食道癌早期怎样治疗

食道癌早期如何治疗配图，仅供参考

Treatment
The past decade has seen significant advances in the treatment of BE. Radiofrequency ablation (RFA) has emerged as the leading ablative therapy modality for BE with excellent results ). Patients with nodular BE are initially treated with EMR as a diagnostic and therapeutic strategy. If the margins are negative without deeper invasion,then the remaining BE is treated with RFA ). Endoscopic submucosal dissection (ESD) is another excellent diagnostic and therapeutic approach for BE and mucosal carcinoma patients.
Patients with superficial esophageal cancer who are not candidates for endoscopic treatment are best served with esophageal resection. Minimally invasive esophagectomy (MIE) is becoming the standard of care,and one of the largest series from University of Pittsburgh has demonstrated a mortality rate of 1.4% with excellent outcomes ). This modality is oncologically comparable to traditional open approaches with much less morbidity and mortality. Robotic-assisted minimally invasive esophagectomy (RAMIE) is competing with MIE to become the standard of care. RAMIE has the advantage of improved lymph node dissection and a better platform for training.
Multimodal treatment remains the mainstay of treatment of locally advanced esophageal cancer. Management depends on the location and histological type. Cervical esophageal squamous cell cancers are usually treated with definitive chemotherapy and radiation therapy. Locally advanced tumors of the mid and lower esophagus and gastric cardia are treated with induction therapy followed by esophageal resection. The optimal induction therapy for esophageal cancer remains controversial. Use of perioperative chemotherapy alone followed by esophagectomy is best shown beneficial in the MRC MAGIC (Medical Research Council Gastric Infusional Chemotherapy) trial ). This trial showed two and five-year survival rates of 50% and 36% respectively. Although only 25% of patients had esophageal and esophagogastric carcinomas,multivariate analysis demonstrated that the benefits are valid irrespective of the site of the tumor. Recently,the CROSS trial from Netherlands showed much better outcomes when chemotherapy and radiation therapy were used in combination for induction therapy ). In this randomized control trial,368 patients with resectable esophageal cancer were included. The majority had adenocarcinoma,while 25% had squamous cell cancer. Patients in the induction treatment arm were treated with five weeks of Carboplatin and Taxol with concurrent 41.4 Gy of Radiation. Overall,29% of patients had a complete response (pCR 49% for SCC and 23% for adenocarcinoma).
In a follow-up of surviving patients,the median overall survival was 48.6 months in the neo-adjuvant chemo-radiotherapy plus surgery group and 24 months in the surgery alone group. Median overall survival for patients with squamous cell carcinomas was 81.6 months in the neo-adjuvant chemo-radiotherapy plus surgery group and 21.1 months in the surgery alone group. For patients with adenocarcinomas,it was 43.2 months in the neo-adjuvant chemo-radiotherapy plus surgery group and 27.1 months in the surgery alone group.
It showed significant benefit for SCC and marginal benefit for adenocarcinoma. Recent trends favor the use of chemotherapy and radiation therapy in combination as adjuvant treatment rather than chemotherapy alone.","department":"