Esophageal cancer is the fourth most lethal tumor in China, accounting for about half of the world's new cases and deaths each year, of which esophageal squamous cell carcinoma accounts for more than 90%, with a 5-year survival rate of 29.6%. With the advancement of radiotherapy technology and optimization of chemotherapy regimens, concurrent chemoradiotherapy has made breakthrough progress which has pushed the overall treatment situation of esophageal cancer to a fundamental change. Several international guidelines recommend neoadjuvant concurrent chemoradiotherapy plus surgery or definitive concurrent chemoradiotherapy as a side-by-side choice for locally advanced esophageal cancer treatment, which provides a theoretical basis for the "organ preservation" concept for patients with locally resectable esophageal cancer. It provides theoretical basis and new ideas for the concept of "organ preservation" for patients with locally resectable esophageal cancer. In order to better guide the whole processing management of concurrent chemoradiotherapy for esophageal cancer, the Infectious Cancer Committee, Chinese and Western Medicine Integrated Esophageal Cancer Committee, and Esophageal Cancer Integrative Rehabilitation Committee of the Chinese Anti-Cancer Association have convened domestic experts in related fields. After several rounds of in-depth discussions and modifications, they systematically reviewed the latest domestic and international guidelines and evidence-based medical evidence, fully considering the specific conditions of clinical practice in China, to form the present expert consensus.

[1]Zheng R S, Chen R, Han B F, et al. Analysis on the Epidemiological Situation of Malignant Tumors in China in 2022 [J]. chinese Chinese Journal of Oncology, 2024,46(3):221-231.
[2]Zhang J, Dang F, Ren J, et al. Biochemical aspects of PD-L1 regulation in cancer immunotherapy[J]. Trends in biochemical sciences, 2018, 43(12): 1014-1032.
[3]Herrera F G, Bourhis J, Coukos G. Radiotherapy combination opportunities leveraging immunity for the next oncology practice[J]. CA: a cancer journal for clinicians, 2017, 67(1): 65-85.
[4]Wang R, Liu S, Chen B, et al. Recent advances in combination of immunotherapy and chemoradiotherapy for locally advanced esophageal squamous cell carcinoma[J]. Cancers, 2022, 14(20): 5168.
[5]Ngwa W, Irabor O C, Schoenfeld J D, et al. Using immunotherapy to boost the abscopal effect[J]. Nature Reviews Cancer, 2018, 18(5): 313-322.
[6]Branch of Radiation Oncology Physicians, Chinese Medical Doctor Association; Professional Committee of Radiation Oncology, Chinese Anti-Cancer Association. Expert Consensus on Neoadjuvant Radiotherapy for Esophageal Squamous Cell Carcinoma in China [J]. chinese Journal of International Oncology, 2023,50(3): 129-137.
[7]Yang J X, Gao L R, Xiao Z F, et al. Advances in the Role of Radiotherapy in the Comprehensive Treatment of Esophageal Cancer [J]. chinese Journal of Multidisciplinary Cancer Management (Electronic Version), 2023,9(02):1-10.
[8]Eyck B M, van Lanschot J J B, Hulshof M C C M, et al. Ten-year outcome of neoadjuvant chemoradiotherapy plus surgery for esophageal cancer: the randomized controlled CROSS trial[J]. Journal of Clinical Oncology, 2021, 39(18): 1995-2004.
[9]Yang H, Liu H, Chen Y, et al. Long-term efficacy of neoadjuvant chemoradiotherapy plus surgery for the treatment of locally advanced esophageal squamous cell carcinoma: the NEOCRTEC5010 randomized clinical trial[J]. JAMA surgery, 2021, 156(8): 721-729.
[10]Branch of Radiation Oncology Physicians, Chinese Medical Doctor Association; Professional Committee of Radiation Oncology, Chinese Anti-Cancer Association. Guidelines for Radiotherapy of Esophageal Cancer in China (2023 Edition) [J]. chinese Journal of International Oncology, 2024,51(1): 1-20.
