胸段食管鳞癌的多学科综合治疗

食管癌患者就诊时大多已为中晚期,第七版UICC食管癌新分期Ⅲ期以上肿瘤单纯手术切除往往疗效不满意,系统性的多学科治疗至关重要.越来越多的证据表明术前同期放化疗是最为有效的诱导治疗方式,可使肿瘤降期并提高根治性切除率;针对食管鳞癌中常见的多组、多野淋巴结转移患者,术前诱导化疗不失为可行的选择.对于已根治性手术切除的局部进展期肿瘤,术后辅助放疗或有助于弥补手术清扫范围的不足以加强局控；术后辅助化疗的作用亦有待进一步深入研究.胸段食管鳞癌与西方国家常见的食管下段腺癌有本质的不同,需要积累更多的前瞻性临床研究,以形成适合我国食管癌患者的综合治疗模式.

Multimodality management of squamous cell carcinoma of thoracic esophagus

Most patients with esophageal cancer have advanced disease at presentation.The efficacy of surgical resection alone is often unsatisfactory in patients with stage Ⅲ or more advanced cancer according to the seventh edition of UICC staging system for esophageal cancer.The systematic multidisciplinary treatment is important.Mounting evidence indicates that preoperative concurrent chemoradiotherapy is the most effective induction therapy to down-stage tumor and increase radical resection rate.For the esophageal squamous cell carcinoma patients with multi-stations and multi-fields lymph node metastasis,preoperative induction chemotherapy would be a viable option.For locally advanced cancers which have been surgically resected,postoperative adjuvant radiotherapy maybe helpful to improve local control for the insufficient surgical dissection.The role of adjuvant chemotherapy also needs further studies.Thoracic esophageal squamous cell carcinoma and lower esophageal adenocarcinoma which is common in western countries are different.We need more prospective clinical studies to establish our treatment modalities for esophageal cancer.