Babic B, Fuchs H F, Bruns C J
Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Universitätsklinikum Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland.
Chirurg. 2020 May;91(5):379-383. doi: 10.1007/s00104-020-01150-6.
According to international guidelines neoadjuvant chemoradiotherapy and chemotherapy are recommended for the treatment of locally advanced esophageal cancer. The treatment approach depends on the tumor entity (adenocarcinoma vs. squamous cell carcinoma).
What benefits do patients with locally advanced esophageal cancer have from neoadjuvant treatment? Is there information in the international literature on whether a particular neoadjuvant treatment is preferred? Does the type of neoadjuvant treatment depend on factors other than the tumor entity? Is there a standard in the drug composition of chemotherapy or a clearly defined chemoradiotherapy regimen?
A review, evaluation and critical analysis of the international literature were carried out.
Patients with locally advanced esophageal cancer benefit from a neoadjuvant treatment. The current data situation for squamous cell carcinoma of the esophagus demonstrates a better response to neoadjuvant chemoradiotherapy compared to chemotherapy alone. Locally advanced adenocarcinoma of the esophagus can be treated with combined neoadjuvant chemoradiotherapy as well as by chemotherapy alone. Both lead to an improvement in the prognosis. There are often differences particularly among radiation treatment regimens in the different centers. Furthermore, the localization of the tumor can also be important for treatment decisions.
A neoadjuvant treatment is clearly recommended for locally advanced esophageal cancer. Currently, chemoradiotherapy according to the CROSS protocol is preferred for squamous cell carcinoma. For adenocarcinoma both chemotherapy according to the FLOT protocol as well as chemoradiotherapy in a neoadjuvant treatment concept lead to an improvement in the prognosis.
根据国际指南，新辅助放化疗和化疗被推荐用于治疗局部晚期食管癌。治疗方法取决于肿瘤类型（腺癌与鳞状细胞癌）。
局部晚期食管癌患者从新辅助治疗中能获得哪些益处？国际文献中是否有关于某种特定新辅助治疗更受青睐的信息？新辅助治疗的类型是否取决于肿瘤类型以外的因素？化疗药物组成是否有标准或明确界定的放化疗方案？
对国际文献进行综述、评估和批判性分析。
局部晚期食管癌患者可从新辅助治疗中获益。目前食管鳞状细胞癌的数据情况表明，与单纯化疗相比，新辅助放化疗的反应更好。局部晚期食管腺癌可采用新辅助放化疗联合治疗以及单纯化疗。两者均能改善预后。不同中心的放疗方案往往存在差异。此外，肿瘤的位置对治疗决策也可能很重要。
明确推荐对局部晚期食管癌进行新辅助治疗。目前，对于鳞状细胞癌，首选根据CROSS方案进行放化疗。对于腺癌，根据FLOT方案进行化疗以及新辅助治疗概念下的放化疗均能改善预后。
