Preoperative therapy in locally advanced esophageal cancer.
Preoperative therapy in locally advanced esophageal cancer.
复制标题
局部晚期食管癌的术前治疗。
DOI：
10.3748/wjg.v22.i39.8750
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发表时间：
2016-10-21
影响因子：
4.3
通讯作者：
Gaur MK
中科院分区：
文献类型：
--
作者：
Garg PK;Sharma J;Jakhetiya A;Goel A;Gaur MK
食管癌是一种侵袭性恶性肿瘤，治疗效果不佳。存在两种不同的组织病理学类型区分它与其他胃肠道恶性肿瘤。手术是局部晚期食管癌（T2或以上或淋巴结阳性）治疗的基石;然而，疾病复发率高（全身和局部区域）和生存率低证明了继续寻找最佳治疗的合理性。正在探索多种综合治疗（术前/围手术期或术后;放疗、化疗或放化疗）的组合，以降低疾病复发并提高生存率。术前治疗后手术目前被认为是可切除的局部晚期食管癌的标准治疗，因为由于食管切除术的发病率和延长的恢复时间限制了患者的耐受性，术后治疗可能对所有患者都不可行。根据机构实践、设施可用性和个人经验，各中心的术前治疗存在很大差异。缺乏文献规范术前治疗。大体上，化放疗是西方国家首选的新辅助治疗方式，而在远东，单独化疗被认为是最佳的。本综述强调了重要的研究，以帮助选择最佳的证据为基础的术前治疗（放疗，化疗或放化疗）局部晚期食管癌。
Esophageal cancer is an aggressive malignancy associated with dismal treatment outcomes. Presence of two distinct histopathological types distinguishes it from other gastrointestinal tract malignancies. Surgery is the cornerstone of treatment in locally advanced esophageal cancer (T2 or greater or node positive); however, a high rate of disease recurrence (systemic and loco-regional) and poor survival justifies a continued search for optimal therapy. Various combinations of multimodality treatment (preoperative/perioperative, or postoperative; radiotherapy, chemotherapy, or chemoradiotherapy) are being explored to lower disease recurrence and improve survival. Preoperative therapy followed by surgery is presently considered the standard of care in resectable locally advanced esophageal cancer as postoperative treatment may not be feasible for all the patients due to the morbidity of esophagectomy and prolonged recovery time limiting the tolerance of patient. There are wide variations in the preoperative therapy practiced across the centres depending upon the institutional practices, availability of facilities and personal experiences. There is paucity of literature to standardize the preoperative therapy. Broadly, chemoradiotherapy is the preferred neo-adjuvant modality in western countries whereas chemotherapy alone is considered optimal in the far East. The present review highlights the significant studies to assist in opting for the best evidence based preoperative therapy (radiotherapy, chemotherapy or chemoradiotherapy) for locally advanced esophageal cancer.
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