[11]Minashi K, Nihei K, Mizusawa J, et al. Efficacy of endoscopic resection and selective chemoradiotherapy for stage I esophageal squamous cell carcinoma[J]. Gastroenterology, 2019, 157(2): 382-390. e3.
[12]Medical Administration Bureau of the National Health Commission of the People's Republic of China. Guidelines for the Diagnosis and Treatment of Esophageal Cancer (2022 Edition) [J]. chinese Chinese Journal of Digestive Surgery, 2022,10:1247-1268.
[13]Pathology Collaboration Group of the Gastroenterology Endoscopy Branch of the Chinese Medical Association. Expert Consensus (Draft) on the Specifications for Biopsy and Pathological Examination of Digestive Endoscopy in China [J]. chinese Chinese Journal of Digestive Endoscopy,2014,(9):481-485.
[14]Chen X Y. Key Points of Pathological Examination for Gastrointestinal Biopsy and Surgical Specimens [J]. chinese Chinese Journal of Gastroenterology, 2012,17(11):641-645.
[15]Jiang D X, Hou Y Y. Clinicopathological Evaluation Issues in Neoadjuvant Therapy for Esophageal Squamous Cell Carcinoma [J]. chinese Chinese Journal of Pathology,2023,52(1): 95-100.
[16]Li B, Wang Y, Yu H, et al. Pattern of tumor regression after neoadjuvant chemoimmunotherapy for esophageal squamous cell carcinoma[J]. Journal of Thoracic Disease, 2023, 15(10): 5517.
[17]Yamada I, Hikishima K, Miyasaka N, et al. Esophageal carcinoma: ex vivo evaluation with diffusion-tensor MR imaging and tractography at 7 T[J]. Radiology, 2014, 272(1): 164-173.
[18]Van Rossum P S N, Van Lier A, Lips I M, et al. Imaging of oesophageal cancer with FDG-PET/CT and MRI[J]. Clinical radiology, 2015, 70(1): 81-95.
[19]Tangoku A, Yamamoto Y, Furukita Y, et al. The new era of staging as a key for an appropriate treatment for esophageal cancer[J]. Annals of Thoracic and Cardiovascular Surgery, 2012, 18(3): 190-199.
[20]Vollenbrock S E, Nowee M E, Voncken F E M, et al. Gross tumor delineation in esophageal cancer on MRI compared with 18F-FDG-PET/CT[J]. Advances in Radiation Oncology, 2019, 4(4): 596-604.
[21]Schröder W, Baldus S E, Mönig S P, et al. Lymph node staging of esophageal squamous cell carcinoma in patients with and without neoadjuvant radiochemotherapy: histomorphologic analysis[J]. World journal of surgery, 2002, 26(5): 584-587.
[22]Foley K G, Christian A, Fielding P, et al. Accuracy of contemporary oesophageal cancer lymph node staging with radiological-pathological correlation[J]. Clinical radiology, 2017, 72(8): 693. e1-693. e7.
[23]Karaosmanoğlu A D, Blake M A. Applications of PET-CT in patients with esophageal cancer[J]. Diagn Interv Radiol, 2012, 18(2): 171-182.
[24]Ishihara R, Muto M. Current status of endoscopic detection, characterization and staging of superficial esophageal squamous cell carcinoma[J]. Japanese Journal of Clinical Oncology, 2022, 52(8): 799-805.
[25]Choi J, Chung H, Lee A, et al. Role of endoscopic ultrasound in selecting superficial esophageal cancers for endoscopic resection[J]. The Annals of Thoracic Surgery, 2021, 111(5): 1689-1695.
[26]National Cancer Center, Thoracic and Cardiovascular Surgery Branch of the Chinese Medical Association, et al. Practice Guidelines for the Perioperative Diagnosis and Treatment of Resectable Esophageal Cancer in China (2023 Edition) [J]. chinese National Medical Journal of China, 2023,103(33): 2552-2570.
[27]Tang H, Wang H, Fang Y, et al. Neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy followed by minimally invasive esophagectomy for locally advanced esophageal squamous cell carcinoma: a prospective multicenter randomized clinical trial[J]. Annals of Oncology, 2023, 34(2): 163-172.
