Esophageal Cancer: New Insights into a Heterogenous Disease
Esophageal Cancer: New Insights into a Heterogenous Disease
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DOI：
10.1159/000464130
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发表时间：
2017-01-01
期刊：
影响因子：
3.2
通讯作者：
Michl, Patrick
中科院分区：
文献类型：
--
作者：
Krug, Sebastian;Michl, Patrick
背景：食道癌是一种异质性恶性肿瘤，多诊断于晚期。在世界范围内，鳞状细胞癌(SCCs)仍然是最常见的亚型；然而，在西方国家，腺癌的发病率正在上升，并将在不久的将来超过SCC。在过去十年中，几项具有里程碑意义的试验有助于更好地了解这种疾病，并强调了多模式治疗方案的重要性。摘要：随着围手术期或新辅助方法的引入，这两种亚型食道癌的存活率都有了显著的提高。几项试验证实，对于可切除的局部晚期腺癌患者，围手术期化疗或新辅助化疗分别对患者的生存有好处。然而，围术期化疗或新辅助化疗对该人群的长期生存更有效的问题尚未完全阐明。在鳞状细胞癌中，先进行新辅助放化疗，然后手术或在功能不能操作的情况下进行明确的放化疗是首选的治疗方案。与新辅助化疗方案相比，辅助化疗或放化疗的影响很小，并且与增强的毒性有关。目前的临床前和临床试验研究了旨在调节免疫检查点和双重抑制HER2的新药的有效性和耐受性。在这篇“切中要害”的文章中，我们回顾了当前的标准，并总结了食道癌的最新和令人鼓舞的治疗进展。食道癌的多模式治疗方法应该在一个多学科团队中进行讨论，该团队基于组织学、肿瘤定位和患者表现状况。新辅助化疗对局部晚期鳞癌和食管胃交界部腺癌(GEJ)患者是有益的，围手术期化疗是GEJ腺癌的有效替代方案。联合疗法适用于转移性腺癌，而姑息化疗在鳞癌中的益处仍存在争议。曲妥珠单抗用于HER2+转移性腺癌。(C)2017年S.Karger AG，巴塞尔。
Background: Esophageal cancer represents a heterogeneous malignancy mostly diagnosed in advanced stages. Worldwide, squamous cell carcinomas (SCCs) continue to be the most prevalent subtype; however, in the Western countries, the incidence of adenocarcinomas is increasing and will exceed that of SCC in the near future. During the last decade, several landmark trials contributed to a better understanding of the disease and emphasized the importance of multimodal treatment protocols. Summary: With the introduction of perioperative or neoadjuvant approaches, the survival of both subtypes of esophageal cancer has significantly improved. Several trials confirmed a survival benefit for perioperative chemotherapy or neoadjuvant chemoradiation, respectively, for patients with resectable locally advanced adenocarcinomas. However, the question of whether perioperative chemotherapy or neoadjuvant chemoradiation is more effective for the long-term survival in this population has yet to be fully elucidated. In SCCs, neoadjuvant chemoradiation followed by surgery or definitive chemoradiation in case of functional inoperability represent the preferred treatment options. Compared to neoadjuvant protocols, adjuvant chemotherapy or chemoradiation have only minor effects and are associated with enhanced toxicities. Current preclinical and clinical trials investigate efficacy and tolerability of novel drugs aiming to modulate immune check-points and dual inhibition of HER2. In this "to-the-point" article, we review the current standard and summarize the most recent and encouraging therapeutic advances in esophageal cancer. Multimodal treatment approaches for esophageal cancer should be discussed in a multidisciplinary team based on histology, tumor localization, and patient performance status. Neoadjuvant chemoradiation is beneficial for patients with locally advanced SCC and adenocarcinomas of the esophagus and the gastroesophageal junction (GEJ), with perioperative chemotherapy representing a valid alternative for GEJ adenocarcinomas. Combination therapies are indicated for metastatic adenocarcinomas, while the benefit of palliative chemotherapy in SCC remains controversial. Trastuzumab is indicated in HER2+ metastatic adenocarcinomas. (C) 2017 S. Karger AG, Basel.