Upper gastrointestinal (GI) malignancies, including esophageal, gastroesophageal junction (GEJ), and gastric adenocarcinomas, remain a major global health concern, with poor overall survival and high recurrence rate despite aggressive treatment. Patients with very early tumors (cT1a) can benefit from endoscopic therapy. However, patients with locally advanced disease require multimodal therapies that may combine surgery, radiation, and systemic therapies. This review provides a comprehensive overview of recent advancements in the treatment of locally advanced upper GI adenocarcinomas. Surgical resection remains the cornerstone of curative treatment, with perioperative chemotherapy emerging as the standard of care. While preoperative chemoradiation has demonstrated some benefits in esophageal and GEJ cancers, recent data suggest a more limited role for radiation going forward. Immunotherapy has shown some promise in both the adjuvant and perioperative settings but has yet to establish definitive survival benefit. The integration of HER2-targeted therapies into treatment regimens for HER2-positive locally advanced gastroesophageal cancers has not yielded significant improvements, underscoring the need for more effective strategies. Ongoing research focuses on better predictive biomarkers, personalized treatment approaches, and potential organ preservation strategies for patients achieving a clinical complete response. Continued advancements in treatment modalities and precision medicine are critical to improving survival for patients with locally advanced upper GI adenocarcinomas.
上消化道恶性肿瘤，包括食管癌、胃食管结合部腺癌和胃癌，仍是全球重大健康问题，即使接受积极治疗，其总体生存率仍较低且复发率高。极早期肿瘤（cT1a期）患者可从内镜治疗中获益。然而，局部进展期患者需要采用手术、放疗和全身治疗相结合的多模式治疗方案。本综述全面概述了局部进展期上消化道腺癌治疗的最新进展。手术切除仍是根治性治疗的基石，围手术期化疗已成为标准治疗方案。虽然术前放化疗在食管癌和胃食管结合部癌中显示出一定优势，但最新数据表明放疗在未来治疗中的作用可能更为有限。免疫治疗在辅助治疗和围手术期治疗中均展现出潜力，但尚未确立明确的生存获益。将HER2靶向治疗纳入HER2阳性局部进展期胃食管癌治疗方案并未带来显著改善，这凸显了开发更有效治疗策略的必要性。当前研究重点在于寻找更优的预测性生物标志物、制定个体化治疗方案，并为达到临床完全缓解的患者探索可能的器官保留策略。治疗模式和精准医学的持续进步对于改善局部进展期上消化道腺癌患者的生存至关重要。
Evolution of Therapeutics for Locally Advanced Upper Gastrointestinal Adenocarcinoma
肿瘤(癌症)患者之家