食管鳞癌根治术后局部区域复发的治疗策略：叙述性综述
Treatment strategies for postoperative locoregional recurrent esophageal squamous cell carcinoma after curative resection: a narrative review.
作者
作者单位
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan. keiichi.jingu.e8@tohoku.ac.jp.
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan.
摘要
中文
食管癌根治术后复发仍是主要的临床难题,且与不良预后相关。术后复发性食管鳞癌的治疗策略必须根据复发模式、既往治疗史和患者相关因素进行个体化制定。局部区域复发及部分非区域淋巴结的寡复发仍有可能通过挽救性手术和根治性放化疗（CRT）等治愈性治疗获得控制。最佳治疗方案的选择应综合考虑肿瘤负荷、体能状态及既往放射暴露情况。对于经严格筛选的患者,尤其是未清扫区域的复发,挽救性手术可带来良好的远期疗效。CRT 仍是不可切除疾病的核心治疗策略,而既往放疗后的再程放疗伴随较高的严重毒性风险,需谨慎选择患者。放疗技术的进步,包括调强放疗和粒子治疗,有望在提高疗效的同时减少毒性。同时,系统治疗（尤其是免疫检查点抑制剂）扩展了治疗选择；但其在局部区域复发中的确切作用仍有待进一步明确。重要的是,预后因素不应仅作为描述性变量,而应整合到临床决策中,以区分适合治愈性还是姑息性治疗的患者。整合精准肿瘤学和多种治疗手段的未来策略有望进一步改善预后。仍需开展前瞻性研究以建立最佳治疗方案。
English
Recurrence following curative esophagectomy remains a major clinical challenge and is associated with poor prognosis. Treatment strategies for postoperative recurrent esophageal squamous cell carcinoma must be individualized based on recurrence patterns, prior treatment history, and patient-related factors. Locoregional recurrence and oligo-recurrence in some non-regional lymph nodes may still be amenable to curative-intent therapy, including salvage surgery and definitive chemoradiotherapy (CRT). Selection of optimal treatment should consider tumor burden, performance status, and prior radiation exposure. Salvage surgery offers favorable long-term outcomes in carefully selected patients, particularly when recurrence occurs in non-dissected regions. CRT remains a central treatment strategy for unresectable disease, whereas re-irradiation after prior radiotherapy carries a substantial risk of severe toxicity and requires cautious patient selection. Advances in radiotherapy techniques, including intensity-modulated radiotherapy and particle therapy, may improve therapeutic efficacy while reducing toxicity. In parallel, systemic therapies, particularly immune checkpoint inhibitors, have expanded treatment options; however, their role in locoregional recurrence remains to be fully defined. Importantly, prognostic factors should not only be considered descriptive variables but also integrated into clinical decision-making to distinguish candidates for curative versus palliative treatment. Future strategies integrating precision oncology and multimodal approaches are expected to further improve outcomes. Prospective studies are needed to establish optimal treatment algorithms.
分类与指标
- 研究类型
- 综述Meta
- 病种
- 食管癌
- JCR 分区
- Q1
- 影响因子
- 5.8
- 新锐分区
- 4区