Blum Murphy M A, Elimova Elena, Ajani Jaffer A
a Department of Gastrointestinal Medical Oncology , University of Texas, MD Anderson Cancer Center , Houston , TX , USA.
Expert Rev Gastroenterol Hepatol. 2016;10(3):383-92. doi: 10.1586/17474124.2016.1116936. Epub 2015 Dec 2.
Many trials have evaluated preoperative chemotherapy for the treatment of locally advanced esophageal cancer (LAEC). Most studies were small with conflicting results and no clear evidence of survival advantage. However, two large trials that included squamous cell carcinomas and adenocarcinomas of the esophagus produced opposite outcomes with one showing limited benefit and the other showing none. Recent meta-analyses suggest only a modest benefit from induction chemotherapy in the treatment of LAEC. Two factors associated with prolonged survival are: (1) an R0 resection and (2) pathological complete remission. Preoperative chemotherapy is preferred in Europe for adenocarcinomas; however, chemoradiation has been the treatment of choice in the US. The individualization and optimization of therapy for esophageal cancer patients may come from an in-depth understanding of molecular biology and the development of predictive biomarkers. The use of targeted and immunotherapy agents in the preoperative setting are also promising and warrant further evaluation.
许多试验评估了术前化疗用于治疗局部晚期食管癌（LAEC）的效果。大多数研究规模较小，结果相互矛盾，且没有明确的生存优势证据。然而，两项纳入食管鳞状细胞癌和腺癌的大型试验得出了相反的结果，一项显示获益有限，另一项则未显示出获益。最近的荟萃分析表明，诱导化疗在LAEC治疗中仅带来适度获益。与生存期延长相关的两个因素是：（1）R0切除和（2）病理完全缓解。在欧洲，腺癌患者首选术前化疗；然而，在美国，放化疗一直是首选治疗方法。对食管癌患者治疗的个体化和优化可能源于对分子生物学的深入理解以及预测性生物标志物的开发。术前使用靶向治疗和免疫治疗药物也很有前景，值得进一步评估。
