Treatment for unresectable or metastatic oesophageal cancer: current evidence and trends

被引:104
作者
van Rossum, Peter S. N. [1 ,2 ]
Mohammad, Nadia Haj [3 ]
Vleggaar, Frank P. [4 ]
van Hillegersberg, Richard [1 ]
机构
[1] Univ Med Ctr Utrecht, Dept Surg, Heidelberglaan 100, NL-3584 CX Utrecht, Netherlands
[2] Univ Med Ctr Utrecht, Dept Radiat Oncol, Heidelberglaan 100, NL-3584 CX Utrecht, Netherlands
[3] Univ Med Ctr Utrecht, Dept Med Oncol, Heidelberglaan 100, NL-3584 CX Utrecht, Netherlands
[4] Univ Med Ctr Utrecht, Dept Gastroenterol & Hepatol, Heidelberglaan 100, NL-3584 CX Utrecht, Netherlands
关键词
ADVANCED GASTRIC-CANCER; RANDOMIZED PHASE-III; EXPANDABLE METAL STENTS; QUALITY-OF-LIFE; PATHOLOGICAL COMPLETE RESPONSE; GIANTURCO-Z-STENTS; TERM-FOLLOW-UP; GASTROESOPHAGEAL JUNCTION; ESOPHAGOGASTRIC JUNCTION; PALLIATIVE TREATMENT;
D O I
10.1038/nrgastro.2017.162
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Approximately half of the patients diagnosed with oesophageal cancer present with unresectable or metastatic disease. Treatment for these patients aims to control dysphagia and other cancer-related symptoms, improve quality of life and prolong survival. In the past 25 years, modestly improved outcomes have been achieved in the treatment of patients with inoperable non-metastatic cancer who are medically not fit for surgery or have unresectable, locally advanced disease. Concurrent chemoradiotherapy offers the best outcomes in these patients. In distant metastatic oesophageal cancer, several double-agent or triple-agent chemotherapy regimens have been established as first-line treatment options. In addition, long-term results of multiple large randomized phase III trials using additional targeted therapies have been published in the past few years, affecting contemporary clinical practice and future research directions. For the local treatment of malignant dysphagia, various treatment options have emerged, and self-expandable metal stent (SEMS) placement is currently the most widely applied method. Besides the continuous search for improved SEMS designs to minimize the risk of associated complications, efforts have been made to develop and evaluate the efficacy of antireflux stents and irradiation stents. This Review outlines the current evidence and ongoing trends in the different modern-day, multidisciplinary interventions for patients with unresectable or metastatic oesophageal cancer with an emphasis on key randomized trials.
引用
收藏
页码:235 / 249
页数:15
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