Recent Progress in the Neoadjuvant Treatment Strategy for Locally Advanced Esophageal Cancer.
Recent Progress in the Neoadjuvant Treatment Strategy for Locally Advanced Esophageal Cancer.
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局部晚期食管癌新辅助治疗策略的最新进展
DOI：
10.3390/cancers13205162
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发表时间：
2021-10-14
期刊：
影响因子：
5.2
通讯作者：
Ding Y
中科院分区：
文献类型：
--
作者：
Hou S;Pan Z;Hao X;Hang Q;Ding Y
新辅助治疗被推荐作为局部晚期可切除食管癌患者的标准治疗。根据几项随机临床试验的结果，新辅助化疗（nCT）和放化疗（nCRT）已令人信服地显示，与单纯手术相比，可提高生存率。免疫治疗因其疗效显著而成为食管癌研究领域的一个新方向。然而，在确定nCT、nCRT、免疫治疗和手术的最适当组合、优化更有效的新辅助治疗方案和监测策略方面仍存在争议。本综述全面总结了研究进展，并描述和讨论了当前试验的结果，优点和缺点。我们相信我们的工作具有很大的学术价值，将有助于研究者了解EC新辅助治疗领域的国内外研究现状。多项随机临床试验的结果显示，新辅助治疗（主要是化疗和放化疗）能够改善局部晚期可切除食管癌（EC）患者的总生存期（OS）。新辅助治疗的优势主要在于降低局部复发和远处转移的风险。因此，它已被推荐为可切除EC患者的标准治疗。然而，仍然存在一些基本问题。首先，新辅助化疗（nCT）、新辅助放化疗（nCRT）和手术联合治疗不同组织学类型的EC患者仍存在争议。此外，为了减少术前化疗的毒性和术前放疗引起的并发症的风险，nCT和nCRT的治疗方案仍需要通过前瞻性试验进行研究和优化。此外，对于新辅助治疗后完全临床应答的患者，值得确定的是，“观察和等待”监测加按需手术政策是否更有利，以及除了术前放化疗外，免疫治疗，特别是与传统新辅助治疗方案联合使用，是否为EC治疗带来了新的前景。本文就局部晚期可切除食管癌新辅助治疗的研究进展及存在的问题作一综述。
Neoadjuvant therapy is recommended as standard care for patients with locally advanced resectable esophageal cancer. Neoadjuvant chemotherapy (nCT) and chemoradiotherapy (nCRT) have convincingly been shown to improve the survival rate compared with surgery alone based on the results of several randomized clinical trials. Immunotherapy has become a new research direction in the field of EC research due to its great curative effects. However, controversies still remain in regard to identifying the most appropriate combination of nCT, nCRT, immunotherapy, and surgery, optimizing more effective neoadjuvant treatment protocols and surveillance strategies. This review comprehensively summarizes the research progress and describes and discusses the outcomes, pros, and cons of current trials. We believe our work has great academic value and will be of great help for researchers to understand the domestic and foreign research status in the field of neoadjuvant therapy in EC. Neoadjuvant therapies, primarily chemotherapy and chemoradiotherapy, are able to improve the overall survival (OS) in patients with locally advanced resectable esophageal cancer (EC) based on the results of several randomized clinical trials. The advantage of neoadjuvant therapy is chiefly attributed to the decreased risk of local–regional recurrence and distant metastasis. Thus, it has been recommended as standard treatment for patients with resectable EC. However, several fundamental problems remain. First, the combination of neoadjuvant chemotherapy (nCT), neoadjuvant chemoradiotherapy (nCRT), and surgery for EC patients with different histological types remain controversial. Furthermore, to reduce the toxicity of preoperative chemotherapy and the risk of complications caused by preoperative radiation therapy, the treatment protocols of nCT and nCRT still need to be investigated and optimized by prospective trials. Moreover, for patients with complete clinical response following neoadjuvant therapy, it is worth ascertaining whether a “watch and wait” surveillance plus surgery-as-needed policy is more favorable, as well as, in addition to preoperative chemoradiotherapy, whether immunotherapy, especially when combined with the traditional neoadjuvant therapy regimens, brings new prospects for EC treatment. In this review, we summarize the recent insights into the research progress and existing problems of neoadjuvant therapy for locally advanced resectable EC.
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