Cleveland Clinic Foundation, Taussig Cancer Institute, 9500 Euclid Avenue R35, Cleveland, OH 44195, USA.
Curr Oncol Rep. 2012 Aug;14(4):342-9. doi: 10.1007/s11912-012-0239-7.
Loco-regionally advanced esophageal cancer is a lethal disease with poor outcomes despite aggressive multimodality therapy. The appropriate management of these patients is contentious and no single standard of care has been defined. Literature suggests that preoperative chemoradiotherapy may be superior to preoperative chemotherapy. Recently, several developments have impacted the care of these patients. The 2010 AJCC TNM staging system now recognizes the biologic heterogeneity of the disease and stages adenocarcinoma and squamous cell carcinoma separately. Studies suggest potentially less toxic chemotherapeutic agents including oxaliplatin may be useful in the management of this disease. FDG-PET imaging appears to have prognostic value and may predict for pathologic response. In addition, several trials have explored inhibition of the ErbB1 (EGFR) and ErbB2 (Her2) receptors. The monoclonal antibody trastuzumab appears to extend survival for patients with metastatic gastric and gastroesophageal junction adenocarcinoma and is under investigation for use in patients with loco-regionally advanced disease.
局部晚期食管癌是一种致命疾病，尽管采用了积极的多模式治疗，但预后仍不佳。这些患者的适当治疗存在争议，尚未确定单一的治疗标准。文献表明，术前放化疗可能优于术前化疗。最近，一些进展影响了这些患者的治疗。2010 年 AJCC TNM 分期系统现在认识到疾病的生物学异质性，并分别分期腺癌和鳞状细胞癌。研究表明，包括奥沙利铂在内的潜在毒性较小的化疗药物在该疾病的治疗中可能有用。FDG-PET 成像似乎具有预后价值，并可预测病理反应。此外，几项试验还探索了 ErbB1（EGFR）和 ErbB2（Her2）受体的抑制。曲妥珠单抗单克隆抗体似乎延长了转移性胃和胃食管交界处腺癌患者的生存时间，目前正在研究用于局部晚期疾病患者。
