Neoadjuvant chemoradiotherapy for resectable esophageal cancer: an in-depth study of randomized controlled trials and literature review.
Neoadjuvant chemoradiotherapy for resectable esophageal cancer: an in-depth study of randomized controlled trials and literature review.
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DOI：
10.7497/j.issn.2095-3941.2014.03.005
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发表时间：
2014-09
影响因子：
5.5
通讯作者：
Yu ZT
中科院分区：
文献类型：
--
作者：
Duan XF;Tang P;Yu ZT
新辅助放化疗（NCRT）后手术是可切除食管癌（EC）常见的多学科治疗。通过对12项随机对照试验的分析，我们讨论了外科治疗可切除EC的关键问题。沿着放化疗，NCRT被推荐用于鳞状细胞癌（SCC）和腺癌（AC）患者，大多数化疗方案基于顺铂、氟尿嘧啶（FU）或两者（CF）。然而，紫杉烷为基础的时间表或额外的研究，以及新的化疗，是必要的。在9项临床试验中，两个治疗组之间的术后并发症相似，无显著差异。10项试验中只有1项的住院死亡率有显著差异。在比较NCRT与EC手术的随机试验中，有一半表明总生存期或无病生存期增加。NCRT为切缘阴性切除、降低疾病分期和改善局部控制提供了很好的机会。然而，NCRT与食管切除术联合使用时不会影响生活质量。未来的试验应侧重于确定最佳方案和选择最有可能从特定治疗方案中获益的患者。
Surgery following neoadjuvant chemoradiotherapy (NCRT) is a common multidisciplinary treatment for resectable esophageal cancer (EC). After analyzing 12 randomized controlled trials (RCTs), we discuss the key issues of surgery in the management of resectable EC. Along with chemoradiotherapy, NCRT is recommended for patients with squamous cell carcinoma (SCC) and adenocarcinoma (AC), and most chemotherapy regimens are based on cisplatin, fluorouracil (FU), or both (CF). However, taxane-based schedules or additional studies, together with newer chemotherapies, are warranted. In nine clinical trials, post-operative complications were similar without significant differences between two treatment groups. In-hospital mortality was significantly different in only 1 out of 10 trials. Half of the randomized trials that compare NCRT with surgery in EC demonstrate an increase in overall survival or disease-free survival. NCRT offers a great opportunity for margin negative resection, decreased disease stage, and improved loco-regional control. However, NCRT does not affect the quality of life when combined with esophagectomy. Future trials should focus on the identification of optimum regimens and selection of patients who are most likely to benefit from specific treatment options.