Royal Marsden Hospital NHS Trust, Sutton and London, UK.
Drugs. 2011 Mar 26;71(5):541-55. doi: 10.2165/11585460-000000000-00000.
Oesophageal cancer is the eighth most common cancer diagnosed worldwide, with almost half a million new cases diagnosed each year. Despite improvements in surgical and radiotherapy techniques and refinements of chemotherapeutic regimens, long-term survival, even from localized oesophageal cancer, remains poor. Surgical resection alone remains the standard approach for very early stage disease (stage I), but whilst surgery remains fundamental to the treatment of stage II-III resectable adenocarcinoma, multimodality therapy with chemotherapy or chemoradiation (CRT) is internationally accepted as the standard of care. Data from two large, randomized phase III trials support the use of perioperative combination chemotherapy in lower oesophageal and oesophagogastric junction adenocarcinomas, but the contribution of the adjuvant therapy is uncertain. There are conflicting data from randomized studies of a purely neoadjuvant approach; however, recent meta-analyses have demonstrated that chemotherapy or CRT given prior to radical surgery improves survival in patients with adenocarcinoma of the oesophagus. Neoadjuvant CRT but not chemotherapy alone is also beneficial for patients with squamous cell carcinoma. Definitive CRT has emerged as a useful option for the treatment of resectable squamous cell carcinoma of the oesophagus, avoiding potential surgical morbidity and mortality for most patients, with salvage surgery reserved for those with persistent disease. In this review, we focus on the pharmacotherapy of resectable oesophageal and oesophagogastric junction cancers and how clinical trials and meta-analyses inform current clinical practice.
食管癌是全球第八大常见癌症，每年新发病例近 50 万。尽管手术和放疗技术有所改进，化疗方案也有所完善，但即使是局限性食管癌患者的长期生存率仍较差。单独手术仍然是非常早期疾病（I 期）的标准治疗方法，但尽管手术仍然是 II-III 期可切除腺癌治疗的基础，但化疗或放化疗（CRT）的多模式治疗已被国际上公认为标准治疗方法。两项大型随机 III 期试验的数据支持在中下段食管癌和食管胃交界腺癌中使用围手术期联合化疗，但辅助治疗的作用尚不确定。单纯新辅助治疗的随机研究结果存在矛盾；然而，最近的荟萃分析表明，在根治性手术前给予化疗或 CRT 可改善食管癌腺癌患者的生存。新辅助 CRT 而非单纯化疗对鳞癌患者也有益。对于可切除的食管鳞癌，确定性 CRT 已成为一种有用的治疗选择，可以避免大多数患者潜在的手术发病率和死亡率，对于那些疾病持续存在的患者，保留挽救性手术。在这篇综述中，我们重点关注可切除食管和食管胃交界部癌症的药物治疗，以及临床试验和荟萃分析如何为当前的临床实践提供信息。
