Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Esophageal carcinoma > Background and recommendations > Flashcards

Background and recommendations Flashcards

(67 cards)

Start Studying
1
Q

Typical path CR rates after preop CRT?

A

16-38%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Is there a role of preop RT alone?

A

No, multiple studies indicate that there is no benefit to giving RT alone before surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Stage IV (adeno)

A

TxMx M1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Stage I (adeno)

A

IA: T1 N0 G1-2

IB: T1 N0 G3 or T2 N0 M0 G1-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Stage II (adeno)

A

IIA: T2 N0, G3

IIB: T3 N0 or T1-2 N1, Any G

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Stage III (adeno)

A

IIIA: T1-2 N2 or T3 N1 M0 or T4a N0

IIIB: T3 N2

IIIC: T4a N1-2, T4b or N3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the optimal number of nodes that should be removed at esophagectomy?

A

23

Peyre CG, Ann Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

T3

A

Invades adventitia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

T4b

A

Invasion of other organs including the aorta, vertebral body, trachea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

T2

A

Invades muscularis propria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

T1a

A

Invasion of the lamina propria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

T1b

A

Invasion of submucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Tis

A

high grade dysplasia or CIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

T4a

A

Pleural, pericardial or diaphragm involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In the history, what do you want to ask about?

A

Sx: indigestion, hoarseness of voice, dysphagia, odynophagia, pain, cough, dyspnea, weight loss and loss of appetite, melana, hematemesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment paradigm for SCCa of the cervical esophagus?

A

Definitive CRT with IMRT and 5FU/cisplatin to 60-66 Gy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Spinal cord constraint?

A

Max dose 45 Gy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Follow up schedule for patients treated with EMR or other ablative procedures?

A

H&P + endoscopy every 3 months for 1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Criteria for EMR?

A 
Tis/T1a
No ulceration 
Tumor < 2 cm 
Well to moderately differentiated 
No LVI
No ulceration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the 5 year OS for patients managed with preop CRT and surgery who have a CR or near CR?

A

5 year OS 60-70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the 5 year OS for patients managed with surgery alone for T1 N0?

A

5 year OS of 77%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the treatment paradigm for patients with T2 or node positive, non-metastatic disease?

A

Neoadjuvant CRT followed by esophagectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is esophageal cancer defined at endoscopy based on location?

A

Esophageal tumors are usually atleast 15 cm from the incisors and can extend to the GE junction and the proximal 5 cm of the stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What imaging and labs are needed for work up?

