Division of Thoracic Surgery, McGill University, Montreal, QC, Canada.
Ann Surg Oncol. 2019 Apr;26(4):1014-1027. doi: 10.1245/s10434-019-07162-9. Epub 2019 Jan 23.
Current treatment of locally advanced esophageal cancers (ECs) centres on a multimodal approach regardless of histology. While surgery remains the mainstay of curative intent therapy, its implementation alone results in suboptimal outcomes, which have improved significantly with the increased utilization of induction regimens comprising of concurrent chemoradiation (CRT) or chemotherapy alone followed by surgery. Due in large part to the positive results of the CROSS trial, neoadjuvant CRT has become the predominant standard applied in the West. However, the bulk of the data published to date suggests that a more nuanced approach to the management of locally advanced EC is required with respect to the application of radiation, which related to the differential sensitivity of esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (SCC) to radiation. While the latter demonstrates excellent radiosensitivity, which has translated into improved survival outcomes, the same cannot be said for patients with EAC who may be subject to greater toxicity without any benefit. Herein, the differential effectiveness of CRT in patients with EAC versus SCC is highlighted, with a focus on the randomized evidence to date.
目前，局部晚期食管癌（EC）的治疗以多模态方法为中心，无论组织学如何。虽然手术仍然是治疗的主要手段，但仅手术的效果并不理想，随着包括同步放化疗（CRT）或单纯化疗后手术在内的诱导方案的应用增加，其效果得到了显著改善。在很大程度上，由于 CROSS 试验的积极结果，新辅助 CRT 已成为西方主要应用的标准。然而，迄今为止发表的大量数据表明，需要更细致地管理局部晚期 EC，尤其是在应用放疗方面，这与食管腺癌（EAC）和食管鳞状细胞癌（SCC）对放疗的不同敏感性有关。虽然后者表现出极好的放射敏感性，这转化为改善的生存结果，但对于 EAC 患者来说，情况并非如此，他们可能会因没有任何获益而遭受更大的毒性。在此，强调了 CRT 在 EAC 与 SCC 患者中的不同效果，并重点介绍了迄今为止的随机证据。
