Department of Medicine, The Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK.
Nat Rev Clin Oncol. 2010 Apr;7(4):231-8. doi: 10.1038/nrclinonc.2010.20. Epub 2010 Mar 9.
There is no international consensus on the optimal management of operable esophageal cancer. Surgery alone is associated with a poor prognosis and is only appropriate in patients with very early-stage disease. Data from randomized phase III clinical trials support the use of neoadjuvant chemotherapy, neoadjuvant chemoradiation and perioperative chemotherapy for patients with adenocarcinomas of the esophagus and neoadjuvant chemotherapy, neoadjuvant chemoradiation or definitive chemoradiation for localized squamous cell carcinomas (SCC). Meta-analyses of published clinical trials have not assessed the role of perioperative chemotherapy and definitive chemoradiation, but have demonstrated a comparable survival benefit from neoadjuvant chemotherapy and chemoradiation for operable adenocarcinomas of the esophagus. A greater benefit for neoadjuvant chemoradiation compared with chemotherapy, however, was noted for localized SCC. In this Review, we discuss the data available from clinical trials and meta-analyses and how they inform current clinical practice.
目前对于可手术治疗的食管癌，国际上尚无统一的最佳治疗方案。单独手术与预后不良相关，仅适用于疾病非常早期的患者。来自随机 III 期临床试验的数据支持新辅助化疗、新辅助放化疗和围手术期化疗用于治疗食管腺癌，以及新辅助化疗、新辅助放化疗或根治性放化疗用于治疗局限性鳞状细胞癌（SCC）。对已发表的临床试验的荟萃分析并未评估围手术期化疗和根治性放化疗的作用，但已证明新辅助化疗和放化疗对可手术治疗的食管腺癌具有相似的生存获益。然而，对于局限性 SCC，新辅助放化疗与化疗相比，获益更大。在本综述中，我们讨论了来自临床试验和荟萃分析的现有数据，以及它们如何为当前的临床实践提供信息。
