在患有食道状细胞癌的患者内镜下膜剖析后进行额外的化学放射治疗:叙述性综述
Yan Lin1, Shou-Feng Wang2, Huan-Wei Liang3
1Department of Gastroenterology, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
Frontiers in oncology
|July 1, 2025
概括
用于食道状细胞癌的内镜下粘膜剖析 (ESD) 需要量身定制的辅助疗法. 对于特定的pT1b阶段,建议进行化疗,加快时间和优化辐射剂量可以改善结果,同时最大限度地降低毒性.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 辐射瘤学 辐射瘤学
背景情况:
- 内镜下粘膜切割 (ESD) 是早期食道状细胞癌的关键治疗方法.
- 最佳的ESD后治疗策略,特别是对于晚期病变,需要进一步澄清.
- 辅助疗法旨在减少复发并改善局部治疗后的生存率.
研究的目的:
- 为了综合证据,在食道状细胞癌的ESD之后,对额外的治疗策略进行综合证据.
- 为ESD后管理中临床决策提供基于证据的建议.
- 优化针对不同瘤阶段和风险因素的治疗方案.
主要方法:
- 对ESD后辅助疗法的现有文献进行批判性审查和综合.
- 基于瘤深度和入侵的淋巴结转移率的分析.
- 评估化学辐射时间,辐射剂量和目标体积的划分.
主要成果:
- 单独使用ESD可以治愈pT1a-EP/LPM病变 (0.0-3.3%结节转移).
- 辅助化学辐射适用于pT1b-MM的淋巴血管入侵 (21.4%结节转移).
- pT1b-SM1病变受益于化疗,特别是血管侵袭 (60.0%的转移风险与没有的13.2%相比).
- 加快化疗和放射治疗 (ESD后1-2个月) 显示出优异的结果.
- 较低的辐射剂量 (40-41.4 Gy) 与较高的剂量 (50-50.4 Gy) 同样有效,毒性较小.
- 优先考虑ESD床,而不是选择性节点覆盖,将辐射暴露降到最低.
- 同时化疗的作用仍在争论中,放射治疗可能提供可比的局部控制.
结论:
- 对食道状细胞癌的ESD后辅助疗法选择应以详细的病理评估为指导.
- 优化化学辐射协议,包括时间和辐射输送,可以提高疗效和降低毒性.
- 需要进一步的研究来澄清并发化疗与确定的放射治疗结合的作用.
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