Esophageal Cancer FRCR CO2A Flashcards
(175 cards)
1
Q
At what length esophagus extends from central incisor?
A
15 to 40 cm
2
Q
Sternal notch, carina and GE Jxn distance from central incisor
A
18 cm
25 cm
40 cm
3
Q
Malignant tumors of esophagus
A
AC 65%
Sq 25%
small cell
lymphoma
melanoma etc
4
Q
sievert classification
A
Type I: esophageal
Type II esophageal and Gastric
Type III: Gastric
5
Q
RFs for Esophageal Cancer
A
GORD
Alcohol
Smoking
Corrosives
Reduced dietary Vit C
malnutrition
6
Q
Possible infective causes of esophageal cancer
A
- H. Pylori
- HPV
- Fungally infected cereals
7
Q
Associated conditions with Ca Esophagus
A
Barrett’s esophagus (1 % lifetime risk of developing an AC)
others
Achalasia
Tylosis palmaris
Celiac Disease
Plummer Vinson Syndrome
Apart from GORT and Barrets, others are a/w sq cell carcinoma
8
Q
sequence from metaplasia to dysplasia and invasive adenocarcinoma
molecular changes
A
loss of TP53 function
loss of heterozygosity (LOH) of Rb gene
over expression of cyclins D1 and E
inactivation of p16 and p27
Amplification of MYC and k and H RAS
9
Q
local spread of esophageal cancer
A
no peri esophageal serosa to inhibit their growth, skip lesions and mediastinal structures infiltration into the trachea, aorta, pleura, diaphragm and vertebrae
10
Q
Lymphatic spread of Esophageal Cancer
A
N1: supraclavicular, upper, middle and lower para esophageal, rt and lt paratracheal, aorto pulmonary, subcarinal, diaphragmatic; paracardial; left gastric, common hepatic, splenic artery and coeliac
11
Q
M1 LNs
A
upper third to celiac and
lower third to supraclavicular
12
Q
metastatic spread of esophageal cancer
A
Liver and lungs
13
Q
Grades of Dysphagia
A
G1: difficulty with some food such as bread and meat
G2: able to eat a soft diet
G3: only liquid diet
G4: Complete dysphagia
14
Q
where does patient point for different location of obstruction in esophagus?
A
sternal notch if upper level
epigastric if lower level
15
Q
Investigations for esophageal cancer
A
FBC
Biochemical Profile
Diagnostic Endoscopy and Biopsy
EUS
PET Scan
16
Q
Advantages of EUS:
A
- staging the primary, disease length
17
Q
when in esophageal cancer PET scan most useful
A
patient suitable for radical treatment
to prevent unnecessary surgery in 20 % of cases
18
Q
when is Bronchoscopy useful
A
above the carina tumors or signs of T4 disease
19
Q
Staging:
A
as per TNM
20
Q
Early Esophageal Cancer (T1 or T2, N0) treatment
A
Surgical Resection is Rx of choice
CRT may play a role if the patient is not fit enough
21
Q
EMR (Endoscopic Mucosal Resection) Indication
A
Early Cancers < 2 cm, non ulcerated, well differentiated cancers
premalignant condition such as high grade dysplasia
superficial esophageal cancers
once the submucosa is breached, EMR would not be treatment of choice, due to increased chances of LN involvement
22
Q
RFA indications in Ca Esophagus
A
more diffuse high grade dysplasia
23
Q
Treatment of locally advanced Esophageal Cancer
A
Neoadjuvant Therapy f/b surgery
24
Q
Sq Cell Carcinoma >T1b or N+
A
Pre op CRT f/b Surgery or
Definitive CRT
25
post op RT indication
R1 or R2 resection
26
Surgeries for Ca Esophagus
1. Ivor Lewis
2. En Bloc
3. total thoracic, three stages (McKeown)
4. Transhiatal approach
27
Ivor Lewis Surgery
Two Stage:
laparotomy and celiac LND
Right Thoracotomy for mobilisation and resection and mediastinal lymphadenectomy along with intrathoracic anastomosis
28
Post op ChT or Post op RT
No evidence of its use
Ajuvant RT: for R1
29
Pre OP Chemotherapy
IN THE UK, two cycles of cisplatin and 5 FU given before surgery
30
MAGIC trial
either perioperative chemotherapy and surgery (250 patients) or surgery alone (253 patients).
