Clinical Research Progress in Postoperative Radiotherapy and Concurrent Chemoradiotherapy for Esophageal Carcinoma
|Keywords||esophagealcarcinoma surgery radiotherapy chemotherapy adjuvant|
Comprehensive therapy is commonly employed in the management of esophageal carcinoma.Surgical resection is one of the main modes of treatment,however,esophagectomy alone has about 20 percent cure rate of long-term survival.Local regional recurrences and metastasis are the major reasons of the failure for the esophageal carcinoma.So,the radiotherapy、chemotherapy and chemoradiotherapy before and after conservative surgery or esophagectomy are debated.At present,the preoperative chemotherapy and/or adjuvant radiotherapy has already made relatively positive results in many prospective trials in improving tumor resection,reducing lymph node metastasis,thus improving patients survival, however , there is bigger dispute on the feasibility of the postoperative radiotherapy and concurrent chemoradiotherapy in clinic practice.So, we reviewed these literatures published in recent years, which are based on the recurrence mode after esophagectomy、the postoperative radiotherapy and chemoradiotherapy. And then,we draw conclusion to three points:firstly, the regional lymph node metastasis is the main recurrence modes after esophagectomy; secondly, esophagectomy combined with radiotherapy is more efficient than esophagectomy alone in improving local control,but whether to improve long-term survival is puzzled. There have been trials confirmed that postoperative prophylactic radiotherapy enhance the local control and improve the long-term survival rate in esophageal carcinoma patients with positive lymph node metastases and in patients with stageⅢdiseases,but still lack of large prospective clinical phaseⅢstudy results;thirdly,there are some trials confirmed that postoperative chemoradiotherapy has showed some advantages,including enhanced the local control and lengthened the long-term survival,besides the toxicities are within acceptable limits.Although these,it still need large prospective clinical trials to demonstrate.All in all, postoperative adjuvant radiotherapy and chemoradiotherapy has shown the overall survival advantage to some patients,whose clinical therapeutic value needs to be confirmed by prospective randomized clinical trials as well.