Kleinberg Lawrence, Forastiere Arlene A
Department of Radiation Oncology and Molecular Sciences, Division of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21231-2410, USA.
J Clin Oncol. 2007 Sep 10;25(26):4110-7. doi: 10.1200/JCO.2007.12.0881.
The combination of chemotherapy, fluorouracil and cisplatin, and radiation has improved outcome for patients with esophageal cancer. A randomized controlled trial confirmed a long-term survival benefit when this chemotherapy was added to radiotherapy for squamous cell carcinoma, but the approach has not been definitively assessed in patients with adenocarcinoma. Preoperative chemoradiotherapy has been tested in numerous phase II studies and underpowered or flawed phase III studies. Nevertheless, collectively, the evidence strongly suggests that preoperative chemoradiotherapy improves outcome, and thus, this strategy has become a standard treatment option. Attempts to improve outcome by intensifying conventional cytotoxic drugs or increasing the radiation dose have not been successful. Camptothecin and taxane-based regimens combined with radiation have altered the toxicity profile, but substantial improvement in survival outcomes has yet to be demonstrated. Future improvements will likely require the incorporation of targeted agents that add minimally to existing toxicity, the use of molecular predictors of response to individualize selection of the chemotherapeutic regimen, and early identification of responders such that therapy might be altered dynamically.
化疗（氟尿嘧啶和顺铂联合）与放疗相结合，改善了食管癌患者的治疗效果。一项随机对照试验证实，对于鳞状细胞癌患者，在放疗基础上加用这种化疗可带来长期生存获益，但该方法在腺癌患者中尚未得到明确评估。术前放化疗已在众多II期研究以及效能不足或存在缺陷的III期研究中进行了测试。尽管如此，总体而言，证据强烈表明术前放化疗可改善治疗效果，因此，该策略已成为一种标准治疗选择。通过强化传统细胞毒性药物或增加放疗剂量来改善治疗效果的尝试并未成功。喜树碱和紫杉烷类方案联合放疗改变了毒性特征，但尚未证明生存结局有实质性改善。未来的改善可能需要加入对现有毒性影响极小的靶向药物，使用反应分子预测指标来个体化选择化疗方案，以及早期识别反应者以便动态调整治疗。
