Lordick F
Interdisziplinäres Tumortherapiezentrum am Klinikum rechts der Isar, Technische Universität München.
Chirurg. 2005 Nov;76(11):1025-32. doi: 10.1007/s00104-005-1098-7.
Neoadjuvant treatment for locally advanced squamous cell carcinoma of the esophagus is widely used, despite minimal evidence of its efficacy. With only a minor effect on survival, the benefits of neoadjuvant radiotherapy alone appear to be limited. The same is true for neoadjuvant chemotherapy alone. While no single randomized study has shown a statistically significant result favoring neoadjuvant chemoradiation vs no treatment, the results of three meta-analyses indicate a prognostic benefit. Unfortunately, earlier chemoradiation protocols were associated with considerable side effects and contributed to perioperative morbidity and mortality. In contrast, modern chemoradiation protocols were revealed to be feasible when carried out in experienced institutions. Therefore, neoadjuvant chemoradiation is indicated in locally advanced stages. Patients should be referred to specialized centers for initial treatment planning and resection, and they should be enrolled in clinical studies whenever possible.
新辅助治疗在局部晚期食管鳞状细胞癌中被广泛应用，尽管其疗效的证据极少。单独的新辅助放疗对生存率仅有微小影响，其益处似乎有限。单独的新辅助化疗亦是如此。虽然尚无单一随机研究显示新辅助放化疗相对于不治疗有统计学显著优势，但三项荟萃分析的结果表明其有预后益处。不幸的是，早期的放化疗方案伴有相当多的副作用，并导致围手术期发病率和死亡率增加。相比之下，现代放化疗方案在经验丰富的机构实施时被证明是可行的。因此，新辅助放化疗适用于局部晚期阶段。患者应被转诊至专业中心进行初始治疗规划和切除，并且应尽可能参加临床研究。
