食管癌被诊断时多已处于局部晚期。单独手术的最佳效果较差,综合治疗已被确立为食管癌II~III期的标准治疗。这篇综述重点关注食管癌管理的最新证据,集中描述局部晚期食管癌的各种不同治疗方法的不同差异。主要区别在于诱导治疗的选择。大多数证据支持新辅助放化疗后进行手术治疗鳞状细胞癌和腺癌。
Esophageal cancer is usually diagnosed at a locally advanced stage. The best results of surgery alone are poor, and combined therapy has been established as the standard of treatment for stage II~III esophageal cancer. This review focuses on the latest evidence on the management of esophageal cancer and focuses on the differences between different treatments for locally advanced esophageal cancer. The main difference is in the choice of induction therapy. Most evidence supports surgical treatment of squamous cell carcinoma and adenocarcinoma after neoadjuvant chemoradiotherapy.
综合治疗,食管癌,食管癌切除术, Combined Modality Therapy Esophageal Cancer Esophagectomy摘要
Treatment Model of Locally Advanced Esophageal Cancer
Hailing Duan1, Honglan Qu2*
1Second Clinical Medical College, Inner Mongolia University for nationalities, Yakeshi Inner Mongolia
2Inner Mongolia Forestry General Hospital, Yakeshi Inner Mongolia
Received: May 20th, 2022; accepted: May 31st, 2022; published: Jun. 13th, 2022
ABSTRACT
Esophageal cancer is usually diagnosed at a locally advanced stage. The best results of surgery alone are poor, and combined therapy has been established as the standard of treatment for stage II~III esophageal cancer. This review focuses on the latest evidence on the management of esophageal cancer and focuses on the differences between different treatments for locally advanced esophageal cancer. The main difference is in the choice of induction therapy. Most evidence supports surgical treatment of squamous cell carcinoma and adenocarcinoma after neoadjuvant chemoradiotherapy.
MAGIC试验 [8] 中术前和术后给予以顺铂、5-FU和表柔比星为基础的化疗(各3个周期)。入组患者主要包括胃癌患者,其中有一个亚组的患者是食管胃交界处和食管癌。围手术期化疗改善了无病生存率和总生存率(P < 0.0001),围手术期化疗的5年总生存期为36%,而单纯手术的5年总生存期为23%。全国癌症研究中心联合会的一项试验 [9],共224例可手术切除的远端食管、胃食管交界处和胃腺癌患者被纳入研究,其中113例随机分为围手术期化疗组,111例单独手术组。接受围手术期化疗的患者总生存率较单纯手术组得到了改善(P = 0.02)。对于接受围手术期化疗组的患者有较高的无病生存率(38% vs 19%, P = 0.01)和R0切除率(87% vs 74%, P = 0.004)。
3. 新辅助放化疗
杨洪等人 [10] 最近报道III期随机临床试验的结果(NEOCRTEC5010),该试验比较了新辅助放化疗手术后与单独手术的结果,新辅助放化疗的pCR为43.2%,R0切除率(98.4% vs 91.2%)、中位生存期(100.1个月vs 66.5个月)、无病生存率(100.1个月vs 41.7个月)和3年总生存率(69.1% vs 58.9%)。在多变量因素分析中,新辅助放化疗是改善总生存期的独立因素。
段海玲,曲洪澜. 局部晚期食管癌治疗模式的研究进展Treatment Model of Locally Advanced Esophageal Cancer[J]. 世界肿瘤研究, 2022, 12(03): 107-110. https://doi.org/10.12677/WJCR.2022.123014
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