[28]Branch of Radiation Oncology Physicians, Chinese Medical Doctor Association; Professional Committee of Radiation Oncology, Chinese Anti-Cancer Association. Expert Consensus on Neoadjuvant Radiotherapy for Esophageal Squamous Cell Carcinoma in China [J]. chinese Journal of International Oncology, 2023,50(3): 129-137.
[29]Eyck B M, van Lanschot J J B, Hulshof M C C M, et al. Ten-year outcome of neoadjuvant chemoradiotherapy plus surgery for esophageal cancer: the randomized controlled CROSS trial[J]. Journal of Clinical Oncology, 2021, 39(18): 1995-2004.
[30]Yang H, Liu H, Chen Y, et al. Long-term efficacy of neoadjuvant chemoradiotherapy plus surgery for the treatment of locally advanced esophageal squamous cell carcinoma: the NEOCRTEC5010 randomized clinical trial[J]. JAMA surgery, 2021, 156(8): 721-729.
[31]Lorenz E, Weitz A, Reinstaller T, et al. Neoadjuvant radiochemotherapy with cisplatin/5-flourouracil or carboplatin/paclitaxel in patients with resectable cancer of the esophagus and the gastroesophageal junction—comparison of postoperative mortality and complications, toxicity, and pathological tumor response[J]. Langenbeck's Archives of Surgery, 2023, 408(1): 429.
[32]Tamtai A, Jiarpinitnun C, Hiranyatheb P, et al. Tolerability and efficacy of concurrent chemoradiotherapy comparing carboplatin/paclitaxel versus platinum/5-FU regimen for locally advanced esophageal and esophagogastric junction cancers[J]. Medical Oncology, 2017, 34: 1-11.
[33]Haisley K R, Hart K D, Nabavizadeh N, et al. Neoadjuvant chemoradiotherapy with concurrent cisplatin/5-fluorouracil is associated with increased pathologic complete response and improved survival compared to carboplatin/paclitaxel in patients with locally advanced esophageal cancer[J]. Diseases of the Esophagus, 2017, 30(7): 1-7.
[34]Sasaki K, Uchikado Y, Omoto I, et al. Neoadjuvant chemoradiotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF-RT) for locally advanced esophageal squamous cell carcinoma[J]. Cancer Chemotherapy and Pharmacology, 2019, 83: 581-587.
[35]Huang T C, Hsu C H, Lin C C, et al. Systematic review and network meta-analysis: neoadjuvant chemoradiotherapy for locoregional esophageal cancer[J]. Japanese Journal of Clinical Oncology, 2015, 45(11): 1023-1028.
[36]Xu Y, Dong B, Zhu W, et al. A phase III multicenter randomized clinical trial of 60 Gy versus 50 Gy radiation dose in concurrent chemoradiotherapy for inoperable esophageal squamous cell carcinoma[J]. Clinical Cancer Research, 2022, 28(9): 1792-1799.
[37]You J, Zhu S, Li J, et al. High-dose versus standard-dose intensity-modulated radiotherapy with concurrent paclitaxel plus carboplatin for patients with thoracic esophageal squamous cell carcinoma: A randomized, multicenter, open-label, phase 3 superiority trial[J]. International Journal of Radiation Oncology* Biology* Physics, 2023, 115(5): 1129-1137.
[38]Hulshof M C C M, Geijsen E D, Rozema T, et al. Randomized study on dose escalation in definitive chemoradiation for patients with locally advanced esophageal cancer (ARTDECO study)[J]. Journal of Clinical Oncology, 2021, 39(25): 2816-2824.
[39]Chen Y, Ye J, Zhu Z, et al. Comparing paclitaxel plus fluorouracil versus cisplatin plus fluorouracil in chemoradiotherapy for locally advanced esophageal squamous cell cancer: a randomized, multicenter, phase III clinical trial[J]. Journal of clinical oncology, 2019, 37(20): 1695.
[40]Ai D, Ye J, Wei S, et al. Comparison of 3 paclitaxel-based chemoradiotherapy regimens for patients with locally advanced esophageal squamous cell cancer: a randomized clinical trial[J]. JAMA Network Open, 2022, 5(2): e220120-e220120.
