Ilson David H
Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center and Weill-Cornell University Medical College New York, NY.
Gastrointest Cancer Res. 2008 Mar;2(2):85-92.
Esophageal cancer, though relatively uncommon in the United States, is a major global health threat. Squamous cell carcinoma remains the most common histology worldwide, whereas adenocarcinoma of the esophagus is increasing at epidemic proportions in the United States and other Western countries. Both histologies carry a poor prognosis: 5-year mortality for esophageal cancer exceeds 85% to 90%. Locally advanced esophageal cancer treated with the standard approaches of surgery or radiotherapy is associated with poor prognosis, due to both a high incidence of local-regional treatment failure and early systemic dissemination of disease. The obvious need to address the early spread of esophageal carcinoma through systemic treatment has led to the study of combined-modality therapies incorporating chemotherapy. Concurrent chemotherapy and radiotherapy is now a standard of care in the nonsurgical management of locally advanced esophageal cancer. Preoperative chemotherapy and combined preoperative chemoradiotherapy are also standards of treatment based on recent clinical trials. With the increasing use of chemotherapy as part of operative management as well, systemic chemotherapy will ultimately be used to treat the majority of patients with esophageal cancer. This article reviews results of recent clinical trials in the use of single-agent chemotherapy, combination chemotherapy, targeted agents, and neoadjuvant chemotherapy in the treatment of esophageal cancer.
食管癌在美国虽相对不常见，但却是全球主要的健康威胁。鳞状细胞癌仍是全球最常见的组织学类型，而食管腺癌在美国和其他西方国家正以流行比例增长。这两种组织学类型的预后都很差：食管癌的5年死亡率超过85%至90%。采用手术或放疗等标准方法治疗的局部晚期食管癌预后较差，这是因为局部区域治疗失败的发生率高且疾病早期就会发生全身播散。显然需要通过全身治疗来解决食管癌的早期扩散问题，这促使人们对包含化疗的综合治疗方法进行研究。同步放化疗现已成为局部晚期食管癌非手术治疗的标准治疗方法。基于近期临床试验，术前化疗和术前同步放化疗也是标准治疗方法。随着化疗在手术治疗中应用的增加，全身化疗最终将用于治疗大多数食管癌患者。本文综述了近期关于单药化疗、联合化疗、靶向药物以及新辅助化疗治疗食管癌的临床试验结果。
