Approximately half of the patients diagnosed with oesophageal cancer present with unresectable or metastatic disease. Treatment for these patients aims to control dysphagia and other cancer-related symptoms, improve quality of life and prolong survival. In the past 25 years, modestly improved outcomes have been achieved in the treatment of patients with inoperable non-metastatic cancer who are medically not fit for surgery or have unresectable, locally advanced disease. Concurrent chemoradiotherapy offers the best outcomes in these patients. In distant metastatic oesophageal cancer, several double-agent or triple-agent chemotherapy regimens have been established as first-line treatment options. In addition, long-term results of multiple large randomized phase III trials using additional targeted therapies have been published in the past few years, affecting contemporary clinical practice and future research directions. For the local treatment of malignant dysphagia, various treatment options have emerged, and self-expandable metal stent (SEMS) placement is currently the most widely applied method. Besides the continuous search for improved SEMS designs to minimize the risk of associated complications, efforts have been made to develop and evaluate the efficacy of antireflux stents and irradiation stents. This Review outlines the current evidence and ongoing trends in the different modern-day, multidisciplinary interventions for patients with unresectable or metastatic oesophageal cancer with an emphasis on key randomized trials.

被诊断患有食道癌的患者中约有一半患有无法切除或转移的疾病。对这些患者的治疗旨在控制吞咽困难和其他与癌症相关的症状，改善生活质量并延长生存期。在过去的25年中，在医学上不适合手术或无法切除的局部晚期疾病的无法手术的非转移性癌症患者的治疗中，取得了适度的改善。同步放化疗在这些患者中提供了最好的结果。在远处转移性食管癌中，已经建立了几种双药或三药化疗方案作为一线治疗选择。此外，在过去的几年中，已经发布了使用其他靶向疗法进行的多个大型随机III期临床试验的长期结果，影响当代临床实践和未来的研究方向。对于恶性吞咽困难的局部治疗，出现了各种治疗选择，并且自膨胀金属支架（SEMS）放置是当前应用最广泛的方法。除了不断寻求改进的SEMS设计以最大程度地降低相关并发症的风险外，还努力开发和评估抗反流支架和辐射支架的功效。本综述概述了针对无法切除或转移性食管癌患者的不同现代，多学科干预措施的最新证据和正在进行的趋势，重点是关键的随机试验。自膨胀金属支架（SEMS）放置是目前应用最广泛的方法。除了不断寻求改进的SEMS设计以最大程度地降低相关并发症的风险外，还努力开发和评估抗反流支架和辐射支架的功效。这篇综述概述了针对无法切除或转移性食管癌患者的不同现代，多学科干预措施的最新证据和正在进行的趋势，重点是关键的随机试验。自膨胀金属支架（SEMS）放置是目前应用最广泛的方法。除了不断寻求改进的SEMS设计以最大程度地降低相关并发症的风险外，还努力开发和评估抗反流支架和辐射支架的功效。这篇综述概述了针对无法切除或转移性食管癌患者的不同现代，多学科干预措施的最新证据和正在进行的趋势，重点是关键的随机试验。