Dr. Chang の 血液腫瘤筆記本

在荷蘭的CROSS study之後  (發表在NEJM 2012)

術前同時化電療(Pre-operative CCRT)後接著開刀幾乎可以確定打敗只有開刀治療

處方如下:

• Carboplatin (Paraplatin) AUC 2 IV on days 1, 8, 15, 22, 29; given second
• Paclitaxel (Taxol) 50 mg/m2 IV over 1 hour on days 1, 8, 15, 22, 29; given first
• Concurrent radiation therapy, 1.8 Gy fractions x 23 fractions given 5 days per week, starting on day 1, for a total dose of 41.4 Gy
• Surgery planned to be done within 6 weeks of finishing chemoradiation
  • van Hagen et al. 2012 said surgery was done as soon as possible after finishing chemoradiotherapy, preferably within 4-6 weeks

5-week course

(Data from: HemOnc.org)

兩組病人的分布差不多 (Age 60, Male 80%, T3 80%, N1 60%, Tumor length 5cm, adenocarcinoma 75%)

跟開刀相比   術前CCRT可以降低復發率 (58%  >>> 35%)

最主要的是   可以降低局部復發 (如接合處、縱隔等34% >>> 14%)  

降低腹膜的復發 (peritoneal carcinomatosis   14% >>> 4%)

而血液的散布也可以降低一些 (35% >>> 29%)

(data from: JCO February 10, 2014vol. 32 no. 5 385-391)

因此   術前CCRT的確可以被推薦使用

在台灣或許    很多病人會先接受開刀    除非一開始開不下來

然而根據這個強有力的研究    或許術前CCRT將來會更受青睞...