Chemotherapy consisted of three preoperative and three postoperative cycles of intravenous epirubicin (50 mg per square meter of body-surface area) and cisplatin (60 mg per square meter) on day 1, and a continuous intravenous infusion of fluorouracil (200 mg per square meter per day) for 21 days.
As compared with the surgery group, the perioperative-chemotherapy group had a higher likelihood of overall survival (hazard ratio for death, 0.75; 95 percent confidence interval, 0.60 to 0.93; P=0.009; five-year survival rate, 36 percent vs. 23 percent) and of progression-free survival (hazard ratio for progression, 0.66; 95 percent confidence interval, 0.53 to 0.81; P<0.001).
31
Pre OP CRT Rationale
CRM positivity after radical resection alone is high (> 50% in T3 tumors)
32
CROSS Trial
DUTCH trial
NACRT f/b Sx Vs Sx alone
Doubling of OS for NACRT f/b Sx
33
Definitive CRT Indications:
inoperable for medical reasons,
or unlikely R0 resection possible
who decline Surgery
34
Upper third Cervical Esophagus distance from incisor
15 to 18 cm
35
Middle Third, from incisor
18 to 31 cm
36
Lower Third, to GO junction
31 to 40 cm
37
How can pts with upper third tumors be treated?
Like H & N cancer Patients, such as post cricoid carcinoma
37
Planning for Esophageal Cancer
4D planning preferred
in supine position with arms above their hands and immobilisation of the legs with knee fix
anter and two lateral fiducials
slice thickness 3 mm
IV contrast can be given to distinguish the GTV from surrounding tissues
38
Target Delineation in UK is based on which trial
SCOPE 1
39
GTV contouring
with the help from diagnostic CT scan, PET CT scan and EUS
40
why is EUS better for GTV delineation?
submucosal spread is better identified
41
CTV expansion
2 cm craniocaudally , 1 cm radially, edited for structures such as vertebrae that do not need to be incorportated in CTV, particularly if there is potential to impact on organs OARs, eg the spinal cord
42
what to include if tumor involves GE junction?
The Gastrohepatic ligament region
43
CTV to PTV margin
1 cm, can be different as per institute's protocol
44
Dose Constraints as per SCOPE 1
Sp COrd PRV, D40 Gy = 0 %
Heart, V 40 Gy < 30 %
Lung V 20 Gy < 25%
Liver V 30 Gy < 60%
Individual Kidney V20 < 25%
45
RT Doses
Definitive RT alone: 60 to 64 Gy, 2 Gy/#
CRT: 50 Gy/ 25#
pre operative CRT, 45 Gy/ 25#
46
Constraint for PTV
PTV V95 > 95 % but less than 107%
47
Conc Chemotherapy
Cisplatin and Capecitabine or 5 FU
Common regimen : 4 three weekly cycles, RT in cycles 3 and 4
48
Recurrent Ca Esophagus Treatment
Prognosis: Very Poor
palliative Chemotherapy
if anastomotic recurrence and no mets on PET, dCRT
After dCRT recurrence, palliative Stent placement
49
M1 Ca esophagus, Adenocarcinoma
Systemic Therapy NCCN 2025
depends on HER 2 expression and PDL1 status and MSI/MMR status
50
Adenocarcinoma esophagus
what if Her 2 overexpression and PDL1 CPS >/= 1
FOLFOX/CAPEOX + Trastuzumab + Pembrolizumab
51
Adenocarcinoma Esophagus
if dMMR/MSI - H
Pembrolizumab
Dostarlimab
Nivo and Ipilimumab
52
Adenocarcinoma Esophagus
what if Her 2 negative and PDL1 CPS >/= 1
FOLFOX/CAPEOX + Pembrolizumab or Nivolumab
53
Adenocarcinoma Esophagus
Cytotoxic chemotherapies in ca esophagus
Paclitaxel with or without carboplatin or cisplatin
Docetaxel with or without cisplatini
54
M1 Squamous Cell Carcinoma Esophagus Regimens
same as adenocarcinoma except for Her2
55
Palliative Endoscopic Rx Options in Ca Esophagus
1. Stents
2. Endoscopic laser thermal Nd-YAG or photodynamic therapy (PDT)
3. Dilation
4. Alcohol Injection
56
Palliative RT dose
30 Gy/ 10 #
40 Gy/ 15#
57
Small Cell Esophageal Cancer Rx
CRT (chemo Cisplatin Etoposide)
57
ILT dose
15 Gy at 1 cm with HDR microselectron
57
SCOPE 1 trial
dCRT in localized esophageal cancer in UK and investigated adding cetuximab to standard cisplatin and 5 FU treatment
Disease control and survival in standard dCRT arm better
57
What is the overall survival rate for oesophageal cancer?
