Esophageal cancer is one of the most common malignant tumors in China. According to the latest global cancer burden data in 2020 released by the international agency for research on cancer (IARC) of the World Health Organization, there were 320000 new esophageal cancer cases and 300000 deaths in China in 2020.
Industry experts said that, on the one hand, different from the pathological characteristics of adenocarcinoma in European and American countries, more than 90% of esophageal cancer in China is squamous cell carcinoma. In clinical treatment, foreign esophageal cancer guidelines can not meet the clinical needs of China, so it is urgent to launch a set of localization guidelines suitable for China’s national conditions. On the other hand, with the rapid development of radiotherapy technology, three-dimensional conformal radiotherapy, intensity modulated radiotherapy and image-guided technology have been widely used in the treatment of esophageal cancer, and the diagnosis and treatment concept combined with radiotherapy needs to be updated simultaneously. Based on this, the Chinese guidelines for radiotherapy of esophageal cancer has been updated every year since its launch in 2019. On January 21, the 2021 edition of Chinese guidelines for radiotherapy of esophageal cancer was officially released.
It is reported that on the basis of the 2020 version, the new version of the guidelines has been updated and supplemented in combination with the clinical application suggestions and the latest research results in recent two years, focusing on the clinical problems of radiotherapy in the diagnosis and treatment of esophageal cancer, such as radiotherapy technology, dose and target area; In terms of drug therapy, especially immunotherapy, the new guidelines support PD-1 inhibitors as a new standard for the treatment of advanced first-line esophageal cancer, in which carrelizumab combined with TP regimen is used as class 1A evidence for the first-line treatment of advanced esophageal cancer.
Yu Jinming, academician of the Chinese Academy of engineering and President of Shandong Cancer Hospital, said that for many years, surgery and radiotherapy have been two means of tumor treatment, but the bottleneck is that tumors will metastasize. Therefore, systemic therapy combined with local therapy is a trend of development. In recent five years, immunotherapy combined with radiotherapy has developed rapidly. The combination of immunotherapy and radiotherapy plays a role of 1 + 1 ≥ 2 in the metastasis of patients with advanced esophageal cancer. Immunotherapy has become an important part of the systemic treatment of esophageal cancer, which has also been included in the new guidelines this time. The biggest feature of this new version of guidelines is that it fully covers the standardized and high-end treatment methods of esophageal cancer treatment, can provide great help for radiotherapy doctors in disease management, become an important reference basis in clinical practice, enable more patients to receive standardized and accurate treatment, and then promote the standardized development of esophageal cancer in China.
Li Baosheng, vice president of Shandong Cancer Hospital, said that China’s esophageal cancer is different from western countries in epidemiology and biology, but the clinical evidence or recommended level of treatment methods provided in the major guidelines are based on the research of western countries, and there are still many problems to be solved for guiding the standardized treatment of esophageal cancer in China, In particular, radiotherapy, which plays an important role in the treatment of esophageal cancer, is still controversial in the process of clinical application. Therefore, based on the relevant international and Chinese research evidence, the Chinese guidelines for radiotherapy of esophageal cancer suitable for China’s national conditions has been formed. The updated guidelines are revised and supplemented after fully referring to the opinions of radiotherapy doctors, so as to further highlight the characteristics of Chinese tumor radiotherapy. It is believed that the release of the new guidelines will bring greater help to the standardized radiotherapy of esophageal cancer and the clinical standardized management of esophageal cancer patients in China. At the same time, it will continue to promote the radiotherapy of esophageal cancer in China and the continuous development of comprehensive treatment with radiotherapy as the core.
It is reported that the value of combined immunotherapy is also being actively explored for inoperable locally advanced esophageal cancer. Among them, the escort-crt study has been completed and incorporated into the group. It is believed that the relevant data will be officially released soon. It is expected that these studies can further expand the application of immunotherapy in esophageal cancer and improve the prognosis of more patients with esophageal cancer.
