关于非转移性治疗方案的相对有效性存在有限的指导,可手术的食管或胃食管交界处(GEJ)腺癌患者。在这次系统审查中,美国镭协会(ARS)胃肠道专家小组召集,以制定适当的使用标准(AUC),评估新辅助和/或辅助治疗方案的相互比较,单独手术,或对治疗的反应明确的放化疗,生活质量,和肿瘤结果。
系统评价和荟萃分析(PRISMA)方法的首选报告项目用于对同行评审的2R期和3期随机对照试验以及OvidMedline中发现的荟萃分析进行广泛分析,CochraneCentral,和Embase数据库在2009年至2019年之间。这些研究被用来告知专家小组,然后通过公认的共识方法(改良的Delphi)评估了4种具有广泛代表性的临床方案中各种治疗方法的适当性。
对于患有食道cT3和/或cN+腺癌或GEJ(SiewertI-II)的可手术非转移性患者,专家组最强烈地推荐新辅助放化疗.对于具有高风险特征的cT2N0M0患者,专家组建议新辅助化疗通常是适当的.对于未接受任何新辅助治疗的病理累及淋巴结(pN+)的患者,专家组建议通常适当的辅助化学放射。这些指南评估了各种剂量分级方案和目标体积的适当性。
食管癌的化疗和/或放疗方案仍在发展,许多领域都在积极研究。这些指南旨在供希望获得有关可手术食管腺癌管理信息的从业者和患者使用。
Limited guidance exists regarding the relative effectiveness of treatment options for nonmetastatic, operable patients with adenocarcinoma of the esophagus or gastroesophageal junction (GEJ). In this systematic
review, the American Radium Society (ARS) gastrointestinal expert panel convened to develop Appropriate Use Criteria (AUC) evaluating how neoadjuvant and/or adjuvant treatment regimens compared with each other, surgery alone, or definitive chemoradiation in terms of response to therapy, quality of life, and oncologic outcomes.
Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology was used to develop an extensive analysis of peer-reviewed phase 2R and phase 3 randomized controlled trials as well as meta-analyses found within the Ovid Medline, Cochrane Central, and Embase databases between 2009 to 2019. These studies were used to inform the expert panel, which then rated the appropriateness of various treatments in 4 broadly representative clinical scenarios through a well-established consensus methodology (modified Delphi).
For a medically operable nonmetastatic patient with a cT3 and/or cN+ adenocarcinoma of the esophagus or GEJ (Siewert I-II), the panel most strongly recommends neoadjuvant chemoradiation. For a cT2N0M0 patient with high-risk features, the panel recommends neoadjuvant chemoradiation as usually appropriate. For patients found to have pathologically involved nodes (pN+) who did not receive any neoadjuvant therapy, the panel recommends adjuvant chemoradiation as usually appropriate. These guidelines assess the appropriateness of various dose-fractionating schemes and target volumes.
Chemotherapy and/or radiation regimens for esophageal cancer are still evolving with many areas of active investigation. These guidelines are intended for the use of practitioners and patients who desire information about the management of operable esophageal adenocarcinoma.