[41]Ji Y, Du X, Zhu W, et al. Efficacy of concurrent chemoradiotherapy with S-1 vs radiotherapy alone for older patients with esophageal cancer: a multicenter randomized phase 3 clinical trial[J]. JAMA oncology, 2021, 7(10): 1459-1466.
[42]Jiang H, Makelike K, Chen B, et al. Definitive concurrent chemoradiotherapy with docetaxel plus cisplatin versus 5-fluorouracil plus cisplatin in patients with esophageal squamous cell carcinoma: long-term follow-up results of a phase II randomized controlled trial[J]. Radiation Oncology, 2023, 18(1): 150.
[43]Jia R, Shan T, Zheng A, et al. Capecitabine or Capecitabine Plus Oxaliplatin Versus Fluorouracil Plus Cisplatin in Definitive Concurrent Chemoradiotherapy for Locally Advanced Esophageal Squamous Cell Carcinoma (CRTCOESC): A Multicenter, Randomized, Open-Label, Phase 3 Trial[J]. Journal of Clinical Oncology, 2024: JCO. 23.02009.
[44]Chen J, Pan J, Liu J, et al. Postoperative radiation therapy with or without concurrent chemotherapy for node-positive thoracic esophageal squamous cell carcinoma[J]. International Journal of Radiation Oncology* Biology* Physics, 2013, 86(4): 671-677.
[45]Kang J, Chang J Y, Sun X, et al. Role of postoperative concurrent chemoradiotherapy for esophageal carcinoma: a meta-analysis of 2165 patients[J]. Journal of Cancer, 2018, 9(3): 584-593.
[46]Van Westreenen H L,Westerterp M,Bossuyt P M,et al. Systematic Review of the Staging Performance of 18f-Fluorodeoxyglucose Positron Emission Tomography in Esophageal Cancer [J]. J Clin Oncol,2004,22(18): 3805-3812.
[47]Cong L,Wang S,Gao T,et al. The Predictive Value of 18f-Fdg Pet for Pathological Response of Primary Tumor in Patients with Esophageal Cancer During or after Neoadjuvant Chemoradiotherapy: A Meta-Analysis [J]. Jpn J Clin Oncol,2016,46(12): 1118-1126.
[48]Xu X, Sun Z Y, Wu H W, et al. Diffusion-weighted MRI and 18 F-FDG PET/CT in assessing the response to neoadjuvant chemoradiotherapy in locally advanced esophageal squamous cell carcinoma[J]. Radiation Oncology, 2021, 16: 1-9.
[49]Cheng B, Yu J. Predictive value of diffusion-weighted MR imaging in early response to chemoradiotherapy of esophageal cancer: a meta-analysis[J]. Diseases of the Esophagus, 2019, 32(4): doy065.
[50]van der Bogt R D, Noordman B J, Krishnadath K K, et al. Endoscopic ultrasound measurements for detection of residual disease after neoadjuvant chemoradiotherapy for esophageal cancer[J]. Endoscopy, 2019, 51(04): 326-332.
[51]Cosgrove N D, Mullady D K. Endoscopic evaluation of the esophageal cancer patient after chemoradiotherapy for persistent/recurrent cancer[J]. Diseases of the Esophagus, 2018, 31(7): doy023.
[52]Eyck B M, Onstenk B D, Noordman B J, et al. Accuracy of detecting residual disease after neoadjuvant chemoradiotherapy for esophageal cancer: a systematic review and meta-analysis[J]. Annals of Surgery, 2020, 271(2): 245-256.
[53]Wang J, Cheng Y, Wu Y, et al. 1262TiP efficacy and safety of consolidative camrelizumab following definitive concurrent chemoradiotherapy in patients with locally advanced esophageal squamous cell cancer[J]. Annals of Oncology, 2022, 33: S1124.
[54]Li C, Zhao S, Zheng Y, et al. Preoperative pembrolizumab combined with chemoradiotherapy for oesophageal squamous cell carcinoma (PALACE-1)[J]. European journal of cancer, 2021, 144: 232-241.
