[Current perspectives in the treatment of epidermoid cancer of the esophagus].
Prior to the eighties, most patients with a diagnosis of epidermoid oesophageal cancer only received palliative symptomatic care. To date, most all undergo either surgery or medical treatment or both. Late diagnosis due to lack of clinical signs in the early phases of the disease, and perhaps insufficient attempts at identifying patients at risk who could benefit from systematic screening, is still an important problem although the number of diagnosed cases continues to rise (from 104 in 1985 to 151 in 1989 in Finistere in western France). Two different therapeutic attitudes could improve the prognosis: extensive surgery as proposed by the Japonese with dissection of all invaded lymph nodes whatever the localization and a multimodal approach combining radiochemotherapy and surgery. Although outcome can apparently be improved in certain types of oesophageal cancer, the proposal of aggressive extensive dissection could have an effect on respiratory complications and would not necessarily be adapted to the risk involved in western patients. Certain teams have nevertheless taken this route and will soon report their results. In France two phase II trials combining radiotherapy, chemotherapy (cisplatinum) and surgery have reported encouraging results with complete sterilization in 24% of the cases and 50% survival at 18 months. In our own series of 68 patients, we have obtained 41% sterilization and 56.3% survival at 3 years with the multi-modal protocol. The high number of non-responders to chemotherapy emphasies the importance of maintaining surgical resection whenever possible. The discouraging reports published before 1980 have been contradicted by improvements in outcome achieved over the last decade. Today, all patients with a diagnosis of epidermoid cancer of the oesophagus should benefit from either palliative or curative care based on the latest advances in radiotherapy, chemotherapy and surgery.
Lozac'h
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D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D008197:Lymph Node Excision; D011183:Postoperative Complications; D011859:Radiography; D014463:Ultrasonography
D002945:Cisplatin; D005472:Fluorouracil
Perspectives actuelles dans le traitement du cancer épidermoíde de l'oesophage.