medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-527medsovet-8784Research ArticleХИМИОТЕРАПИЯCHEMOTHERAPYОпыт применения химиолучевого лечения рака пищевода с использованием химиотерапии по схеме FOLFOXThe experience of using chemoradiotherapy for esophageal cancer with the FOLFOX chemotherapy regimenhttps://orcid.org/0000-0001-8590-2350ТонеевЕ. А.ToneevE. A.

Тонеев Евгений Александрович, к.м.н., врач – торакальный хирург хирургического отделения торакальной онкологии; доцент кафедры факультетской хирургии, медицинский факультет имени Т.З. Биктимирова, Институт медицины, экологии и физической культуры

432017, Ульяновск, ул. 12 Сентября, д. 90

432017, Ульяновск, ул. Льва Толстого, д. 42

Evgeniy A. Toneev, Cand. Sci. (Med.), Thoracic Surgeon of the Surgical Department of Thoracic Oncology; Associate Professor of the Department of Faculty Surgery, Faculty of Medicine named after T.Z. Biktimirov Institute of Medicine, Ecology, and Physical Education

90, 12th Sentyabrya St., Ulyanovsk, 432017

42, Lev Tolstoy St., Ulyanovsk, 432017

e.toneev@inbox.ruhttps://orcid.org/0000-0002-6608-2745ДеньгинаН. В.DenginaN. V.

Деньгина Наталья Владимировна, к.м.н., врач-радиотерапевт, онколог, заведующая радиологическим отделением

432017, Ульяновск, ул. 12 Сентября, д. 90

Natalia V. Dengina, Cand. Sci. (Med.), Radiation Oncologist, Head of the Department of Radiotherapy

90, 12th Sentyabrya St., Ulyanovsk, 432017

indigo.radonc@gmail.comhttps://orcid.org/0009-0004-0218-666XШагдалеевР. Ф.ShagdaleevR. F.

Шагдалеев Роман Фатыхович, ординатор кафедры госпитальной хирургии, анестезиологии, реаниматологии, урологии, травматологии и ортопедии, факультет стоматологии, фармации и последипломного медицинского образования, Институт медицины, экологии и физической культуры

432017, Ульяновск, ул. Льва Толстого, д. 42

Roman F. Shagdaleev, Resident of the Department of Hospital Surgery, Anesthesiology, Resuscitation, Urology, Traumatology, and Orthopedics, Faculty of Dentistry, Pharmacy, and Postgraduate Medical Education, Institute of Medicine, Ecology, and Physical Education

42, Lev Tolstoy St., Ulyanovsk, 432017 

roman2000shagdaleev@gmail.comhttps://orcid.org/0000-0002-0827-0115ПрохоровД. Д.ProkhorovD. D.

Прохоров Даниил Дмитриевич, ординатор кафедры госпитальной хирургии, анестезиологии, реаниматологии, урологии, травматологии и ортопедии, факультет стоматологии, фармации и последипломного медицинского образования, Институт медицины, экологии и физической культуры

432017, Ульяновск, ул. Льва Толстого, д. 42

Daniil D. Prokhorov, Resident of the Department of Hospital Surgery, Anesthesiology, Resuscitation, Urology, Traumatology, and Orthopedics, Faculty of Dentistry, Pharmacy, and Postgraduate Medical Education, Institute of Medicine, Ecology, and Physical Education

42, Lev Tolstoy St., Ulyanovsk, 432017

prokhrow143@gmail.comhttps://orcid.org/0000-0003-4662-9886МартыновА. А.MartynovA. A.

Мартынов Александр Александрович, врач – торакальный хирург, заведующий хирургическим торакальным отделением

432017, Ульяновск, ул. 12 Сентября, д. 90

Alexander A. Martynov, Thoracic Surgeon, Head of the Surgical Thoracic Department

90, 12th Sentyabrya St., Ulyanovsk, 432017

katy-shis94@mail.ruhttps://orcid.org/0000-0002-8121-4654АнохинаЕ. П.AnokhinaE. P.

Анохина Екатерина Павловна, врач-онколог отделения химиотерапии №1

432017, Ульяновск, ул. 12 Сентября, д. 90

Ekaterina P. Anokhina, Oncologist of the Department of Chemotherapy No. 1

90, 12th Sentyabrya St., Ulyanovsk, 432017

katy-shis94@mail.ruОбластной клинический онкологический диспансер; Ульяновский государственный университетРоссияRegional Clinical Oncology Dispensary; Ulyanovsk State UniversityRussian FederationОбластной клинический онкологический диспансерРоссияRegional Clinical Oncology DispensaryRussian FederationУльяновский государственный университетРоссияUlyanovsk State UniversityRussian Federation2024221220240216269Copyright © Тонеев Е.А., Деньгина Н.В., Шагдалеев Р.Ф., Прохоров Д.Д., Мартынов А.А., Анохина Е.П., 20242024Тонеев Е.А., Деньгина Н.В., Шагдалеев Р.Ф., Прохоров Д.Д., Мартынов А.А., Анохина Е.П.Toneev E.A., Dengina N.V., Shagdaleev R.F., Prokhorov D.D., Martynov A.A., Anokhina E.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8784Введение

Введение. В течение длительного времени проводятся многочисленные работы по поиску оптимальной схемы лечения рака пищевода. Химиолучевая терапия продемонстрировала удовлетворительные результаты в лечении локальных и местнораспространенных форм данного заболевания. Однако поиском оптимальной схемы химиотерапии при проведении лучевой терапии в настоящий момент занимаются многие исследователи.

