文档介绍：食管癌化疗
化疗原则
T1aN0的食管癌不需术后辅助化疗
T1b(侵及粘膜下层)尤其分化差的鳞癌术后应作适当辅助化疗
II、III期最好行新辅助放化疗或放疗或化疗
IV期:放化疗
转移:化疗
颈段环咽肌5cm以内的食管癌:放化疗
化疗有效药物及方案
Preoperative chemotherapy
RTOG8911
FP+ surgery VS surgery alone
R0切除率提高(64 vs 59%)
但 OS无差异
MRCOEO2
2周期FP+surgery VS surgery alone
( VS )
Meta分析
5年生存及DFS提高4%(small but significant)
Preoperative chemotherapy
Abstract 180:es associated with T4 esophageal cancer
3 (%) pCR, 17 (%) pPR, 18 (%) NR
R0 resections were plished in 37 (%)
14 例术后复发:pCR 1 (%), pPR 6 (%), NR 7 (50%)
median time to recurrence of (4-71) months
Patients achieving a pCR had a 5-year overall and disease free survival of (43% and 47%), compared to pPR (30% and 21%) while there were no 5-year survivors in the NR cohort
we have demonstrated that neoadjuvant therapy and down staging of T4 tumors leads to increased R0 resections and improvements in overall and disease free survival
Preoperative chemotherapy
Abstract 4060 : Final results of feasibility study of neoadjuvant chemotherapy with DCF for clinical stage II/III esophageal squamous cell carcinoma (Japan)
RR 60%, pCR 22%
mon grade 3 or 4 toxicities were neutropenia (83%), febrile neutropenia (2%), anorexia (7%), and stomatitis (5%).
chemoradiation
RTOG85-01 trial (randomized)
5-Fu+DDP RT
+RT(50Gy) ( 60Gy)
中位生存 14月 9月
5年生存率 27% 0
INT0123 trial
不同放疗剂量联合相同化疗方案,中位生存、2年生存率及局部复发率无统计学差异
VS
chemoradiation
Abstract 4034 (2011 ASCO) Phase II trial (Japan)
RT 30Gy/3wks + S1 80mg/m2/d d1-14
DDP 70mg/m2 d8
S1 80mg/m2/d d1-14
DDP 70mg/m2 d8
2wks later
chemoradiation
Abstract 4034 (2011 ASCO) Phase II trial(Japan)
stage II III IV
patient 12 61 29
CR (%) 92 64 24
PR (%) 100 85 66
OS 100% 795d 369d
主要不良反应:3/4度骨髓抑制(36/14%)
2度恶心呕吐,口腔黏膜炎等
chemoradiation
Abstract 4072 (2011 ASCO) (France)
Chemoradiation with FOLFOX plus cetuximab in locally advanced cardia or esophageal cancer: Final results of a GERCOR phase II trial (ERaFOX). (Stage III)
FOLFOX6 + C