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11 Cards in this Set
- Front
- Back
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Esophagus - SqCCa vs adeno
1 Incidence 2 Risk factors 3 Location of disease 4 Histopathologic progression |
Esophagus - SqCCa vs adeno
1 Incidence - Adeno: Increasing in western nations - SqCCa: Stable to decreasing 2 Risk factors - Adeno: GERD, Barrett's, obesity, men, whites - SqCCa: Tobacco, EtOH, men, black 3 Location of disease - Adeno: Lower 1/3, GE junction - SqCCa: Upper 2/3 4 Histopathologic progression - Adeno: Barrett's - metaplsia - dysplasia - cancer - SqCCa: Atypia - cis - cancer |
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Esophagus - Surgery alone
- US Intergroup RCT - MRC RCT |
Esophagus - Surgery alone
- US Intergroup RCT -- Median survival 16 m -- OS 1,2,3yr: 60, 37, 26% - MRC RCT -- Median survival 14 m -- OS 2yr: 34% |
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Esophagus - Def CCRT - RTOG 8501
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Esophagus - Def CCRT - RTOG 8501
-- CCRT (Ctx x 4 cycles (2a/2p RT) --- FU 1000mg/m2/d CI x 4d --- Cis 75mg/2/day 1 --- 50 Gy -- 64 Gy alone --> CCRT better OS 30 v 0 at 3y --> LR 46 v 68% (neither good!) |
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Esophagus - Def CCRT studies
1 2 3 |
Esophagus - Def CCRT studies
1 RTOG 8501 2 Intergroup 0122 3 RTOG 9405 |
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Esophagus - Def CCRT - Intergroup 0122
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Esophagus - Def CCRT - Intergroup 0122
- Chemo and RT escalation FU/Cis x 5 (3a/2p RT 64.8 Gy) --> Too toxic --> 9% tx-related death rate --> No improved efficacy |
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Esophagus - Def CCRT - RTOG 9405
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Esophagus - Def CCRT - RTOG 9405
- Escalation RT (few adeno) - 64.8 vs 50.4 - Same chemo x 2a/2p -- Cis 75mg/m2 day 1 -- 5FU 1000mg/m/d x 4 days --> No improved - Median survival (13 v 18m) - 2yr survival (31 v 40%) - LRC (44 v 48%) --> Standard of care from RTOG 8506 1992 - RT 50-50.4 Gy - Cis/5FU x 3 cycles |
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Esophagus - Neoadj CCRT studies
1 2 3 |
Esophagus - Neoadj CCRT studies
1 Urba 2 Walsh 3 Tepper |
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Esophagus - Neoadj CCRT - Urba
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Esophagus - Neoadj CCRT - Urba
- CCRT-Cis5FU-45 Gy - 3yr survival: 16 v 30% (CMT) - pCR 28% - 75% adeno - Underpowered |
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Esophagus - Neoadj CCRT - Walsh
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Esophagus - Neoadj CCRT - Walsh
- CCRT-Cis5FU-40 Gy - 3yr survival: 6 v 32% (CMT) - pCR: 25% - All adeno - Closed by benefit with early stopping rule |
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Esophagus - Neoadj CCRT - Tepper
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Esophagus - Neoadj CCRT - Tepper
- CCRT-Cis5FU-50.4 Gy - 3yr survival: 1.8 v 4.5y (CMT) - pCR: 40% - 40% adeno - Poor accrual (56 patients) |
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Esophagus - Tx Recs
- SqCCa - Adeno JCO 2007 25 4110 |
Esophagus - Tx Recs
- SqCCa 1 Neoadj chemoRT then surgery 2 Def CCRT - Adeno 1 Resection alone 2 Neoadj CCRT with surgery |
