Barnett Stephen A, Rizk Nabil P
Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
Surg Oncol Clin N Am. 2010 Jan;19(1):59-80. doi: 10.1016/j.soc.2009.09.007.
The treatment of esophageal cancer with curative intent remains highly controversial, with advocates of surgery alone, chemoradiotherapy alone, surgery with adjuvant therapy (including neoadjuvant and postoperative), and trimodality therapy each contributing prospective randomized controlled trials (PRCTs) to the body of scientific publications between 2000 and 2008. Any improvements in survival have been small in absolute percentage terms, and as such PRCTs published over the last decade have met the same primary obstacle encountered by the studies from the two prior decades, namely lack of power to detect small differences in outcome. Variations in staging methods, surgical technique, radiotherapy technique, and chemotherapy regime have in turn been the subject of PRCTs over the last nine years. In many cases primary end points have not been survival but rather rates of complication or response. As well as giving an overview of PRCTs, this article collates the level Ia evidence published to date.
以治愈为目的的食管癌治疗仍极具争议，2000年至2008年间，单独手术、单独放化疗、手术联合辅助治疗（包括新辅助治疗和术后治疗）以及三联疗法的支持者均为科学出版物贡献了前瞻性随机对照试验（PRCT）。从绝对百分比来看，生存率的任何提高都很小，因此过去十年发表的PRCT遇到了前两个十年研究中同样的主要障碍，即缺乏检测结果微小差异的能力。分期方法、手术技术、放疗技术和化疗方案的差异反过来又成为过去九年PRCT的研究对象。在许多情况下，主要终点不是生存率，而是并发症发生率或缓解率。除了概述PRCT外，本文还整理了迄今为止已发表的Ia级证据。