Цель

Цель. Определить эффективность и безопасность применения химиолучевой терапии по схеме FOLFOX у больных раком пищевода.

Материалы и методы

Материалы и методы. Проспективное исследование проведено на базе ГУЗ ОКОД г. Ульяновска. В анализ были включены пациенты, которым проводилась химиолучевая терапия по схеме FOLFOX в период с 01.12.2022 по 01.03.2024. Всего было проанализировано 19 случаев лечения больных раком пищевода I–III стадии, 5 (26,3%) пациентам впоследствии было выполнено радикальное оперативное лечение. Проведена оценка характеристик исследуемых пациентов по единому разработанному протоколу.

Результаты

Результаты. В исследуемой группе 18 (94,7%) пациентов закончили лечение в запланированном объеме. Одна пациентка получила неполный курс лучевой терапии, но весь объем запланированной химиотерапии. Наиболее распространенным гематологическим осложнением стала лейкопения, которая была отмечена у 9 пациентов (47,3%) по завершении полного курса химиолучевого лечения. Явлений фебрильной нейтропении не отмечено. Гематологические осложнения были корригируемыми и не стали причиной прекращения лечения. Среди негематологических осложнений наиболее часто регистрировалась тошнота 1–2-й степени у 11 (58%) пациентов, рвота 1–2-й степени наблюдалась лишь в 2 (10%) случаях и эффективно купировалась антиэметической терапией. Была проведена оценка общей и безрецидивной выживаемости. Причиной прекращения лучевой терапии 1 (5,3%) пациентки стал язвенный стоматит. Оперировано 5 пациентов, патоморфоз (TRG) по Mandard 1–2-й степени отмечен у 4 (80%) из них. У 1 (20%) пациента имелся ответ TRG 3-й степени.

Выводы

Выводы. После проведения химиолучевого лечения по схеме FOLFOX у оперированных пациентов с плоскоклеточным раком пищевода частота лечебного патоморфоза TRG1–2 достигает 80%. Безрецидивная одногодичная выживаемость составила 58%, а общая одногодичная выживаемость – 73%, что свидетельствует об эффективности и безопасности применения данной схемы химиотерапии в составе комплексного лечения рака пищевода.

Introduction

Introduction. For an extended period, numerous studies have been conducted to find the optimal treatment regimen for esophageal cancer. Chemoradiotherapy has demonstrated satisfactory results in the treatment of localized and locally advanced forms of this disease. However, the search for the best chemotherapy regimen in combination with radiotherapy remains a current focus of many researchers.

Aim

Aim. To evaluate the effectiveness and safety of chemoradiotherapy (CRT) using the FOLFOX regimen in patients with esophageal cancer.

Materials and methods

Materials and methods. A prospective study was conducted at the Ulyanovsk Regional Clinical Oncology Dispensary. The analysis included patients who received chemoradiotherapy with the FOLFOX regimen from December 1, 2022, to March 1, 2024. A total of 19 cases of esophageal cancer treatment at stages I–III were analyzed. Radical surgical treatment was subsequently performed on 5 patients (26.3%). The characteristics of the studied patients were evaluated according to a standardized protocol.

Results

Results. In the study group, 18 patients (94.7%) completed the planned course of treatment. One patient received an incomplete course of radiotherapy but completed the entire planned chemotherapy. The most common hematologic complication was leukopenia, observed in 9 patients (47.3%) after the full course of chemoradiotherapy. No cases of febrile neutropenia were reported. The hematologic complications were manageable and did not lead to the discontinuation of treatment. Among non-hematologic complications, the most frequently reported were grade 1–2 nausea in 11 patients (58%) and grade 1–2 vomiting in only 2 cases (10%), which was effectively controlled with antiemetic therapy. Overall and relapse-free survival were assessed. The reason for discontinuing radiotherapy in 1 patient (5.3%) was ulcerative stomatitis. Surgery was performed on 5 patients, with tumor regression (TRG) grades 1–2 according to the Mandard scale observed in 4 of them (80%). One patient (20%) had a TRG 3 response.

Conclusions

Conclusions. After chemoradiotherapy with the FOLFOX regime in patients with squamous cell carcinoma of the esophagus, the rate of therapeutic tumor regression (TRG1–2) in operated patients reached 80%. One-year relapse-free survival was 58%, one-year overall survival was 73%, indicating the effectiveness and safety of this chemotherapy regimen as part of the comprehensive treatment of esophageal cancer.

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The authors declare that there are no conflicts of interest present.