Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, China.
Front Med. 2013 Jun;7(2):172-9. doi: 10.1007/s11684-013-0268-0. Epub 2013 May 17.
Trimodality based on neoadjuvant chemoradiotherapy (nCRT) followed by surgery is gaining popularity as a treatment strategy for locally advanced esophageal cancer. In this review, we summarize the role of nCRT and the recommended nCRT regimens based on clinical trials and meta-analyses. We analyze the relationship of nCRT with pathologic complete response (pCR) and then identify potential predictive markers of response. Compared with surgery alone and neoadjuvant chemotherapy followed by surgery, trimodality provides longer survival and has the advantage of local control compared with definitive chemoradiotherapy. The standard regimen is a platinum-based regimen with a radiation dose range of 41.4-50.4 Gy by conventional fractionation. Evidence shows that patients with pCR tend to live longer than non-responders, indicating that pCR is a significant prognostic factor for patients with esophageal cancer. Individualized medicine requires predictive markers of individual patients based on their own genes. Currently, no definite marker is proved to be sufficiently sensitive and specific for use in clinical practice, although 18-fluorodeoxyglucose positron emission tomography shows promise in predicting response to nCRT.
新辅助放化疗（nCRT）后再手术的三联疗法作为局部晚期食管癌的治疗策略越来越受到关注。在这篇综述中，我们根据临床试验和荟萃分析总结了 nCRT 的作用和推荐的 nCRT 方案。我们分析了 nCRT 与病理完全缓解（pCR）的关系，然后确定了潜在的反应预测标志物。与单纯手术和新辅助化疗后手术相比，三联疗法提供了更长的生存时间，并具有与根治性放化疗相比的局部控制优势。标准方案是含铂方案，常规分割的放射剂量范围为 41.4-50.4 Gy。证据表明，pCR 患者的生存期长于无反应者，表明 pCR 是食管癌患者的重要预后因素。个体化医学需要根据患者自身的基因预测个体患者的标志物。目前，虽然 18-氟脱氧葡萄糖正电子发射断层扫描显示出在预测 nCRT 反应方面有希望，但尚无确定的标志物被证明具有足够的敏感性和特异性用于临床实践。
