Neoadjuvant treatment of esophageal cancer: chemotherapy, chemoradiation, immunotherapy, and future trends of therapy.

IF 1.7 Q2 SURGERY
Innovative Surgical Sciences Pub Date : 2024-11-25 eCollection Date: 2025-03-01 DOI:10.1515/iss-2023-0005
Freschta Malekzada, Miljana Vladimiriov, Michael Leitz, Julia Michel, Fabian Nimzewski, Jens Hoeppner
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Abstract

In the Western hemisphere, nonmetastatic locally advanced esophageal carcinoma is mostly treated in multimodal therapy protocols according to current therapy guidelines. In squamous cell carcinoma of the esophagus, neoadjuvant chemoradiation is the favorable option. Unimodal surgical and chemoradiation treatment alternatives show inferior results on this entity. For locally advanced adenocarcinoma of the esophagus perioperative chemotherapy and neoadjuvant chemoradiation have been competing treatment approaches in the recent past. Both are evidence based (class I evidence) and superior compared to unimodal surgery. However, the latest results of head-to-head comparative therapy studies show superior overall survival results for the FLOT regimen of perioperative chemotherapy. Furthermore, immunotherapy and targeted therapy with monoclonal antibodies have become a strong focus of current clinical research. Nivolumab as well as trastuzumab are already an important part of the current standard therapies. In both entities - SCC and AC - a significant quota of patients shows a locoregional complete remission of the tumor in the specimen after modern neoadjuvant therapy and surgical resection. The addition of immunotherapy and targeted therapy to neoadjuvant therapy further increases complete remission rates in defined subgroups according to the results of current studies. Currently, three prospective randomized trials are ongoing on the subject of future possibilities for organ-preserving concepts in case of complete clinical remission ("surgery as needed," "watch and wait"). It is to be expected for the future that curative short-term and long-term treatment results in locally advanced esophageal carcinoma will significantly improve, particularly due to the additional possibilities of immunotherapy and organ-preserving therapy concepts in postneoadjuvant complete remission.

食管癌的新辅助治疗:化疗、放化疗、免疫治疗及治疗的未来趋势。
在西半球,根据目前的治疗指南,非转移性局部晚期食管癌大多采用多模式治疗方案。在食管鳞状细胞癌中,新辅助放化疗是有利的选择。单模手术和放化疗替代治疗显示较差的结果在这个实体。对于局部晚期食管癌,围手术期化疗和新辅助放化疗一直是相互竞争的治疗方法。两者都是基于证据的(I类证据),与单模手术相比优于单模手术。然而,最新的头对头比较治疗研究结果显示,FLOT方案围手术期化疗的总生存期优于其他方案。此外,免疫治疗和单克隆抗体靶向治疗已成为当前临床研究的热点。纳武单抗和曲妥珠单抗已经是目前标准治疗的重要组成部分。在SCC和AC这两种肿瘤中,在现代新辅助治疗和手术切除后,有相当一部分患者的标本显示肿瘤局部完全缓解。根据目前的研究结果,在新辅助治疗的基础上增加免疫治疗和靶向治疗进一步提高了定义亚组的完全缓解率。目前,三个前瞻性随机试验正在进行中,主题是在完全临床缓解的情况下器官保存概念的未来可能性(“根据需要进行手术”,“观察和等待”)。可以预期,局部晚期食管癌的短期和长期治疗结果将显著改善,特别是由于免疫治疗和器官保留治疗概念在新辅助后完全缓解中的额外可能性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.40
自引率
0.00%
发文量
29
审稿时长
11 weeks
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