Organ-Sparing Approach after Neoadjuvant Treatment in Oesophageal Cancer.

IF 1.2 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY
Matteo Pittacolo, Oleksandr Khoma, Sjoerd M Lagarde, Bianca Mostert, Bas P L Wijnhoven
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引用次数: 0

Abstract

Background: Neoadjuvant chemoradiotherapy (nCRT) or perioperative chemotherapy followed by surgical resection is the standard of care for oesophageal and gastroesophageal junction cancer. Up to a third of patients will have a pathological complete response to neoadjuvant treatment. Given the significant morbidity associated with surgery, active surveillance is considered as a potential alternative for patients with clinical complete response post-nCRT.

Summary: The preSANO and preSINO trials have validated a multimodal diagnostic strategy combining oesophagogastroduodenoscopy with bite-on-bite biopsies, endoscopic ultrasonography with fine-needle aspiration of suspicious lymph nodes, and PET-CT to detect residual disease. The SANO trial is assessing whether active surveillance leads to non-inferior overall survival compared to planned surgery. Early results of randomized studies support previous retrospective reports of comparable oncological outcomes, with improved quality of life in the surveillance group. Despite concerns of increased morbidity of postponed surgery upon recurrence, recent data indicate comparable surgical outcomes of delayed oesophagectomy. Ongoing trials, including SANO-2, CELEAC, and NEEDS, aim to rationalize surveillance protocols, while SANO-3 is investigating the role of adding immunotherapy in improving response durability.

Key messages: Active surveillance represents a promising alternative to surgery for oesophageal cancer patients achieving complete clinical response after neoadjuvant therapy. While it can spare patients the morbidity of oesophagectomy and significantly improve quality of life, it requires accurate response assessment and structured follow-up. Future developments, including immunotherapy and non-invasive diagnostics, may further refine this approach and expand its safe applicability.

食管癌新辅助治疗后保留器官入路。
新辅助放化疗(nCRT)或围手术期化疗(pCT)后手术切除是食管癌和胃食管癌的标准治疗方法。多达三分之一的患者对新辅助治疗有病理完全反应(pCR)。鉴于与手术相关的显著发病率,主动监测被认为是ncrt后临床完全缓解(cCR)患者的潜在替代方案。preSANO和preSINO试验验证了一种多模式诊断策略,该策略结合了食管胃十二指肠镜检查(OGD)和咬对咬活检,内镜超声检查(EUS)和细针穿刺可疑淋巴结,以及PET-CT检测残留疾病。与计划手术相比,SANO试验正在评估主动监测是否会导致非劣势的总生存率。随机研究的早期结果支持先前的回顾性报告,可比较肿瘤预后,并改善了监测组的生活质量。尽管担心复发后延迟手术的发病率增加,但最近的数据表明延迟食管切除术的手术结果相当。正在进行的试验,包括SANO-2、CELEAC和NEEDS,旨在使监测方案合理化,而SANO-3正在研究添加免疫治疗在提高反应持久性方面的作用。本文综述了食管癌主动监测方法的发展和现状。
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
Digestive Surgery
Digestive Surgery 医学-外科
CiteScore
4.90
自引率
3.70%
发文量
25
审稿时长
3 months
期刊介绍: ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.
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