Kleinberg Lawrence, Gibson Michael K, Forastiere Arlene A
Johns Hopkins University, MD, USA.
Nat Clin Pract Oncol. 2007 May;4(5):282-94. doi: 10.1038/ncponc0796.
Concurrent chemoradiotherapy administered either before surgery or as definitive treatment has a central role in the multimodality treatment of locally advanced esophageal cancer. Initial studies of this combined-modality regimen were based on models of squamous-cell cancers from other primary sites; this approach progressed from use of bleomycin or fluorouracil plus cisplatin concurrent with radiation in early trials, to the integration of taxanes, camptothecins and platinum analogs in recent trials. These trials demonstrated the tumoricidal effect of concurrent chemotherapy and radiotherapy and showed the survival advantages of this approach. Preoperative concurrent chemoradiation is used to downstage the tumor, ideally to a pathological complete response status in which there is no residual tumor in the resected primary and nodal tissues. A pathological complete response is associated with long-term survival but occurs in a minority (30%) of patients. While clinical trials have demonstrated an improvement in survival with concurrent chemoradiotherapy this effect is limited, as indicated by the plateau in survival beyond 5 years of approximately 30% or less. The recent clinical development of biologic, targeted therapies provides a new avenue for the study of chemoradiotherapy and an opportunity to increase long-term survival.
术前或作为根治性治疗进行的同步放化疗在局部晚期食管癌的多模式治疗中起着核心作用。这种联合治疗方案的初步研究是基于其他原发部位鳞状细胞癌的模型；这种方法从早期试验中使用博来霉素或氟尿嘧啶加顺铂与放疗同步，发展到近期试验中紫杉烷、喜树碱和铂类类似物的联合应用。这些试验证明了同步放化疗的杀瘤作用，并显示了这种方法的生存优势。术前同步放化疗用于降低肿瘤分期，理想情况下达到病理完全缓解状态，即切除的原发组织和淋巴结组织中无残留肿瘤。病理完全缓解与长期生存相关，但仅在少数（30%）患者中出现。虽然临床试验表明同步放化疗可提高生存率，但这种效果是有限的，5年以上的生存率约为30%或更低，呈平台期。生物靶向治疗的最新临床进展为放化疗研究提供了新途径，并有机会提高长期生存率。
