Msika S, Hay J M
Service de Chirurgie Générale et Digestive, Hôpital Louis Mourier, Colombes.
J Chir (Paris). 2002 Feb;139(1):17-24.
Radiotherapy and chemotherapy have been used for more than twenty years as adjuvant treatment of operable cancer of the esophagus. The palliative effect of adjuvant (or neoadjuvant) radio- and/or chemotherapy has been demonstrated in numerous randomized trials. The purpose of this review is to present the principal randomized trials conducted in the treatment of operable cancer of the esophagus. Alone, radiotherapy does not significantly improve survival in patients with operable cancer of the esophagus, irrespective of the pre- or postoperative timing (three trials and one meta-analysis for preoperative, three trials for postoperative, and one trial for pre- and postoperative radiotherapy). Likewise, alone chemotherapy does not significantly improve survival whether given preoperatively (four trials), postoperatively (two trials) or pre- and postoperatively (one trial). Radiochemotherapy combinations appear to provide more hope, but preliminary results are insufficient to draw a clear conclusion. Nevertheless, trial comparing radiotherapy results with chemotherapy, conducted pre- or postoperatively (four trials) appear to demonstrate a significant effect of chemotherapy. The two trials using neoadjuvant therapy have been conducted on patients with adenocarcinomas of the cardia and/or the lower esophagus and have demonstrated very encouraging results for a small number of patients. Finally, the Herslovic trial, while conducted in patients who were initially inoperable, is the only one which has demonstrated superiority of radiochemotherapy over radiotherapy alone. In conclusion, there is still much room for improvement in survival using combined radio- and chemotherapy with different forms (new agents, new associations) and treatment modes (pre- and postoperative or postoperative alone). Despite the wide use of radiotherapy and chemotherapy for cancer of the esophagus, it must be recalled that surgical resection remains the method providing the best chances of survival.
放疗和化疗作为可手术食管癌的辅助治疗手段已应用二十多年。辅助（或新辅助）放疗和/或化疗的姑息治疗效果已在众多随机试验中得到证实。本综述的目的是介绍在可手术食管癌治疗中开展的主要随机试验。单独放疗并不能显著提高可手术食管癌患者的生存率，无论放疗是在术前还是术后进行（术前放疗有三项试验和一项荟萃分析，术后放疗有三项试验，术前及术后放疗有一项试验）。同样，单独化疗无论在术前（四项试验）、术后（两项试验）还是术前及术后（一项试验）进行，都不能显著提高生存率。放化疗联合似乎带来了更多希望，但初步结果尚不足以得出明确结论。然而，术前或术后比较放疗与化疗结果的试验（四项试验）似乎显示化疗有显著效果。两项采用新辅助治疗的试验针对的是贲门和/或食管下段腺癌患者，且已在少数患者中取得了非常令人鼓舞的结果。最后，赫斯洛维奇试验虽然针对的是最初无法手术的患者，但它是唯一一项证明放化疗优于单纯放疗的试验。总之，采用不同形式（新药物、新联合方案）和治疗模式（术前及术后或仅术后）的放化疗联合在提高生存率方面仍有很大改进空间。尽管放疗和化疗在食管癌治疗中广泛应用，但必须记住，手术切除仍然是提供最佳生存机会的方法。
