局部晚期食管癌放疗进展

Advances in radiotherapy for locally advanced esophageal carcinoma

食管鳞癌是我国最常见的恶性肿瘤之一,其中局部晚期食管鳞癌异质性强,对综合治疗的水平要求较高。放疗是局部晚期食管鳞癌的重要治疗手段:对于可手术切除的患者,术前同步放化疗加手术治疗是全球范围内最广泛推荐的标准治疗;此外,放疗在术后辅助、术后复发挽救以及前置同步放化疗而把手术作为挽救手段这三种模式下均展现出良好的临床效果,亟待进一步研究。对于不可切除的患者,同步放化疗是标准根治性治疗手段,高剂量与低剂量的争议尚无定论,靶向治疗的联合未能带来明确获益。放疗在新辅助和根治治疗中与免疫治疗的联合值得更多研究。随着放疗技术的发展,食管癌应以调强放疗为主要治疗技术,同时积极探索质子治疗的应用价值。

Esophageal squamous cell carcinoma(ESCC)is one of the most common malignant tumors in China,while the high heterogeneity of locally advanced ESCC poses great challenge for comprehensive treatment.Radiotherapy plays an important role in the treatment of locally advanced ESCC:for the patients with resectable tumor,preoperative chemoradiation plus surgery is the most widely recommended standard of care;in addition,the encouraging results have been observed for radiotherapy in the modality of adjuvant,salvage of postoperative recurrence,and upfront chemoradiation with surgery as salvage,which should be investigated urgently.On the other hand,for the patients with unresectable tumor,chemoradiation is the mainstay of definitive treatment,with pros and cons of high-dose and low-dose so far are inconclusive,and there was no survival benefit from adding targeted therapy.In neoadjuvant and definitive treatment,the combination of radiotherapy and immunotherapy deserves intense research attention.With the development of radiotherapy technique,the intensity-modulated radiotherapy should be the main technique,and the proton beam therapy deserves actively explored.