The purpose of preoperative radiotherapy for esophageal cancer

The purpose of preoperative chemotherapy plus radiotherapy is to improve the local tumor-free rate, reduce the metastasis rate of extrathoracic lymph nodes and blood metastasis rate, and ultimately achieve the purpose of improving surgical resection and survival rate without increasing the surgical mortality rate and complications caused by chemotherapy and radiotherapy. At present, the treatment results of preoperative chemotherapy, radiotherapy or chemotherapy are different, and one of the commonly used effective treatment methods has not yet been formed. Therefore, three groups of prospective research data are selected here for reference.

There are many reports on randomized studies of preoperative chemotherapy. Commonly used regimens are cisplatin (DDP) and 5-fluorouracil (5-FU), but the pathological complete response rate is mostly between 4% and 12.8%.

Comprehensively analyzing the randomized research data of preoperative chemotherapy or preoperative chemoradiotherapy in recent years, there are the following characteristics: ① Preoperative chemotherapy or chemoradiotherapy is tolerable: the pathological response rate of chemoradiotherapy, especially CR (25%-30%) is higher than that of preoperative single chemotherapy (≤13%); ② Early staging and improved radical (RO) surgery rate; ④ DDP-based chemotherapy regimen; ⑤ The overall survival rate has not been significantly improved, but the survival rate of those with pathological CR is significantly improved compared with those without radiotherapy or chemotherapy response, and the tumor-free survival rate and local tumor recurrence rate seem to show good signs; ⑥ Postoperative complications, the degree of pathological response and postoperative mortality determine the dose and course of preoperative chemoradiotherapy.

At present, the problem that needs to be focused on is how to increase the degree of pathological response without increasing postoperative complications and surgical mortality, and ultimately improve the survival rate.