Multimodal Treatment of Resectable Esophageal Cancer.

IF 3.6 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Thoracic Surgery Pub Date : 2025-01-01 Epub Date: 2024-05-21 DOI:10.1016/j.athoracsur.2024.04.034
John Waters, Marisa Sewell, Daniela Molena
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Abstract

Background: The current guidelines for the treatment of esophageal cancer recommend a multimodal approach that includes chemotherapy, targeted therapy and immunotherapy, radiation, and surgery. Despite advances in treatment, rates of treatment failure, pathologic incomplete response, tumor metastasis, and death remain unacceptably high.

Methods: This study was a narrative literature review using the terms "resectable esophageal cancer" and "multimodal therapy" to identify prospective trials of neoadjuvant radiation and chemotherapy, individually or combined with surgery, for esophageal cancer. Trials performed between 1984 and 2022 were identified and analyzed.

Clinicaltrials: gov was queried to identify ongoing studies.

Results: Twenty-one clinical studies were identified: 15 randomized controlled trials and 6 prospective nonrandomized trials. The results of the randomized trials suggest that multimodal therapy-in the form of neoadjuvant chemotherapy in combination with radiation or chemotherapy alone, followed by surgery-is associated with better rates of local disease control and partial clinical response and, potentially, longer survival than is surgery alone. Immunotherapy is an emerging option for the treatment of patients with esophageal cancer.

Conclusions: The treatment of patients with resectable esophageal cancer is rapidly evolving. Although previous treatment options have had only limited benefits for patients, significant progress has been made during last 3 decades. The results of the available studies suggest that advances in the treatment of esophageal cancer have the potential to improve survival in these patients; however, questions remain regarding mechanisms of action, patient selection, and the use of personalized approaches that are based on genetics.

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可切除食管癌的多模式治疗。
背景:目前的食管癌治疗指南建议采用多模式方法,包括化疗、靶向治疗和免疫治疗、放疗和手术。尽管治疗方法不断进步,但治疗失败率、病理不完全反应率、肿瘤转移率和死亡率仍然居高不下,令人难以接受:我们以 "可切除食管癌 "和 "多模式疗法 "为关键词进行了叙述性文献综述,以确定单独或联合手术治疗食管癌的新辅助放疗和化疗的前瞻性试验。对1984年至2022年期间进行的试验进行了鉴定和分析,并查询了Clinicaltrials: gov以确定正在进行的研究:结果:确定了 21 项临床研究:结果:确定了 21 项临床研究:15 项随机对照试验和 6 项前瞻性非随机试验。随机试验的结果表明,与单纯手术相比,新辅助化疗加放疗或单纯化疗加手术的多模式疗法具有更高的局部疾病控制率和部分临床反应率,并有可能延长生存期。免疫疗法是治疗食道癌患者的新选择:对可切除食管癌患者的治疗正在迅速发展。虽然以往的治疗方案对患者的益处有限,但在过去 30 年中已取得了重大进展。现有研究结果表明,食管癌治疗的进步有可能提高这些患者的生存率;但是,在作用机制、患者选择和基于遗传学的个性化方法的使用方面仍存在问题。
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来源期刊
Annals of Thoracic Surgery
Annals of Thoracic Surgery 医学-呼吸系统
CiteScore
6.40
自引率
13.00%
发文量
1235
审稿时长
42 days
期刊介绍: The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.
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