ABSTRACT
Esophageal carcinoma is one of the malignant tumors with a high mortality rate， accounting for nearly 570，000 cancer deaths worldwide annually， and this number is increasing year by year. In recent years， despite the continuous improvement of treatment programs for esophageal carcinoma， the overall five-year survival rate of esophageal carcinoma is still less than 20% due to the development of drug resistance and the tolerance of patients during the treatment process. Tumor microenvironment （TME） is composed of various cells and related components with tumor cells as the core and featured by hypoxia， acidosis， chronic inflammation and immunosuppression， which plays an important role in the progression of tumors. Studies have found that tumor-associated fibroblasts， tumor-associated macrophages， myeloid-derived suppressor cells and regulatory T cells in TME can promote the proliferation， migration， invasion， and lymph node metastasis of cancer cells by secreting cytokines and activating pro-inflammatory pathways， and promote cancer progression by inducing the drug resistance of cancer cells and evading immunosuppression. Because cancer-associated cells in TME are genetically more stable than cancer cells， have fewer mutations and have lower chance of drug resistance， targeting cancer-associated cells in TME by regulating TME is a new research direction of cancer therapy. Traditional Chinese medicine has the advantages of multi-component and multi-target. It can participate in the regulation of TME through multiple ways， reduce the number of cancer-associated cells in TME， inhibit crosstalk between TME and cancer cells， and restore immune cell function. It is an important source for the regulation of TME and the research and development of drugs targeting cancer-associated cells in TME. In this paper， the role of cancer-associated cells in the TME of esophageal cancer and the current application of traditional Chinese medicine targeting cancer-associated cells in TME are reviewed， so as to provide reference for the research and development of TME targeted drugs for esophageal carcinoma.
ABSTRACT
Esophageal cancer has a high morbidity and mortality worldwide， and the burden of esophageal cancer is still heavy in China. The conventional treatments such as radiotherapy and chemotherapy fail to yield a satisfactory outcome， implying that the safe and effective treatments are not available for the majority of patients. At present， esophageal cancer is mainly treated by Chinese medicine combined with radiotherapy and chemotherapy. The retrieval of related papers in Chinese and English reveals that Kang'ai injection， Compound Kushen injection， Kanglaite injection， Xiaoaiping injection， Aidi injection， Bruceae Fructus Oil Emulsion， Cinobufotalin injection， and Shenmai injection have been commonly used in esophageal cancer treatment. These eight injections are either single medicinal or compound preparations， involving 11 Chinese medicinals， which synergize the effects of radiotherapy and chemotherapy and reduce their adverse reactions in the treatment of esophageal cancer. Due to the complexity of Chinese medicinal components， a series of adverse reactions such as phlebitis， phlebosclerosis， and hemolysis may be caused by irrational dosage， administration speed， and compatibility in the use of injection. There are many clinical studies on Chinese medicine injections for anti-esophageal cancer but few studies on their active components and molecular mechanism. This paper reviewed the active components， effectiveness， safety， and mechanism of Chinese medicine injections frequently employed for treating esophageal cancer， in order to provide reference for their clinical application as well as the development of new Chinese drugs.