A

Imaging: PET/CT scan with diagnostic CT of the chest and abdomen/pelvis
Labs: CMP including LFTs and alk phos, BMP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What special studies are needed in work up?
1. EGD with EUS and biopsy 2. Bronchoscopy upper upper/mid thoracic lesions to rule out tracheoesophageal fistula 3. PFTs
26
What labs are needed at work up?
CBC, LFTs, CEA, BMP
27
What is the PE at work up?
LN exam: cervical, supraclavicular Abdominal exam Respiratory exam
28
What counseling is needed?
Nutrition assessment
29
What are the types of esophagectomies?
Transhiatal Right thoracotomy: Ivor-Lewis Left thoracotomy Radical resection
30
Treatment for Stage T2 or N+?
Preop CRT with 50.4 Gy of RT concurrent with 5FU and cisplatin followed by esophagectomy and node dissection
31
What is the expected OS and LF after prep-CRT and surgery?
3 year OS: 20-30% | 3 year LF: 45%
32
What is the preferred treatment for T1b N0?
Esophagectomy and node dissection
33
Indications for PORT
Node positive T3/4 Close or positive margin Unfavorable T2 N0 (LVSI, poorly differentiated)
34
What is the preferred treatment for inoperable patients
CRT with 50.4 Gy of RT concurrent with 5FU and cisplatin
35
What are some palliative RT doses?
30 Gy in 10 fractions, provide 4 Gy/fx initially for bleeding 35 Gy in 14 fractions
36
CT simulation
``` Supine Arms Up Indexed bag Esophotrast 4D scan for distant esophageal tumors ```
37
Describe RT volumes
GTV: gross tumor and nodes as seen on EGD and CT scan/PET scan CTV: GTV + 4 cm sup and inf and 1 cm radial. Include SCV nodes and mediastinal nodes for tumors above carina. Include celiac nodes for tumors near the GE junction. PTV: 0.5
38
Expected acute side effects of CRT
1. Esophagitis 2. Weight loss 3. Fatigue 4. Anorexia
39
Subacute side effects of CRT
1. Pneumonitis
40
Late side effects of CRT
Esophageal strictures Pericarditis CAD
41
Follow up after CRT and surgery
H&P every 4 months for 1 year, then very 6 months for 4 more years, then annually
42
Nodal stage
N1: Metastasis to 1-2 nodes N2: Metastasis to 3-6 nodes N3: Seven or more regional nodes
43
M stage
M1: distant metastasis
44
Stage IV: Squamous cell carcinoma
M1
45
Stage III: SCCa
IIIA: T1-2 N2 or T3 N1 or T4a N0 IIIB: T3 N2 IIIC: T4a N1-2 or N3 or T4b
46
Stage II: SCCa
IIA: T2-3 N0 Grade 1, X (Upper or middle) T2-3 N0 M0 Grade 2,3 (Lower) Stage IIB: T2-3 N0 Grade 2-3 (Upper or middle) T1-2 N1 M0 Any Grade (Any location)p
47
Stage I: SCCa
IA: T1 N0 M0 Grade 1, X (Any location) IB: T1 N0 M0 Grade 2-3 (Any location) T2-3 N0 M0 Grade 1,X (Lower, X)
48
What are some esophageal constraints for stricture?
Data from Emami V60<100%
49
Heart constraint?
V40<30%
50
What dose of cisplatin and 5FU?
Cisplatin 75 mg/m2 | 5FU 1000 mg/m2 x 4d
51
What study supports CRT vs. RT alone?
RTOG 8501 RT vs. CRT CRT improved 2 year OS
52
What is the risk for LF with CRT alone?
47-58%
53
What study examined CRT +/- surgery for SCCa of the upper to middle esophagus? What was the result?
German Esophgeal Cancer Study Group | Results: Overall no difference but in non-responders, surgery improved 3 year OS to 32%
54
What study showed improvement in OS for patients treated with Preop CRT + surgery vs. surgery alone? What did it show?
CROSS Phase III Improvement of 23 months in median OS CRT improved R0 resection rates from 67% to 92% CR rate of 29%
55
What is the path CR rate following CRT?
16% to 29%
56
What study evaluated preop chemo vs. preop CRT for T3-4 GE junction tumors?
the POET trial | Pre surgery cisplatin/etoposide + RT vs.
57
Liver constraints?
Mean < 25 Gy | V30 < 60%
58
Kidney constraints
Mean < 18 Gy
59
Which study supports the use of IMRT?
MDAH Lin et al Red Journal 2012 Lowee OS with 3D conformal due to cardiac and undocumented deaths being higher
60
Lung constraints?
V20<30%
61
5 year OS for patients treated with Preop CRT + surgery?
30-40%
62
What distance is the cervical esophagus from the incisors?
15-20 cm
63
What distance is the upper thoracic esophagus from the incisors?
20-25 cm
64
What distance is the middle thoracic esophagus from the incisors?
25 to 30 cm
65
What distance is the lower thoracic esophagus from the incisors?
30-40 cm
66
What alternative chemo regimen is there?
Carboplatin AUC 2 IV on day 1 Txaol 50 mg/m2 IV on day 1 weekly for 5 weeks
67
The GEJ is a marker of two different mucosal surfaces? What are they? What is the transition called?
1. Squamous esophageal 2. Gastric columnar 3. The Z line

Esophageal carcinoma (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions