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食管胃结合部腺癌(AEG)的首要治疗方式是手术切除,但根治性切除病例中5年内复发率或病死率均超过50%,提示AEG围手术期放化疗的多学科综合治疗的必要性。近年来AEG的新辅助治疗受到较多关注,当前认为术前新辅助放疗能够提高术后5年总体存活率。而且欧洲癌症研究与治疗组织亦制定了AEG术前新辅助放疗的共识性指南,其对临床实践有很好的指导意义。术前新辅助化疗对提高R0切除率有重要意义,但需与术后辅助化疗序贯应用以提高总体存活率。术后辅助化疗和胃癌相同,NCCN推荐的多药方案为经典的ECF或改良ECF方案,而单药S1的试验结果也有不错的远期存活率。目前术中和术后放疗的证据令人遗憾,并不能提高远期存活率。因此,目前来说术前同步新辅助放化疗联合术后序贯辅助化疗应该是较为理想的方式。

Rational use and appraisal of perioperative chemotherapy and radiotherapy for adenocarcinoma of the esophagogastric junction

The primary treatment of adenocarcinoma of the esophagogastric junction(AEG) is surgery,but more than 50% of curatively resected patients undergo recurrence or cancer-related death during postoperative 5 years.It implies multidisciplinary treatment of radio-and chemotherapy is still necessary.Recently,neoadjuvant therapy has been paid more attention to,and neoadjuvant radiotherapy is currently considered able to improve 5-year overall survival.Moreover,European Organization for Research and Treatment of Cancer has made a consensus guideline of neoadjuvant radiotherapy for AEG,which is useful in clinical practice.Neoadjuvant chemotherapy is meaningful to increase R0 resection rate,but should combine adjuvant chemotherapy to improve overall survival.Concept on adjuvant chemotherapy is according to gastric cancer,and NCCN guideline recommends classic ECF or modified ECF regimens.Results of monotherapy S1 trial also showed improved overall survival.The evidence of intra-or postoperative radiotherapy is poor and can not improve long term survival.Therefore,preoperative concurrent chemoradiotherapy plus postoperative chemotherapy is currently preferable multidisciplinary treatment model.