Less than 10%
## Footnote
Oesophageal cancer is known for its aggressive nature and low survival rate.
58
How many new oesophageal cancer patients are there per year in the UK?
Over 7000
## Footnote
The number of new cases highlights the prevalence of this cancer in the UK.
59
What is the median age at diagnosis for oesophageal cancer?
69 years
## Footnote
This statistic indicates the typical age group affected by the disease.
60
What is the male to female ratio for oesophageal cancer?
2.5:1
## Footnote
This ratio shows a higher incidence in males, although cervical oesophageal cancer is more common in women.
61
What two conditions are thought to increase the risk of adenocarcinoma?
Oesophageal reflux and Barrett's oesophagus
## Footnote
These conditions are significant risk factors associated with the development of adenocarcinoma.
62
What percentage increase in adenocarcinoma incidence is attributed to oesophageal reflux in the Western world?
10% per year
## Footnote
This statistic emphasizes the growing concern related to oesophageal reflux.
63
What dietary habits have been shown to reduce the relative risk of oesophageal cancer?
Diet rich in fruit and vegetables
## Footnote
A healthy diet is associated with lower cancer risk.
64
What is the length of the oesophagus?
25 cm
## Footnote
This anatomical measurement is important for understanding the organ's structure.
65
What percentage of oesophageal tumours arise in the middle and lower third of the oesophagus?
85%
## Footnote
The majority of tumours are located in these sections.
66
What are the three types of adenocarcinoma classified by the Siewert Classification?
* Type I - distal oesophageal cancer that may infiltrate GOJ
* Type II - straddles the GOJ (junctional cancer)
* Type III - subcardial cancer that may infiltrate OGJ and distal oesophagus
## Footnote
This classification helps in understanding the location and implications of the cancer types.
67
What percentage of oesophageal cancers in the UK are adenocarcinomas?
65%
## Footnote
Adenocarcinoma is the most common type of oesophageal cancer.
68
What is the incidence of carcinoma arising in Barrett’s oesophagus?
1 per 100 patient-years
## Footnote
This statistic highlights the risk associated with Barrett's oesophagus.
69
What are the major etiological factors for squamous cell carcinoma (SCC)?
* Alcohol
* Smoking
## Footnote
These lifestyle factors are significant in the development of SCC.
70
What percentage of oesophageal cancer cases are squamous cell carcinoma?
25%
## Footnote
SCC is less common than adenocarcinoma but still significant.
71
What are the most common sites of metastatic spread for oesophageal cancer?
* Lymph nodes (70%)
* Lung (20%)
* Liver (35%)
* Bone (9%)
* Adrenal glands (2%)
## Footnote
Understanding the metastatic spread is crucial for treatment planning.
72
What are the common clinical features of oesophageal cancer?
* Progressive dysphagia
* Painful swallowing
* Reflux
* Regurgitation
* Vomiting after eating
* Rapid weight loss
## Footnote
These symptoms often indicate an advanced stage of cancer.
73
What complications can arise from local invasion of oesophageal cancer?
* Pain
* Nerve compression
* Horner’s syndrome
* Recurrent laryngeal nerve palsy
* Raised hemi-diaphragm
## Footnote
These complications can significantly affect the patient's quality of life.
74
75
What is a risk factor for adenocarcinoma related to gastro-oesophageal reflux?
Hiatus hernia and obesity
## Footnote
Gastro-oesophageal reflux can lead to conditions like achalasia, which are associated with squamous cell carcinoma (SCC) and adenocarcinoma.
