Yagi Koichi, Toriumi Tetsuro, Aikou Susumu, Yamashita Hiroharu, Seto Yasuyuki
Department of Gastrointestinal Surgery Graduate School of Medicine The University of Tokyo Tokyo Japan.
Ann Gastroenterol Surg. 2021 Mar 10;5(4):436-445. doi: 10.1002/ags3.12448. eCollection 2021 Jul.
Definitive chemoradiotherapy (dCRT) for the esophageal squamous cell carcinoma (ESCC) is performed for patients with cT4 disease without distant metastasis and also for those with cStage I-III who are unable to tolerate or who refuse surgery. The rates of clinical complete response (cCR) after dCRT differ depending on the cStage, and patients who once achieved cCR frequently experience tumor recurrence. For those with residual tumor or with recurrence, salvage treatment is performed to achieve a cure. Several procedures have been reported as salvage treatments. Salvage esophagectomy is associated with high rates of morbidity and mortality, but can offer long-term survival. With R0 resection, with cCR to dCRT, pulmonary complications appear to be important prognostic factors affecting overall survival (OS). Lymphadenectomy is performed for the patients with lymph node metastasis without recurrence of primary lesions or distant metastasis, but the contribution to long-term OS is unclear. Metastasectomy is performed when distant metastasis is limited to the lung and there are few lesions, possibly contributing to long-term OS. Endoscopic resection and photodynamic therapy are indicated for cT1a and cT1-2 residual or recurrent tumors, respectively, and can yield favorable outcomes. Re-CRT and re-radiotherapy are performed for the patients with contraindications for surgery, but neither appears to contribute to long-term OS despite high incidences of esophageal fistula and perforation.
食管鳞状细胞癌（ESCC）的确定性放化疗（dCRT）适用于无远处转移的cT4期患者，以及无法耐受手术或拒绝手术的cI - III期患者。dCRT后的临床完全缓解（cCR）率因c期不同而有所差异，且曾经达到cCR的患者经常会出现肿瘤复发。对于有残留肿瘤或复发的患者，需进行挽救性治疗以实现治愈。已有多种手术被报道可作为挽救性治疗手段。挽救性食管切除术虽与较高的发病率和死亡率相关，但可提供长期生存。在实现dCRT后的cCR且进行R0切除的情况下，肺部并发症似乎是影响总生存期（OS）的重要预后因素。对于无原发灶复发或远处转移的淋巴结转移患者，会进行淋巴结清扫术，但其对长期OS的贡献尚不清楚。当远处转移局限于肺部且病灶较少时，会进行转移灶切除术，这可能有助于长期OS。内镜切除术和光动力疗法分别适用于cT1a和cT1 - 2期残留或复发肿瘤，且可取得良好疗效。对于有手术禁忌证的患者会进行再次CRT和再放疗，但尽管食管瘘和穿孔发生率较高，两者似乎均对长期OS无贡献。
