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Điều trị tiền phẫu so với điều trị bổ trợ: điều nào tốt hơn cho ung thư biểu mô tế bào vảy thực quản có thể cắt bỏ?
Tóm tắt
Ung thư thực quản là loại ung thư phổ biến thứ tám trên toàn cầu, và đặc biệt ở một số khu vực của Trung Quốc, nó là nguyên nhân gây tử vong phổ biến thứ tư và có mô bệnh học là ung thư biểu mô tế bào vảy (SCC) trong hơn 90% các trường hợp. Phẫu thuật đơn thuần từng là phương pháp điều trị chính trong quá khứ, nhưng tỷ lệ thất bại nội địa và toàn thân cao đã thúc đẩy việc điều tra quản lý đa ngành. Trong bài đánh giá này, chúng tôi thảo luận về các vấn đề chính được nêu ra bởi sự khả dụng gần đây của điều trị SCC thực quản với sự bổ sung của hóa trị, xạ trị, và hóa xạ trị cho việc quản lý phẫu thuật của bệnh có thể cắt bỏ và thảo luận cách các thử nghiệm lâm sàng và phân tích tổng hợp thông báo cho thực hành lâm sàng hiện tại. Không có thử nghiệm ngẫu nhiên nào so sánh xạ trị hay hóa trị tiền phẫu với phẫu thuật đơn thuần trong SCC thực quản cho thấy sự gia tăng sống sót tổng thể ở những bệnh nhân được điều trị bằng xạ trị hoặc hóa trị tiền phẫu. Hóa xạ trị tiền phẫu đã được chấp nhận gần đây cho ung thư thực quản vì chế độ điều trị như vậy mang lại cơ hội lớn cho phẫu thuật cắt bỏ có biên độ âm, kiểm soát tại chỗ vùng tốt hơn và tăng cường sống sót. Phần lớn các bằng chứng hiện có hiện nay cho thấy chỉ những trường hợp SCC thực quản giai đoạn địa phương tiến triển được chọn lọc mới có khả năng hưởng lợi nhiều hơn từ liệu pháp bổ trợ. Trọng tâm của các thử nghiệm trong tương lai nên hướng vào việc xác định chế độ điều trị tối ưu và nên nhằm giảm thiểu độc tính của điều trị và ảnh hưởng đến chất lượng cuộc sống, cũng như cố gắng xác định và chọn lọc những bệnh nhân có khả năng hưởng lợi từ các lựa chọn điều trị cụ thể.
Từ khóa
#ung thư thực quản #ung thư biểu mô tế bào vảy #hóa trị #xạ trị #hóa xạ trịTài liệu tham khảo
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