Fink U, Stein H J, Bochtler H, Roder J D, Wilke H J, Siewert J R
Department of Surgery, Technische Universität München, Germany.
Ann Oncol. 1994;5 Suppl 3:17-26. doi: 10.1093/annonc/5.suppl_3.s17.
A number of studies have demonstrated that preoperative chemotherapy (CTx) and combination radiochemotherapy (RTx/CTx) in patients with potentially resectable and locally advanced squamous cell esophageal carcinoma is feasible. In patients with potentially resectable tumors, neoadjuvant therapy followed by surgical resection has, however, so far not shown an increase in the resection rate, rate of complete macroscopic and microscopic tumor resections, i.e. R0-resections according to the UICC, or survival time as compared to patients who had surgical resection alone. In this situation a survival benefit, if at all, can be expected only in those who respond to preoperative therapy. At the present time preoperative CTx or RTx/CTx in patients with potentially resectable esophageal carcinoma must therefore be considered investigational and should not be performed outside the context of clinical trials. In patients with locally advanced esophageal carcinoma, neoadjuvant therapy markedly increases the rate of R0-resections and appears to prolong survival. Combined modality therapy in this context is, however, associated with a substantial perioperative mortality and morbidity. Open questions that have to be addressed by randomized studies include the role, extent and timing of surgical resection in the combined modality approach to patients with locally advanced squamous cell esophageal carcinoma. Research has to focus on preoperative staging modalities and the development of more effective and less toxic preoperative therapy regimen to improve identification of patients that might benefit from combined modality therapy and to more effectively combat systemic recurrences.
多项研究表明，对于潜在可切除的局部晚期食管鳞状细胞癌患者，术前化疗（CTx）以及放化疗联合（RTx/CTx）是可行的。然而，对于潜在可切除肿瘤的患者，新辅助治疗后再行手术切除，与单纯接受手术切除的患者相比，到目前为止，在切除率、肉眼及显微镜下肿瘤完全切除率（即根据国际抗癌联盟定义的R0切除率）或生存时间方面并未显示出提高。在这种情况下，只有对术前治疗有反应的患者才有望获得生存益处。因此，目前对于潜在可切除食管癌患者的术前CTx或RTx/CTx必须被视为试验性的，不应在临床试验背景之外进行。对于局部晚期食管癌患者，新辅助治疗显著提高了R0切除率，且似乎能延长生存期。然而，在这种情况下，综合治疗方式与较高的围手术期死亡率和发病率相关。随机研究必须解决的悬而未决的问题包括，在局部晚期食管鳞状细胞癌患者的综合治疗方式中，手术切除的作用、范围和时机。研究必须聚焦于术前分期方法，以及开发更有效且毒性更小的术前治疗方案，以改善对可能从综合治疗中获益的患者的识别，并更有效地对抗全身复发。
