| Esophageal cancer is a common cancer, the incidence of esophageal cancerand cancer mortality rates are listed in the forefront. Any single treatment methods aredifficult to significantly increase the efficacy of esophageal cancer. Previous studieshave shown that clinical efficacy and pathological response rate is better whenchemoradiotherapy combined with surgery, it is more rational treatment strategies.And the approach of preoperative chemoradiotherapy combined with surgery is a hotresearch.This paper do a review by referring to a large number of new domesticforeign literature, research progress in respect of therapy. Preoperative concurrentradiotherapy and chemotherapy Progress: radiotherapy, the applications ofthree-dimensional conformal radiotherapy technology improve efficacy ofpreoperative chemoradiotherapy, reduce toxicity.But It did not show advantage whenimproved preoperative radiation dose; chemotherapy, the multi-choice chemotherapywith platinum-based regimens, the most commonly used cisplatin (DDP),5-fluorouracil (5-Fu) chemotherapy regimens. Whose efficacy is better in Cisplatin,oxaliplatin (OXA) and nedaplatin (NED)? It has different conclusions, but OXA andNED show a good prospect. Paclitaxel, docetaxel, irinotecan and joint programs weremore effective platinum-based and well tolerated. Two kinds of platinum combinedOCF program (ie OXA/DDP/5-FU) is a promising treatment option, especially forpatients with squamous cell carcinoma. Three-drug combination of platinum-freeprogram is also actively feasible and safe, but not superior to those of platinum-basedregimens have been published. The Indications were patients of T3, T4, N1, M1awithesophageal cancer, or on the chest upper, middle and lower esophagus were longerthan4cm,5cm,6cm. It is noteworthy that pathological reactions significantly associated with theprognosis of patients with preoperative chemoradiotherapy. Currently a variety ofclinical examination indicators are not satisfactorily to predict efficacy on preoperative chemoradiotherapy, the application of modern molecular biologytechniques are expected to put the efficacy of preoperative chemoradiotherapy forsynchronous early prediction of esophageal cancer before surgery to provide powerfultools, such as Ki67, REG I-α, COX-2, NF-κ B, PI3K/PTEN/AKT/mTOR and othersignal transduction pathway gene variants, survivin protein and Rad51protein.Contrast effect:1. treatment of esophageal cancer with surgery alone in randomizedcontrolled clinical studies and Meta-analysis showed that preoperativechemoradiotherapy group were significantly better than surgery alone in PFS and OS.2.Comparative efficacy of chemoradiotherapy alone found that when radicalchemoradiotherapy can not achieve local control, palliative esophageal resection isoften the only viable treatment prolonged survival, surgical resection of residualtumors aims. Although some scholars hold the opposite view that patients whoreached pCR after chemoradiotherapy do not need further surgery. But most scholarsbelieve that the effective patients after chemoradiotherapy still need surgery. Security:Most report that preoperative chemoradiotherapy may increase the incidence ofcomplications, along with improvements in radiotherapy techniques and theapplication of new drugs, preoperative chemoradiotherapy group and the surgeryalone group, or simply put the complications of chemotherapy group synchronizationoccurs rate difference was not statistically significant.In general, preoperative chemoradiotherapy for locally advanced enabling (IIb~III period) Preoperative esophageal achieve the purpose of reducing, easy surgery,and is expected to enable improved overall survival. Although preoperativechemoradiotherapy increased toxicity and postoperative complications, but operativemortality was not high, and treatment toxicity is still acceptable. |