76
What condition is associated with an increased risk of adenocarcinoma in the oesophagus?
Barrett’s oesophagus
## Footnote
Barrett’s oesophagus is a precancerous condition that can develop due to chronic gastro-oesophageal reflux.
77
Which nutritional deficiencies are risk factors for squamous cell carcinoma (SCC)?
Vitamins A, C, and riboflavin
## Footnote
Nutritional deficiencies can contribute to the development of SCC in the oesophagus.
78
What type of injury is a risk factor for squamous cell carcinoma (SCC)?
Oesophageal injury
## Footnote
Physical or chemical injuries to the oesophagus can increase the risk of SCC.
79
True or False: Alcohol consumption is a risk factor for squamous cell carcinoma (SCC).
True
## Footnote
Alcohol is known to be a significant risk factor for various cancers, including SCC of the oesophagus.
80
What lifestyle habit is considered a risk factor for squamous cell carcinoma (SCC)?
Smoking
## Footnote
Smoking is a well-established risk factor for many types of cancer, including SCC.
81
What type of toxins from infected cereals can be a risk factor for oesophageal cancer?
Fungal toxins
## Footnote
Consumption of contaminated grains can lead to exposure to harmful fungal toxins that increase cancer risk.
82
What syndrome is associated with an increased risk of upper third squamous cell carcinoma (SCC)?
Plummer–Vinson syndrome
## Footnote
This syndrome is characterized by iron deficiency anemia and is linked to SCC in the upper third of the oesophagus.
83
What hereditary condition has a 50% lifetime risk of squamous cell carcinoma (SCC)?
Tylosis palmaris
## Footnote
Tylosis palmaris is a rare genetic condition that significantly increases the risk of developing SCC.
84
What medical history is a risk factor for squamous cell carcinoma (SCC)?
History of head and neck cancer
## Footnote
Patients with a history of head and neck cancers are at higher risk for developing SCC of the oesophagus.
85
What dietary factors are associated with an increased risk of squamous cell carcinoma (SCC)?
High fat, low-protein and low calorie diet
## Footnote
Diets lacking in essential nutrients and high in fats can contribute to the risk of SCC.
86
What chemical compounds are linked to both adenocarcinoma and squamous cell carcinoma (SCC)?
Nitrosamines
## Footnote
Nitrosamines are carcinogenic compounds found in certain processed foods and are associated with an increased risk of both types of oesophageal cancer.
87
What can metastatic disease result in?
Liver capsular pain, bony metastases, ascites, or peritoneal deposits
## Footnote
Patients are usually cachectic at this stage.
88
What details should be included in the history for evaluation?
Symptoms including performance status, weight loss, and degree of dysphagia
89
What are some examination findings in patients with metastatic disease?
Cachexia, anaemia, jaundice, enlarged supraclavicular nodes, chest (for pleural effusion), abdomen (hepatomegaly, ascites)
90
True or False: Patients with metastatic disease are typically in good nutritional status.
False
91
Fill in the blank: Patients with metastatic disease are usually _______.
cachectic
92
What should be checked in the chest during examination?
Pleural effusion
93
What abdominal conditions should be assessed during examination?
Hepatomegaly, ascites
94
Anatomic division of esophagus
95
What is the primary aim of investigations in disease assessment?
To establish the extent of disease, obtain histologic diagnosis, and assess fitness for appropriate treatment
## Footnote
Investigations are crucial for planning effective treatment strategies.
96
What is usually the initial investigation of choice for oesophageal assessment?
Barium swallow
## Footnote
Barium swallow helps visualize the level of obstruction.
97
What do malignant strictures appear as in a barium swallow?
Asymmetric narrowing with abrupt, shelf-like margins and irregular contours
## Footnote
May show proximal dilatation.
98
What does endoscopy allow in the assessment of oesophageal tumors?
Visual assessment of the tumour and biopsy
## Footnote
Endoscopy is critical for direct visualization and tissue sampling.
99
What is the accuracy of endoscopic ultrasound (EUS) in assessing depth of invasion?
>90% accuracy
## Footnote
EUS is also useful for evaluating adjacent structures and lymph nodes.
100
What characterizes a malignant lymph node in EUS?