[55]Van Den Ende T, De Clercq N C, van Berge Henegouwen M I, et al. Neoadjuvant chemoradiotherapy combined with atezolizumab for resectable esophageal adenocarcinoma: a single-arm phase II feasibility trial (PERFECT)[J]. Clinical Cancer Research, 2021, 27(12): 3351-3359.
[56]Hong M H, Kim H R, Park S Y, et al. A phase II trial of preoperative chemoradiotherapy and pembrolizumab for locally advanced esophageal squamous cell carcinoma (ESCC)[J]. 2019, 37 4027-4027.
[57]Jiang N, Zhang J, Guo Z, et al. Short-course neoadjuvant radiotherapy combined with chemotherapy and toripalimab for locally advanced esophageal squamous cell carcinoma (SCALE-1): a single-arm phase Ib clinical trial[J]. Journal for Immunotherapy of Cancer, 2024, 12(1): e008229.
[58]Chen R, Liu Q, Li Q, et al. A phase II clinical trial of toripalimab combined with neoadjuvant chemoradiotherapy in locally advanced esophageal squamous cell carcinoma (NEOCRTEC1901)[J]. EClinicalMedicine, 2023, 62.
[59] Liu Y, Bao Y, Yang X, et al. Efficacy and safety of neoadjuvant immunotherapy combined with chemoradiotherapy or chemotherapy in esophageal cancer: A systematic review and meta-analysis[J]. Frontiers in Immunology, 2023, 14: 1117448.
[60]Zhang W, Yan C, Zhang T, et al. Addition of camrelizumab to docetaxel, cisplatin, and radiation therapy in patients with locally advanced esophageal squamous cell carcinoma: a phase 1b study[J]. Oncoimmunology, 2021, 10(1): 1971418.
[61]Zhu Y, Wen J, Li Q, et al. Toripalimab combined with definitive chemoradiotherapy in locally advanced oesophageal squamous cell carcinoma (EC-CRT-001): a single-arm, phase 2 trial[J]. The Lancet Oncology, 2023, 24(4): 371-382.
[62]Park S, Oh D, Choi Y L, et al. Durvalumab and tremelimumab with definitive chemoradiotherapy for locally advanced esophageal squamous cell carcinoma[J]. Cancer, 2022, 128(11): 2148-2158.
[63]Shah M A, Bennouna J, Doi T, et al. KEYNOTE-975 study design: a Phase III study of definitive chemoradiotherapy plus pembrolizumab in patients with esophageal carcinoma[J]. Future Oncology, 2021, 17(10): 1143-1153.
[64]Yu R, Wang W, Li T, et al. RATIONALE 311: tislelizumab plus concurrent chemoradiotherapy for localized esophageal squamous cell carcinoma[J]. Future oncology, 2021, 17(31): 4081-4089.
[65]Wang L, Chen M, Kato K, et al. A phase 3 randomized, double-blind, placebo-controlled, multicenter, global study of durvalumab with and after chemoradiotherapy in patients with locally advanced, unresectable esophageal squamous cell carcinoma: KUNLUN[J]. 2022, 40
[66]Taniyama T K, Tsuda T, Miyakawa K, et al. Analysis of fistula formation of T4 esophageal cancer patients treated by chemoradiotherapy[J]. Esophagus, 2020, 17: 67-73.
[67]Watanabe S, Ogino I, Kunisaki C, et al. Relationship between nutritional status and esophageal fistula formation after radiotherapy for esophageal cancer[J]. Cancer/Radiothérapie, 2019, 23(3): 222-227.
[68]Nishibuchi I, Murakami Y, Kubo K, et al. Temporal changes and risk factors for esophageal stenosis after salvage radiotherapy in superficial esophageal cancer following non-curative endoscopic submucosal dissection[J]. Radiotherapy and Oncology, 2022, 166: 65-70.

下载信息  [文件大小：646 KB 下载次数： 次]

点击下载文件:ExpertConsensusontheWholeProcessingManagementofConcurrentChemoradiotherapyforEsophagealCancer1.pdf