Klevebro Fredrik, Ekman Simon, Nilsson Magnus
Division of Surgery, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet and Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
Department of Oncology and Pathology, Karolinska Institutet and Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
Surg Oncol. 2017 Sep;26(3):290-295. doi: 10.1016/j.suronc.2017.06.002. Epub 2017 Jun 10.
Multimodality treatment has now been widely introduced in the curatively intended treatment of esophageal and gastroesophageal junction cancer. We aim to give an overview of the scientific evidence for the available treatment strategies and to describe which trends that are currently developing.
We conducted a review of the scientific evidence for the different curatively intended treatment strategies that are available today. Relevant articles of randomized controlled trials, cohort studies, and meta analyses were included.
After a systematic search of relevant papers we have included 64 articles in the review. The results show that adenocarcinomas and squamous cell carcinomas of the esophagus and gastroesophageal junction are two separate entities and should be analysed and studied as two different diseases. Neoadjuvant treatment followed by surgical resection is the gold standard of the curatively intended treatment today. There is no scientific evidence to support the use of chemoradiotherapy over chemotherapy in the neoadjuvant setting for esophageal or junctional adenocarcinoma. There is reasonable evidence to support definitive chemoradiotherapy as a treatment option for squamous cell carcinoma of the esophagus.
The evidence base for curatively intended treatments of esophageal and gastroesophageal junction cancer is not very strong. Several on-going trials have the potential to change the gold standard treatments of today.
多模态治疗现已广泛应用于食管癌和胃食管交界癌的根治性治疗。我们旨在概述现有治疗策略的科学证据，并描述当前正在发展的趋势。
我们对目前可用的不同根治性治疗策略的科学证据进行了综述。纳入了随机对照试验、队列研究和荟萃分析的相关文章。
在对相关论文进行系统检索后，我们在综述中纳入了64篇文章。结果表明，食管和胃食管交界的腺癌和鳞状细胞癌是两个不同的实体，应作为两种不同的疾病进行分析和研究。新辅助治疗后进行手术切除是当今根治性治疗的金标准。在食管或交界腺癌的新辅助治疗中，没有科学证据支持使用放化疗优于单纯化疗。有合理证据支持根治性放化疗作为食管鳞状细胞癌的一种治疗选择。
食管癌和胃食管交界癌根治性治疗的证据基础并不十分充分。几项正在进行的试验有可能改变当今的金标准治疗方法。
