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食道癌的多学科管理:当前的做法和未来的方向
1Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Thailand.
Critical reviews in oncology/hematology
|March 10, 2024
概括
消化管癌的管理因亚型而异. 三种治疗方式是可切除食道状细胞癌 (ESCC) 的标准,而化学疗法则是食道胃结腺癌 (EGJ AC) 的首选.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 医学瘤学 医学瘤学
背景情况:
- 食道癌呈现出不同的亚型:ESCC (亚洲常见) 和EGJ AC (西方常见).
- 这些亚型表现出不同的遗传特征和对治疗的反应,需要量身定制的管理策略.
- 克罗斯研究确立了新辅助性化疗和放射治疗,随后是手术作为ESCC的标准.
研究的目的:
- 概述当前对食道癌亚型的管理范式.
- 根据证据,区分ESCC和EGJ AC的治疗方法.
- 为应对当地的晚期食道癌的管理所面临的挑战.
主要方法:
- 对里程碑式研究和当前临床指导方针的审查.
- 对ESCC和EGJAC治疗结果的比较分析.
- 讨论多模式治疗策略,包括手术,化疗和放射治疗.
主要成果:
- 三种疗法 (新辅助化疗或放射治疗+手术) 为适合的ESCC患者提供了生存益处.
- 对于不可切除或非手术ESCC候选人,建议进行终极化疗.
- 对于EGJ AC,由于不确定的益处和潜在的毒性,新辅助或术前化学疗法通常优先于放射疗法.
结论:
- 消化管癌的管理需要特定亚型的方法.
- 三种疗法是可切除ESCC的标准,而化学疗法则是EGJ AC的首选.
- 具有治愈意图的多式疗法,包括新辅助化疗和转换手术,可以考虑在局部晚期疾病的选择病例.
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