Blanke C D, Choy H, Teng M, Beauchamp R D, Leach S, Roberts J, Washington K, Johnson D H
Department of Medicine, Oregon Health Sciences University, Portland, OR 97201, USA.
Semin Radiat Oncol. 1999 Apr;9(2 Suppl 1):43-52.
Esophageal cancer is a major cause of morbidity and mortality worldwide. Although patients often present with apparently resectable disease, systemic spread frequently occurs before the development of symptoms and detection of tumor. The use of combined chemoradiation therapy, particularly before resection, appears to prolong survival and increase cure rates in certain histologic subtypes. Four randomized phase III trials compared preoperative chemoradiotherapy plus surgery with surgery alone. In trials including only patients with squamous histology, no improvement in survival was observed with preoperative chemoradiation therapy; however, in a trial including only patients with adenocarcinoma histology, improved median and overall survival were observed. Paclitaxel has been evaluated as a single agent in a phase II trial in previously untreated patients with locally advanced unresectable or metastatic esophageal cancer; the overall response rate was 32% and median survival was 13.2 months. Paclitaxel-based combinations also have been evaluated in esophageal cancer; particularly encouraging preliminary results have been achieved with paclitaxel/cisplatin/5-fluorouracil. Because paclitaxel is a potent radiosensitizer, it also has been evaluated in combination with radiation therapy for esophageal and other thoracic cancers, alone and in combination with other chemotherapeutic agents. Preliminary results suggest that neoadjuvant therapy with paclitaxel-based combinations (including 5-fluorouracil and cisplatin) and radiation is highly active, with variable toxicity. A goal of future trials is to assess paclitaxel-based combined modality therapy in combination with other new chemotherapeutic agents.
食管癌是全球发病和死亡的主要原因。尽管患者通常表现为看似可切除的疾病，但在症状出现和肿瘤检测之前，全身扩散经常发生。联合放化疗的使用，尤其是在切除术前使用，似乎可以延长某些组织学亚型患者的生存期并提高治愈率。四项随机III期试验比较了术前放化疗加手术与单纯手术的效果。在仅纳入鳞状组织学患者的试验中，术前放化疗未观察到生存期的改善；然而，在一项仅纳入腺癌组织学患者的试验中，观察到中位生存期和总生存期有所改善。在一项II期试验中，对先前未经治疗的局部晚期不可切除或转移性食管癌患者评估了紫杉醇单药治疗；总体缓解率为32%，中位生存期为13.2个月。基于紫杉醇的联合方案也已在食管癌中进行了评估；紫杉醇/顺铂/5-氟尿嘧啶取得了特别令人鼓舞的初步结果。由于紫杉醇是一种有效的放射增敏剂，它也已被评估与放疗联合用于食管癌和其他胸段癌，单独使用或与其他化疗药物联合使用。初步结果表明，基于紫杉醇的联合方案（包括5-氟尿嘧啶和顺铂）与放疗的新辅助治疗活性很高，但毒性各不相同。未来试验的一个目标是评估基于紫杉醇的联合治疗模式与其他新型化疗药物联合使用的效果。
