Semenkovich Tara R, Meyers Bryan F
Department of Cardiothoracic Surgery, Washington University in St. Louis, St. Louis, MO, USA.
Ann Transl Med. 2018 Feb;6(4):81. doi: 10.21037/atm.2018.01.31.
There currently exists an area of controversy in treatment of esophageal cancer for patients who have an apparent clinical complete response (cCR) after induction chemoradiation. A standard treatment is to offer these patients an esophagectomy, but increasingly there is interest from both the patient and provider for active surveillance with so-called "salvage" esophagectomies for local recurrence as an alternative treatment paradigm. In this article, we review the existing evidence that stakeholders should consider for clinical decision-making in this specific patient population, including: the accuracy of post-induction clinical restaging, the reliability of operative risk assessment, the feasibility and adherence to surveillance strategies, and the observed outcomes in these patients after salvage esophagectomy or continued active surveillance. We also briefly discuss quality of life and future directions for this field.
目前，对于诱导放化疗后出现明显临床完全缓解（cCR）的食管癌患者，其治疗存在争议。标准治疗方法是为这些患者实施食管切除术，但患者和医疗服务提供者越来越倾向于采用所谓的“挽救性”食管切除术进行积极监测，以应对局部复发，作为一种替代治疗模式。在本文中，我们回顾了利益相关者在这一特定患者群体临床决策时应考虑的现有证据，包括：诱导化疗后临床再分期的准确性、手术风险评估的可靠性、监测策略的可行性和依从性，以及这些患者在挽救性食管切除术后或持续积极监测后的观察结果。我们还简要讨论了该领域的生活质量和未来方向。
