局部晚期不可手术食管癌放射治疗研究进展

Treatment progress of radiotherapy in locally advanced inoperable esophageal cancer

目的 探讨局部晚期不可手术食管癌患者行根治性同步放化疗的研究进展。方法 以“locally advanced esophageal cancer、radiotherapy”为英文关键词,“局部晚期食管癌、放疗”为中文关键词在PubMed和中国知网数据库进行检索,检索时间为自建库至2022年10月。共检索到英文文献1 668篇,中文文献138篇。纳入标准:(1)局部晚期食管癌的流行病学、放疗技术和剂量、放疗靶区范围、同步化疗方案以及新辅助放化疗;(2)放疗联合免疫检查点抑制剂在局部晚期食管癌治疗中的研究进展。排除标准:(1)综述类文献及个案报道;(2)重复的临床试验;(3)Ⅰ期临床试验。共纳入文献57篇(中文5篇,英文52篇)。结果 局部晚期不可手术食管癌目前的主要治疗方式仍是根治性同步放化疗。放疗技术首选调强放射治疗(IMRT),放疗靶区采用累及野照射(IFI)。放疗剂量的提高和同步化疗方案的改变并未提高患者的治疗疗效。经过诱导放化疗后降期的患者也可能有手术机会,从而获得更好的生存获益。食管癌免疫治疗的相关临床试验正在进行,免疫治疗的添加有可能带来更好的生存获益。结论 局部晚期不可手术食管癌的治疗需要成熟可靠的筛选模式,需针对每位患者制定个体化治疗方案。

Objective To review the related studies on the treatment progress in chemoradiotherapy of locally advanced inoperable esophageal cancer, in order to provide reference for clinical treatment.Methods The "locally advanced esophageal cancer, radiotherapy" were selected as the keywords from Pubmed and CNKI database, 1668 English and 138 Chinese literatures were retrieved.Inclusion criteria:(1)epidemiology of locally advanced esophageal cancer;(2)radiotherapy technology and radiation dose in the treatment of locally advanced esophageal cancer;(3)comparison of elective nodal irradiation and involved-field irradiation in locally advanced esophageal cancer;(4)synchronization chemotherapy in locally advanced esophageal cancer;(5)neo-chemoradiotherapy in locally advanced esophageal cancer;(6)immune checkpoint inhibitors combined with radiotherapy in the treatment of locally advanced esophageal cancer.Exclusion criteria:(1)review and case report;(2)reduplicative clinical trial;(3)phase Ⅰ clinical trial.A total of 57 literatures were included(5 Chinese literatures and 52 English literatures).Results Definitive chemoradiotherapy is still the main alternative curative management for patients with locally advanced disease who are not eligible for or refuse surgery.IMRT and involved-field irradiation is recommended.Higher radiation dose and change of chemotherapy regimens do not significantly improve the survival of patients.The patients who down staged after neo-chemoradiotherapy may benefit from surgery.Immunotherapy may provide a new treatment and survival benefit for advanced inoperable esophageal cancer.Conclusion A mature model and individualized treatment plan are required in the treatment of locally advanced inoperable esophageal cancer.