Improving the therapeutic ratio in non-operable oesophageal cancer

摘要

The management of oesophageal cancer has undergone substantial changes in the past two decades, resulting in improved survival and better regional control of the disease. In patients with inoperable oesophageal cancer, the major advance has been the use of cisplatin-based chemoradiotherapy, which has improved survival, but at the cost of increased toxicity.1'2 In the past 10 years, attempts have been made to further improve the survival of these patients by introducing new drugs into the concomitant, neoadjuvant, and adjuvant phases of treatment. So far, none of these different regimens have significantly increased survival beyond the therapies currently used in clinical practice.Research in science and technology often leads to changes in the desirable endpoint. However, in some cases, practical boundaries for these endpoints are reached when further improvements are limited by conflicting interests. In oncology, the therapeutic ratio is the balance between the amount of a drug that causes a therapeutic effect and the amount that causes death or toxicity. For many cancers, we have achieved good survival outcomes with combinations of chemoradiotherapy, but room for improvement still exists in terms of quality of life, reduction of toxicity (including toxic deaths), and cost. Such improvements might occur in radiation oncology techniques whereby intensity-modulated radiotherapy can reduce late effects in the head and neck, and possibly other sites.3 Alternatively, with respect to chemotherapy, improvements in quality of life, toxicity, and cost could be achieved with changes in the scheduling of available drugs, the introduction of new effective chemotherapeutics, or the addition of targeted therapy.