The curative management of localized esophageal and esophagogastric junction (EGJ) cancers has undergone major changes over the past decade, shaped by multimodal strategies integrating chemotherapy, chemoradiotherapy, surgery, and more recently, immunotherapy. For esophageal squamous cell carcinoma (SCC), neoadjuvant or definitive chemoradiotherapy remains the standard of care in Western countries. In contrast, for adenocarcinoma (AC) of the esophagus and EGJ, perioperative chemotherapy has emerged as the preferred strategy. Despite these advances, long-term outcomes remain suboptimal, and recurrence continues to pose a major challenge, highlighting the need to optimize patient selection and treatment sequencing. The integration of immunotherapy in the perioperative or adjuvant setting has recently led to improvements in surrogate endpoints yet overall survival benefit remains under investigation. For patients with tumors harboring microsatellite instability-high (MSI-H) or mismatch repair deficiency (dMMR), checkpoint inhibitors show exceptional activity, and non-operative management may be feasible in select cases. Conversely, human epidermal growth receptor 2 (HER2)-targeted strategies, although effective in metastatic disease, have not yet translated into practice-changing benefit in the curative setting. The role of circulating tumor deoxyribo nucleic acid (DNA) and functional imaging as real-time tools to assess response and guide treatment adaptation is also being actively explored. This review provides a comprehensive overview of current standards, ongoing developments, and future directions for the treatment of localized esophageal and EGJ cancers, with a focus on emerging personalization strategies and biomarker-driven approaches aimed at improving cure rates and minimizing treatment-related morbidity.
过去十年间，局部食管癌及食管胃结合部（EGJ）癌的根治性治疗模式发生了重大变革，其发展轨迹由化疗、放化疗、手术及近年兴起的免疫治疗等多模式综合策略共同塑造。对于食管鳞状细胞癌（SCC），新辅助或根治性放化疗仍是西方国家的标准治疗方案。相比之下，食管及EGJ腺癌（AC）的治疗则更倾向于采用围手术期化疗策略。尽管治疗手段不断进步，长期预后仍不理想，肿瘤复发仍是重大临床挑战，这凸显了优化患者筛选与治疗时序的重要性。近期免疫治疗在围手术期及辅助治疗中的应用虽已改善部分替代终点指标，但其对总生存期的获益仍有待验证。对于存在高度微卫星不稳定（MSI-H）或错配修复缺陷（dMMR）的肿瘤患者，免疫检查点抑制剂展现出卓越疗效，部分病例甚至可能实现非手术治疗。相反，针对人表皮生长因子受体2（HER2）的靶向策略虽然在转移性疾病中有效，但在根治性治疗领域尚未产生变革性影响。循环肿瘤DNA与功能影像学作为实时评估疗效、指导治疗调整的动态监测工具，其临床应用价值也正在积极探索中。本综述系统梳理了当前局部食管癌及EGJ癌的治疗标准、研究进展与未来方向，重点关注旨在提升治愈率并降低治疗相关损伤的新兴个体化策略与生物标志物驱动疗法。
肿瘤(癌症)患者之家