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食管胃结合部腺癌(AEG)的首要治疗方式是手术切除,但根治性切除病例中5年内复发率或病死率均超过50%,提示AEG围手术期放化疗的多学科综合治疗的必要性。近年来AEG的新辅助治疗受到较多关注,当前认为术前新辅助放疗能够提高术后5年总体存活率。而且欧洲癌症研究与治疗组织亦制定了AEG术前新辅助放疗的共识性指南,其对临床实践有很好的指导意义。术前新辅助化疗对提高R0切除率有重要意义,但需与术后辅助化疗序贯应用以提高总体存活率。术后辅助化疗和胃癌相同,NCCN推荐的多药方案为经典的ECF或改良ECF方案,而单药S1的试验结果也有不错的远期存活率。目前术中和术后放疗的证据令人遗憾,并不能提高远期存活率。因此,目前来说术前同步新辅助放化疗联合术后序贯辅助化疗应该是较为理想的方式。
Esophageal-gastric junction adenocarcinoma (AEG) is the primary treatment of surgical resection, but the radical resection of the case within 5 years, the recurrence rate or mortality were more than 50%, suggesting that the AEG perioperative radiotherapy and chemotherapy multidisciplinary comprehensive treatment of necessity . In recent years, neoadjuvant AEG treatment has received more attention, and it is currently considered that neoadjuvant radiotherapy can improve the overall survival after 5 years. Moreover, the European Organization for Research and Treatment of Cancer has also established a consensus guideline for preoperative neoadjuvant radiotherapy for AEG, which is of great guiding significance for clinical practice. Neoadjuvant chemotherapy before surgery to improve the R0 resection rate is important, but the need for postoperative adjuvant chemotherapy and sequential application to improve the overall survival rate. Postoperative adjuvant chemotherapy is the same as for gastric cancer. The multidrug regimen recommended by NCCN is a classic ECF or modified ECF regimen, whereas the single-agent S1 trial also has good long-term survival. The current evidence of intraoperative and postoperative radiotherapy is regrettable and does not improve long-term survival. Therefore, at present, the preoperative synchronized neoadjuvant chemoradiation combined with sequential adjuvant chemotherapy should be the more ideal way.