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1、食管癌论文：食管癌术后放射治疗及同步放化疗的临床研究进展【中文摘要】目前食管癌主要治疗模式为以手术为主的综合治疗模式,单一手术治疗后的5年生存率一直维持在20%左右。局部复发及远处转移为其治疗失败主要原因。因此,手术前后联合放疗或/和化疗成为当前研究热点。目前术前联合放疗或/和化疗在提高食管肿瘤切除率、减少淋巴结转移率,进而提高患者的生存率方面,已经在多项前瞻性研究中取得了相对肯定的结果。但关于食管癌术后是否需要行放射治疗或术后同期放化疗存在较大争议。于是我们通过对近年来发表的有关食管癌术后复发模式,食管癌术后放疗及同步放化疗的文献进行了综述,得到了如下结论:(1)食
2、管癌术后复发模式主要以区域淋巴结复发为主;(2)食管癌术后联合放疗较单一的手术能提高局部控制率,但是否提高其远期生存率结果不一。已有研究证实术后辅助性放射治疗对于Ⅲ期及淋巴结阳性患者能降低局部复发率、提高总体生存率,但是仍缺乏大型Ⅲ期前瞻性临床研究结果;(3)食管癌术后同步放化疗较单一手术、单纯术后放疗及化疗的局部控制率和远期生存率均有不同的程度的提高,显示出生存优势,并且相关毒性均在可接受范围内,但仍需大规模前瞻性临床实验证实。总的来说,食管癌术后辅助性放疗或者放化疗显示出对部分患者获益,其治疗价值有待于前瞻性随机临床研究加以证实。【英文摘要】Comprehensi
3、vetherapyiscommonlyemployedinthemanagementofesophagealcarcinoma.Surgicalresectionisoneofthemainmodesoftreatment,however,esophagectomyalonehasabout20percentcurerateoflong-termsurvival.Localregionalrecurrencesandmetastasisarethemajorreasonsofthefailurefortheesophagealcarcinoma.So,theradio
4、therapy、chemotherapyandchemoradiotherapybeforeandafterconservativesurgeryoresophagectomyaredebated.Atpresent,thepreoperativechemotherapyand/oradjuvantradiotherapyhasalreadymaderelativelypositiveresultsinmanyprospectivetrialsinimprovingtumorresection,reducinglymphnodemetastasis,thusimpro
5、vingpatientssurvival,however,thereisbiggerdisputeonthefeasibilityofthepostoperativeradiotherapyandconcurrentchemoradiotherapyinclinicpractice.So,wereviewedtheseliteraturespublishedinrecentyears,whicharebasedontherecurrencemodeafteresophagectomy、thepostoperativeradiotherapyandchemoradiot
6、herapy.Andthen,wedrawconclusiontothreepoints:firstly,theregionallymphnodemetastasisisthemainrecurrencemodesafteresophagectomy;secondly,esophagectomycombinedwithradiotherapyismoreefficientthanesophagectomyaloneinimprovinglocalcontrol,butwhethertoimprovelong-termsurvivalispuzzled.Therehav
7、ebeentrialsconfirmedthatpostoperativeprophylacticradiotherapyenhancethelocalcontrolandimprovethelong-termsurvivalrateinesophagealcarcinomapatientswithpositivelymphnodemetastasesandinpatientswithstageⅢdiseases,butstilllackoflargeprospectiveclinicalphaseⅢstudyresults;thirdly,ther
