Combination chemotherapy is not only suitable for the treatment of advanced esophageal cancer, but also for the combined treatment of surgery or radiotherapy. This article discusses the chemotherapy regimen for locally advanced esophageal cancer and recurrent metastatic esophageal cancer. Pre-operative neoadjuvant chemotherapy and post-operative adjuvant chemotherapy for locally advanced esophageal cancer 1. Pre-operative neoadjuvant chemotherapy (1) Principles of neoadjuvant chemotherapy Neoadjuvant chemotherapy can reduce the tumor stage, shrink the volume of primary tumor, and control or eliminate small or occult distant metastases. Therefore, except for patients with T1-2N0 stage who can be treated by surgery alone, patients with locally advanced esophageal cancer beyond T2 stage and with any positive lymph nodes can be considered for preoperative neoadjuvant chemotherapy. (2) Neoadjuvant chemotherapy regimen: DDP-5-FU, DDP-CF/5-FU, PTX-DDP, CPT11-DDP are commonly used. (3) Preoperative adjuvant concurrent radiotherapy: Since the tumor control effect of concurrent radiotherapy (CRT) is higher than that of radiotherapy or chemotherapy alone, preoperative CRT plus surgery can improve the survival advantage of patients with locally advanced esophageal cancer. The preoperative chemotherapy regimen is mostly DDP-5-FU, DDP-PTX, and radiotherapy dose is 40-45Gy of conventional segmentation (4-5 weeks to complete). 2.Post-operative adjuvant chemotherapy (1) Principles of adjuvant chemotherapy The purpose of post-operative adjuvant chemotherapy for esophageal cancer is to kill residual tumor cells from surgery and tumor cells that enter proliferation cycle in large quantities after tumor reduction surgery due to negative feedback; to eliminate micro metastases and residual cancer foci outside the main cancer foci and positive foci at the cut edge, to prevent local recurrence and distant metastases, and to improve long-term survival rate after surgery. (2) Adjuvant chemotherapy regimen: DDP-5-FU, DDP-CF/5-FU, DDP-PTX (or TXT) are mostly used for 4-6 cycles in general. (3) Adjuvant radiotherapy: For patients with obvious external invasion or with lymph node metastasis such as T1-4N1 patients, concurrent radiotherapy can be considered to be started in 3-4 cycles after surgery. Chemotherapy or radiotherapy for advanced, recurrent metastatic esophageal cancer 1.Chemotherapy Clinically, the first-line chemotherapy is mostly DDP-5-FU, DDP-CF/5-FU, DDP-PTX and CPT-11-DDP/NDP, which have more certain efficacy, better tolerability, low cost and easy application, with a course of 4-6 cycles. When properly applied, near-term remission rates of 50%-60% and median survival (MST)
5-10 months. In locally advanced esophageal cancer, the near-term remission rate can reach 80%-90%, including CR of 30%-40% when using esophageal arterial infusion chemotherapy. Compared with systemic chemotherapy, it significantly improves the remission rate and long-term productivity. Combined radiotherapy uses chemotherapy drugs as sensitizers for radiotherapy to kill tumor cells outside the target volume and systemic micrometastases while enhancing local control of the tumor. Radiotherapy is applied in the form of simultaneous, sequential, alternating and induction chemotherapy for 2 cycles followed by radiotherapy, etc. (1) Concurrent radiotherapy: The most applied chemotherapy regimens are DDP-5-FU, DDP-CF/5-FU and PTX and CPT-11 based regimens. At present, most scholars believe that 50.4Gy is the standard radiotherapy dose in concurrent radiotherapy. (2) Sequential radiotherapy: For patients with distant metastasis or relatively advanced stage or those who do not meet the indications for radiotherapy, sequential therapy of chemotherapy followed by radiotherapy can be used. (3) Alternating radiotherapy: i.e. chemotherapy-radiotherapy-chemotherapy, which is less toxic, better tolerated by patients and has better efficacy.