PMC:7314075 / 6900-9314 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7314075","sourcedb":"PMC","sourceid":"7314075","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7314075","text":"Conversely, oesophageal cancer is an important disease in the clinical practice of thoracic surgery, and oesophagectomy is the earliest and most important treatment method so far. In China, squamous cell carcinoma accounts for 90% of oesophageal cancer [19], and 90% of these cancers show locally advanced disease at the first visit. There is strong clinical evidence that the long-term survival of patients with locally advanced oesophageal cancer is significantly better with induction chemoradiation followed by surgery compared with upfront surgery [20, 21]. However, in clinical practice in China, preoperative treatment of locally advanced oesophageal cancer is not universal because of different understanding of multimodality treatments, a lack of multi-disciplinary cooperation and unbalanced deployment of radiation technology and equipment. Thus, postoperative adjuvant treatment accounts for ˃50% of the comprehensive treatment for oesophageal cancer [22], which not only affects the long-term survival of patients, but also places patients at risk of infection during the COVID-19 pandemic. Preoperative induction chemoradiotherapy improves the curative effect of surgery, and some scholars even question the role of surgery in comprehensive treatment of oesophageal squamous cell carcinoma. These specialists concluded that overall survival after concurrent chemoradiation was not statistically different from survival after trimodality therapy, therefore, concurrent chemoradiation could replace surgery entirely [23]. Although this viewpoint is controversial because of a lack of strong evidence, under the current COVID-19 pandemic situation, we should more strictly consider the indications for surgery. We should choose more conservative treatments for seniors, those with severe comorbidities, and those with advanced disease, to decrease the risks associated with surgery under this special situation. Conversely, we have noticed that preoperative radiation dosage is a controversial issue in preoperative chemoradiation. In fact, the ‘curative’ radiation dosage in Asian countries is similar to the ‘preoperative induction’ radiation dosage in western countries. In this special period, we might as well give ‘curative’ concurrent chemoradiotherapy (radiation dose similar to the Western preoperative dose), and consider surgery in a ‘salvage’ situation after close observation and 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