Kelsen D P, Ilson D H
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA.
Chest. 1995 Jun;107(6 Suppl):224S-232S. doi: 10.1378/chest.107.6_supplement.224s.
Treatment of esophageal carcinoma with radiation alone or surgery alone has yielded unsatisfactory cure rates and has not had a major impact on survival. The failure to cure or prolong survival of patients with esophageal cancer is because of our inability to eradicate residual disease at the primary site and to early systemic dissemination of disease. Three neoadjuvant approaches involving chemotherapy have been studied in patients with apparently localized esophageal cancer: preoperative chemotherapy followed by surgery, chemotherapy and concurrent radiation therapy followed by surgery, and chemotherapy and radiation therapy without surgery. All of these approaches have shown potential in pilot trials. Large-scale trials comparing surgery alone with chemotherapy prior to operation are underway. For patients with local-regional epidermoid carcinoma who are not able to undergo or who refuse operation, chemotherapy plus concurrent radiation appears, in random assignment trials, to be superior to radiation alone.
单独使用放射疗法或手术疗法治疗食管癌，治愈率都不尽人意，对生存率也没有重大影响。食管癌患者无法治愈或延长生存期，是因为我们无法根除原发部位的残留病灶以及疾病的早期全身扩散。对于明显局限期食管癌患者，已研究了三种涉及化疗的新辅助治疗方法：术前化疗后手术、化疗与同步放疗后手术、化疗与放疗但不手术。所有这些方法在试点试验中均显示出潜力。比较单纯手术与术前化疗的大规模试验正在进行中。对于无法接受手术或拒绝手术的局部区域表皮样癌患者，在随机分配试验中，化疗加同步放疗似乎优于单纯放疗。
