Roberts J G
Br J Surg. 1980 Nov;67(11):791-7. doi: 10.1002/bjs.1800671111.
An analysis of the biology of cancer of the oesophagus suggests that significant dissemination may not have taken place at the time of diagnosis in approximately one-third of cases. Positive nodal histology in the mediastinum or abdomen is the best available evidence of disseminated disease. Patients without such nodal involvement therefore represent a group in whom the disease is most likely to be localized. It is suggested that only these patients be subjected to aggressive local therapy. The effects of no treatment, orth- and megavoltage radiotherapy, surgery and combinations of surgery and radiotherapy are reviewed. The need for cooperative randomized clinical trials to test the biological hypothesis outlined is discussed. Megavoltage radiotherapy as a primary treatment for oesophageal cancer followed by radical surgery in those patients without evidence of dissemination from nodal histology is proposed as a basis for such clinical trials.
对食管癌生物学特性的分析表明，在大约三分之一的病例中，诊断时可能尚未发生显著的扩散。纵隔或腹部淋巴结组织学检查呈阳性是疾病已扩散的最佳现有证据。因此，没有这种淋巴结受累的患者代表了一组疾病最可能局限的人群。建议仅对这些患者进行积极的局部治疗。本文回顾了不治疗、正交和兆伏放疗、手术以及手术与放疗联合治疗的效果。讨论了开展合作随机临床试验以检验上述生物学假设的必要性。提出将兆伏放疗作为食管癌的主要治疗方法，对于那些淋巴结组织学检查无扩散证据的患者，随后进行根治性手术，以此作为此类临床试验的基础。
