Gamliel Ziv, Krasna Mark J
Division of Thoracic Surgery, University of Maryland Medical Center, 22 South Greene Street, N4E35, Baltimore, MD 21201, USA.
Surg Clin North Am. 2005 Jun;85(3):621-30. doi: 10.1016/j.suc.2005.01.011.
Stage specific management of non-small cell lung cancer is widely accepted. The use of pretreatment disease stage to guide therapy for esophageal cancer is an intellectually appealing concept. To date, there isa relative lack of data upon which one may base stage specific treatment decisions for esophageal carcinoma. This is because thorough pretreatment TNM staging is not universally practiced. As a result, stage-specific treatment varies widely. Based upon the available data, surgery alone may be appropriate for resectable, node-negative disease. In the case of clearly un-resectable disease, definitive chemoradiation is indicated.The value of neoadjuvant or adjuvant treatment modalities in the case of clearly resectable node-negative disease (TlN0 or T2N0) is questionable;however, in the presence of lymph node involvement (N1), or in the case of a marginally resectable primary tumor (T3 or T4), neoadjuvant chemoradiation is probably indicated. Although the achievement ofa complete pathologic response following chemoradiation may obviate surgical resection, even microscopic residual cancer can result in local recurrence. To date, there is no reliable method of ascertaining a complete pathologic response before surgical resection. Therefore, when feasible, the addition of surgical resection following chemoradiation is warranted. Future treatment trials for esophageal cancer should include rigorous pretreatment staging protocols to elucidate stage-specific results of therapy.
非小细胞肺癌的阶段特异性管理已被广泛接受。利用术前疾病分期来指导食管癌治疗是一个颇具吸引力的概念。迄今为止，缺乏可作为食管癌阶段特异性治疗决策依据的数据。这是因为全面的术前TNM分期并未普遍实施。因此，阶段特异性治疗差异很大。根据现有数据，对于可切除、无淋巴结转移的疾病，单独手术可能是合适的。对于明显不可切除的疾病，则应进行根治性放化疗。对于明显可切除且无淋巴结转移的疾病（T1N0或T2N0），新辅助或辅助治疗方式的价值存在疑问；然而，存在淋巴结受累（N1）或原发性肿瘤边缘可切除（T3或T4）的情况时，可能需要新辅助放化疗。尽管放化疗后实现完全病理缓解可能无需手术切除，但即使是微小残留癌也可能导致局部复发。迄今为止，在手术切除前尚无确定完全病理缓解的可靠方法。因此，在可行的情况下，放化疗后应加行手术切除。未来的食管癌治疗试验应包括严格的术前分期方案，以阐明阶段特异性治疗结果。
