Emerging evidence has shown remarkable advances in the multimodal treatment of esophageal squamous-cell carcinoma. Despite these advances, the oncological outcomes for advanced esophageal cancer remain controversial due to the frequent observation of local recurrence in the regional or other lymph nodes and distant metastasis after curative treatment. For cases of locoregional recurrence in the cervical lymph nodes alone, salvage surgery with lymph node dissection generally provides a good prognosis. However, if recurrence occurs in multiple regions, the oncological efficacy of surgery may be limited. Radiotherapy/chemoradiotherapy can be employed for unresectable or recurrent cases, as well as for selected cases in neo- or adjuvant settings. Dose escalation and toxicity are potential issues with conventional three-dimensional conformal radiotherapy; however, more precise therapeutic efficacy can be obtained using technical modifications with improved targeting and conformality, or with the use of proton beam therapy. The introduction of immune checkpoint inhibitors, including pembrolizumab or nivolumab, in addition to chemotherapy, has been shown to improve the overall survival in unresectable, advanced/recurrent cases. For patients with lymph node recurrence in multiple regions, chemotherapy (5-fluorouracil [5-FU] plus cisplatin) and combination therapy with nivolumab and ipilimumab have shown comparable oncological efficacy. Further prospective studies are needed to improve the treatment outcomes in patients with esophageal cancer with locoregional recurrence.
新兴证据显示，食管鳞状细胞癌的多模式治疗已取得显著进展。尽管如此，由于在根治性治疗后常观察到区域或其他淋巴结的局部复发及远处转移，晚期食管癌的肿瘤学结局仍存在争议。对于仅出现颈部淋巴结局部复发的病例，淋巴结清扫的挽救性手术通常预后良好。然而，若复发发生在多个区域，手术的肿瘤学疗效可能有限。对于不可切除或复发病例，以及新辅助或辅助治疗中的特定病例，可采用放疗/放化疗。传统三维适形放疗存在剂量递增和毒性的潜在问题；但通过改进靶向和适形性的技术调整，或采用质子束治疗，可获得更精确的疗效。除化疗外，引入免疫检查点抑制剂（如帕博利珠单抗或纳武利尤单抗）已被证明可改善不可切除、晚期/复发病例的总生存期。对于多区域淋巴结复发的患者，化疗（5-氟尿嘧啶联合顺铂）以及纳武利尤单抗联合伊匹木单抗的联合疗法显示出相当的肿瘤学疗效。为改善局部复发性食管癌患者的治疗结局，仍需进一步的前瞻性研究。
肿瘤(癌症)患者之家