食管癌综合治疗的现状与展望

Current status and future prospect of multimodality management of esophageal cancer

我国是食管癌大国，手术是食管癌最为可靠且主要的治疗方法．规范的手术操作和彻底的淋巴结清扫是综合治疗的基础．也是关系到治疗成败和患者预后的关键所在。目前．对于可手术的食管癌患者．推荐术前采用同步放化疗．术前放疗并不增加手术难度和并发症：不推荐术前单纯化疗。NCCN建议采用的术后辅助治疗是以氟尿嘧啶（5-Fu）为基础的化疗方案与放疗同步进行。国内推荐对ⅡB-Ⅲ期食管癌患者进行术后同步放化疗。目前实施的各种治疗组合模式如何让患者最大获益，还需大样本、多中心、前瞻性对照试验进行进一步研究。

The prevalence of esophageal cancer in China is significant. Surgery remains to he the mainstay treatment for esophageal cancer. Standardized surgical procedure and radical lymph node dissection is the base of muhimodality treatment, which is also related to the success of the treatment and prognosis. At present, synchronized preoperative chemoradiation is recommended for operable esophageal cancer. Use of preoperative radiation is not associated with increased difficulty in performing surgery or increased complications. Preoperative chemotherapy alone is not recommended. NCCN recommends 5-fluouracil-based adjuvant therapy administered synchronously with radiation. In China, postoperative synchronized chemoradiation is recommended for IIS-m esophageal cancer. Large-scale, multi-center, prospective controlled clinical trials are warranted to determine the optimal combination of therapeutic alternatives to benefit patients the most.