prospective study conducted from 2007 to 2014 there were included 83 patients who received combined treatment for thoracic esophageal cancer. For a comparative analysis there was used a retrospective control group of 51 patients with esophageal cancer who had undergone surgery alone from 1999 to 2014. Complex treatment of patients with advanced forms of thoracic esophageal cancer included argon-plasma recanalization of the lumen of the esophagus followed by neoadjuvant chemoradiotherapy in two versions. One group of patients (29) received external beam radiotherapy, prescription dose of 40-45 Gy, the other group of patients (54) received intraluminal brachytherapy, 3 sessions of 7 Gy, prescription dose of 21 Gy. All patients synchronously with radiotherapy there were performed two cycles of polychemotherapy on PF scheme. A month after the neoadjuvant treatment there was carried out resection of the esophagus with simultaneous plastics by gastric stem. Complete local tumor regression was achieved in 34,7% of patients in group with intraluminal brachytherapy and 30% in the group with external beam radiotherapy. Long-term results could be traced in 90.8% of patients. Using chemoradiotherapy on preoperative stage we managed to increase disease-free and overall survival of patients with an increase of median of progression-free survival - 27 against 12 months and overall survival - 29 against 14 months in comparison with surgery alone.
Asunto(s)
Neoplasias Esofágicas/terapia , Neoplasias Torácicas/terapia , Supervivencia sin Enfermedad , Neoplasias Esofágicas/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Tasa de Supervivencia , Neoplasias Torácicas/mortalidadRESUMEN
During the period from April 2012 to December 2014 54 patients aged 29-76 years, 36 (66.6%) males and 18 (33.4%) females, with esophageal cancer underwent minimally invasive esophagectomy as final phase of treatment. Squamous cell carcinoma was diagnosed in 50 patients and adenocarcinoma identified in 4 patients. The disease was staged as follows: IA--5 (9.3%) patients, IB--11 (20.4%) patients, IIA-- (16,.%) cases, III -- (3,.%) cases, IIII --8 (33,.%), IIII -- (14,8%), III -- (1,.%). 37 (68,.%) patients had surgery after induction chemoradiation therapy. Of 54 surgical interventions there were 20 hybrid and 34 minimally invasive operations. 19 (35,.%) patients developed complications, postoperative mortality was 2 (3,.)%. Minimally invasive esophagectomy meets basic oncological principles and leads to tolerable short-term results.
Asunto(s)
Neoplasias Esofágicas/cirugía , Esofagectomía/métodos , Adenocarcinoma/cirugía , Adulto , Anciano , Carcinoma de Células Escamosas/cirugía , Quimioradioterapia Adyuvante , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/terapia , Esofagectomía/mortalidad , Femenino , Humanos , Quimioterapia de Inducción , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Estadificación de Neoplasias , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Neoplasias Esofágicas/cirugía , Esofagectomía , Procedimientos Quirúrgicos Mínimamente Invasivos , Ensayos Clínicos como Asunto , Esofagectomía/efectos adversos , Esofagectomía/métodos , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Evaluación de Procesos y Resultados en Atención de SaludRESUMEN
For treatment of cancer of the thoracic esophagus, the method of neoadjuvant chemoradiotherapy (CRT) with a use of intraluminal brachytherapy (BT) was performed. The study included 51 patients (mean age 56.9 ± 4.3 years). The length of the primary tumor up to 6 cm was determined in 18 patients, more than 6 cm--33 patients. CRT included three BT sessions (7Gy X 3; q7d) and two cycles of chemotherapy (PF; q28d). After CRT in 30 (62.4%) patients there was marked a complete or partial radiological tumor regression. In 40-45 days after CRT surgery performed. Subtotal resection of esophagus of the Lewis type was performed in 29 cases, transtracheal ex- tirpation of the esophagus--in 2, minimally invasive esopha- gectomy--in 17 cases. Postoperative complications occurred in 22 (44%) patients; one patient died (2%). In 11 (23%) patients morphological investigation revealed a complete regression of the primary tumor. Thus, a use of intraluminal BT in combination with chemotherapy in many cases promoted reducing the size of the primary tumor of the esophagus, which was an effective factor in improving surgical results.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Braquiterapia , Neoplasias Esofágicas/radioterapia , Esofagectomía , Terapia Neoadyuvante/métodos , Adulto , Anciano , Anciano de 80 o más Años , Quimioradioterapia Adyuvante , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del TratamientoRESUMEN
An investigation included 33 patients with cancer of thoracal section of the esophagus at the age from 42 to 74 years old. A surgical method of treatment was applied as only one in 13 patients and methods of nonadjuvant chemoradiation therapy were used for 20 patients. A hybrid minimally invasive esophagectomy (laparoscopic mobilization of the stomach and right-side thoracotomy) was performed on 16 patients. The rate of postoperative complications consisted of 31%. The minimally invasive esophagectomy (performed by totally endovideosurgical approach) was carried out in 15 cases. Postoperative complications developed in 53% of follow-up patients. There weren't cases of lethality. The experience of minimally invasive methods indicated the satisfactory results of application of given methods in patient treatment of esophageal cancer. The use of endovideosurgical approaches allowed performing oncologically adequate volume of operative interventions.