Yesterday, the Cancer Center of Sun Yat-sen University was released to the public. The phase III clinical trial results of a new adjuvant chemotherapy and radiotherapy and surgical treatment of locally advanced esophageal squamous cell carcinoma led by the center Fu Jianhua and Professor Liu Mengzhong were officially announced on August 9, 2018. Published in the Journal of Clinical Oncology (hereinafter referred to as JCO). This is the first time since the publication of JCO that the results of clinical research on esophageal cancer led by Chinese doctors have been published.
After 10 years of data tracking and rigorous statistics of more than 400 clinical patients, this study proves that in the traditional simple surgical treatment, the removal of visible lesions on the naked eye, the scope of pre-operative radiotherapy and chemotherapy in the patient's body can be "killed" and invisible to the naked eye. The cancer cells can effectively control postoperative recurrence and metastasis, and the patient's five-year survival is expected to exceed 50%, significantly extending life.
Esophageal cancer in China:
Morbidity and mortality account for more than half of the world
The project leader, Professor Fu Jianhua, chief physician of the Department of Thoracic Surgery, and the chief expert of esophageal cancer treatment at the Cancer Center of Sun Yat-sen University, said that esophageal cancer is the sixth most common malignant tumor in the world. China is a country with high incidence of esophageal cancer, with morbidity and mortality accounting for more than half of the world. There are 259,000 new cases and 211,000 deaths each year. More than 90% of Chinese esophageal cancer is squamous cell carcinoma, which seriously threatens people's health and life. At present, surgery is the main method for the treatment of esophageal cancer, but the 5-year survival rate of patients with locally advanced esophageal cancer is only 20.64% to 34.00%.
It is understood that there is no sufficient evidence for the optimal treatment of locally advanced esophageal squamous cell carcinoma. Although studies from European and American countries have discussed the efficacy of "surgical treatment of locally advanced esophageal squamous cell carcinoma with neoadjuvant chemoradiotherapy", there are still problems such as too small sample size and inconsistent final results. The level of evidence is limited. However, the treatment of this cancer in China generally lacks the concept of comprehensive treatment. Although foreign preoperative neoadjuvant therapy has become a trend, there is still a lack of strong Chinese data support in the domestic implementation. Therefore, for Asian countries with high incidence of esophageal squamous cell carcinoma such as China and Japan, it is of great clinical significance to further carry out such research for Asian populations.
In addition, because China is in the world with high incidence of esophageal cancer, and most of the Asian population suffering from esophageal cancer is squamous cell carcinoma, this study is equivalent to providing a set of "tailor-made" treatment programs for a large number of patients in China.
Ten years of grinding a sword:
Eight centers work together to sustain patients
Fu Jianhua introduced that the study was initiated in 2007. After 10 years, 8 domestic cancer prevention and treatment centers participated in the study. A total of 451 patients were enrolled, randomly divided into 224 patients in the preoperative chemoradiotherapy group and 227 patients in the simple surgery group. The efficacy comparison, the researchers performed follow-up tracking of these patients for more than three years. The study found that patients who received radiotherapy and chemotherapy before surgery, the pathological examination results were completely relieved (that is, the cut lesions after pathological examination, it has been found that no cancer cells) reached 43.2%. The final results confirmed that preoperative radiotherapy and chemotherapy can prolong the overall survival of locally advanced esophageal cancer, and extend the median survival life of patients with esophageal cancer by nearly 50%.
Fu Jianhua lamented that such a large-scale clinical study of “a decade of grinding a sword†requires team members to “stand the lonelinessâ€. The time period is long, the progress of personnel enrollment is slow, and the compliance is poor. Doctors and patients are worried about the safety of preoperative radiotherapy and chemotherapy treatment mode. It is considered that the physical condition of patients with advanced disease is already very poor and cannot withstand the side effects of radiotherapy and chemotherapy. pain. At the beginning of the face of difficulties, everyone has only one solution, that is, persistence. Adhere to high quality to do each of the cases, and continue to optimize the research program.
With the advancement of research, the curative effect gradually appeared. In mid-2011, the interim analysis was carried out as scheduled. The results confirmed that the short-term efficacy of preoperative radiotherapy and chemotherapy was high, the safety was good, the researchers had stronger confidence, and the patient's compliance improved significantly. The progress of the group has been greatly improved, and all the targets for the group have finally been completed by the end of 2014. Through multi-center 10 years of cooperation, we have completed the excellent clinical research of Chinese researchers themselves, and established the status of preoperative radiotherapy and chemotherapy and surgical treatment of locally advanced esophageal squamous cell carcinoma at home and abroad, which will also optimize domestic Guidelines for the treatment of external esophageal cancer, the promotion of comprehensive treatment of esophageal cancer, for the benefit of esophageal cancer patients play a major role, high-level answers to the focus of the field of international esophageal cancer.
Newly diagnosed patients
Three to 40% for new programs
Fu Jianhua introduced that the surgery can only remove the tumor seen by the naked eye, and can not catch the cancer cells that are invisible to the naked eye. In the past, the failure of esophageal cancer treatment was due to postoperative tumor metastasis and local recurrence. Now, the preoperative chemotherapy drugs act on the whole body and radiation therapy penetrates the lesions. The superposition effect is larger, the lesions are reduced, and the number and activity of cancer cells are reduced. Before the operation, the scope of "killing" cancer cells will be expanded to achieve "downgrade" of the tumor, which can reduce the difficulty of surgery and control the recurrence and metastasis of the operation. It can be said that "one plus one is greater than two."
According to reports, at present, there are more than 1,000 newly diagnosed esophageal cancer patients at the Zhongda Cancer Center, 70% to 80% of which are locally advanced and advanced patients, and nearly half of them, that is, all newly diagnosed patients. Among them, 30% to 40% are suitable for this new treatment for treatment, and it is expected to benefit from it. (Reporter Zhou Jieying correspondent Yu Guangwei, Yang Sen)
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