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RADT 724 > Oesophagus Management Options > Flashcards

Oesophagus Management Options Flashcards

1
Q

What is the action for limited disease (T1,T2,N0,M0)?

A
  • Resection surgery

- Easier if lower oesophagus

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2
Q

Who has FDG-PET/CT?

A
  • Anyone eligible for resection, except T1a

- To avoid futile debilitating surgery (mets)

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3
Q

Why is nutritional support important?

A
  • over 50% of patients lose >5% of body weight

- 40% lose >10% before admission for oesophagectomy

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4
Q

For localised GOJ adenocarcinoma what is the standard of care?

A
  • Peri-operative chemotherapy
    (cisplatin, oxaliplatin or carboplatin) Or capceitabeine/5FU 8-9 weeks
  • FLOT trial regimine
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5
Q

For resectable locally advanced SCC what is the standard of care?

A
  • Neo-adj chemoRT
  • 45Gy in 25#/5 weeks (neoscope trial)

or

  • Neo-adj chemoRT (Cross trial)
  • 41.4 Gy in 23#/4.5 weeks with carboplatin and paclitaxel
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6
Q

Whar is the NeoAEGIS trial?

A
  • Neo-adj ChemoRT vs neo-adj chemo
  • T2-3 N0-1 M0
  • Arm 1 followed MAGIC or FLOT pre-and post surgery
  • Arm 2 chemoRfollowed CROSS 4.5 weeks RT (41.4Gy/23) with carboplatin and paclitaxel
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7
Q

What is the surgical option for T1?

A
  • Surgery or endocsopic resection
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8
Q

What is the surgical option for cT2N0?

A
  • surgery alone (NO neoadj)
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9
Q

What is the surgical option for SCC?

A
  • neoadj chemoRT followed by surgery and definitive chemotherapy are equally successful
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10
Q

What is the surgical option for locally advanced disease?

A
  • surgery alone is not standard, complete resection cannot be achieved in many patients
  • Long term survival generally lower than 20% even after surgery
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11
Q

What is Ivor Lewis oesophagectomy?

A
  • hybrid of two approaches
  • laparotomy incision to allow for mobilisation of the stomach
  • A right sided throacotomy for excision and resection of the oesophagus
  • open laparotomy allows for good abdo exporusre and wider lymph disection
  • big op with complications
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12
Q

What is a minimally invasive oesophagectomy?

A
  • Keyhole
  • total or partial excision
  • same result as open but with less morbidity
  • Less surgery related morbidity with same clinical outcomes
  • No evidence for recurrence rate or in-hospital rates compared with open
  • better physical functioning
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13
Q

Who has definitive chemoRT?

A
  • cervically localised tumours

- patients unable/unwilling to undergo surgery

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14
Q

What is the prescription for definitive chemoRT?

A
  • 50Gy in 25
  • 50.4 in 28
  • with carboplatin and 5FU
  • RTOG-85-01 trial looked at dose escalation (64Gy) but survival was worse. Survival 27 v 0%
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15
Q

When and how is definitive RT used?

A
  • When surgery and chemotherapy are contraindicated
  • 50 Gy in 15/16#
  • 50-55 in 20#
  • 60 Gy in 30#
  • Not a lot of evidence
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16
Q

What are the effects of RT?

A
  • oesophagitis (usually around 3rd week)
  • Swallowing difficulties
  • Skin reaction
  • Late effects include oesphpgeal fistula, stricture, haemorrage, radiation pneumonitis and pericarditis
  • Late complications of radical RT may include fibrosis
17
Q

What did SCOPE2 trial show?

A
  • Uses PET CT to identify high uptake regions
  • Dose escalation for either chemo or RT to ty and improve outcomes
  • reducing unnecessary treatment
18
Q

What does follow up involve?

A
  • No investigations

- It is about symptom management

19
Q

How are palliative conditions managed?

A
  • consider chemoradiotherapy if no mets
  • or chemotherapy alone
  • look at best supportive care

-RT = 30/10#, 35/15#, 20/5#, 40/15# - reduce bleeding or symptoms

20
Q

How is brachytherapy used?

A
  • intra-luminal brachy
  • palliative
  • used less now due to the use of IMRT (integrated boost)
  • 5-20Gy at 1cm depth
  • 12 Gy in 1 or 12-16Gy in 2 fractions
  • risk of fistula formation
  • is useful in helping with dysphasia in the long term
21
Q

What chemo regimin is used to treat palliatively?

A
  • platinum based and 5FU or capceitabeine.
  • less proved in SCC
  • no definitive remit for them, but they can be given
22
Q

What forms of targeted therapies are available?

A
  • monoclonal antibodies , man made antibodies to attack specific targets on cancer cells
  • small-molecule drugs
  • need to be specific because sepsis is a risk
23
Q

When is herceptin used?

A
  • HER2+, AC, metastatic
  • administered weekly over 90 mins
  • cardiotoxicity
24
Q

What is the CRUCIAL trial?

A
  • to assess feasibility and safety of nivolumab in inoperable patients with locally advanced oesophageal cancer

RADT 724 (24 decks)

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