More than 1 cm, round, hypoechoic area with distinct margins
## Footnote
These features help differentiate malignant from benign lymph nodes.
101
What is the role of EUS guided fine needle aspiration (FNA)?
To improve diagnostic accuracy of suspicious lesions, particularly lymph nodes of >5 mm
## Footnote
FNA aids in confirming the presence of malignancy.
102
What is routinely assessed by CT scan in oesophageal cancer staging?
Local extent of the tumour and local and distant staging
## Footnote
CT scans provide detailed information about tumour spread.
103
What is the sensitivity and specificity of PET in detecting distant metastases?
Sensitivity of 90% and specificity of >90%
## Footnote
PET is increasingly used in the management of oesophageal cancer.
104
What is the usefulness of laparoscopy in oesophageal cancer?
To visualize and biopsy small peritoneal metastases prior to major surgical procedure
## Footnote
Up to 20% of patients may be up-staged after this procedure.
105
When is bronchoscopy useful in the context of oesophageal cancer?
As a preoperative procedure in upper and middle third oesophageal cancer to rule out bronchial invasion
## Footnote
It helps ensure that the cancer has not spread to the lungs.
106
How is tissue diagnosis obtained in oesophageal cancer?
Via endoscopic biopsy
## Footnote
This method is essential for confirming the diagnosis of cancer.
107
What investigations are included before considering surgery for oesophageal cancer?
Full blood count, biochemistry, coagulation profile, pulmonary function tests, arterial blood gases, ECG, exercise test
## Footnote
These tests assess overall health and suitability for surgery.
108
What does staging determine in oesophageal cancer management?
Prognosis and guides treatment
## Footnote
TNM staging is commonly used for this purpose.
109
What stages of oesophageal cancer are considered localized disease?
Stages I–III and operable stage IVa
## Footnote
Operable stage IVa involves pleura, pericardium, and diaphragm.
110
What percentage of patients present with localized disease?
One-third
## Footnote
Majority present with stage II or III disease.
111
What is an essential component of the treatment decision for oesophageal cancer?
Assessment of fitness for suitable treatment
## Footnote
This ensures that patients can tolerate the proposed therapies.
112
List treatment options for localized oesophageal cancer.
* Endoscopic mucosal resection (EMR)
* Radical surgery alone
* Radical chemoradiotherapy
* Preoperative chemotherapy followed by radical surgery
* Radical chemoradiotherapy followed by surgery
* Radical radiotherapy
* Palliative treatment or best supportive care
## Footnote
Each option depends on the cancer stage, tumor location, and patient fitness.
113
What is the best single modality treatment for oesophageal cancer?
Radical surgery
## Footnote
Compared to radiotherapy alone, radical surgery offers better outcomes.
114
What is the approximate 5-year survival rate after radical surgery from specialist centers?
35%
## Footnote
This statistic reflects outcomes in specialized surgical settings.
115
What is the postoperative mortality rate for radical surgery?
Less than 5%
## Footnote
Indicates the safety of the procedure when performed in specialized centers.
116
What type of surgery is typically performed for upper third oesophageal cancer?
Three-phase approach with complete removal of the tumour and lymphadenectomy
## Footnote
This includes mediastinal and supraclavicular lymphadenectomy.
117
What is the surgical approach for middle and lower third oesophageal cancers?
Two-stage Ivor–Lewis approach
## Footnote
Involves laparotomy and thoracotomy for tumor removal and anastomosis.
118
Who is considered for radical radiotherapy?
Patients with localized disease who are medically unfit for surgery
## Footnote
This treatment is also used when chemotherapy is contraindicated.
119
What is the overall 5-year survival rate for patients treated with radical radiotherapy?
Less than 10%
## Footnote
This indicates limited effectiveness in this patient group.
120
What is radical chemoradiotherapy (CRT)?
Combination of radiotherapy with chemotherapy
## Footnote
Proven to be superior to radical radiotherapy alone.
121
What is the commonly used chemotherapy combination with radiotherapy?
Cisplatin with 5-fluorouracil
## Footnote
This combination is administered with a radiotherapy dose of 50 Gy in 2 Gy per fraction.
122
What remains the major cause of overall failure in oesophageal cancer treatment?
Locoregional recurrence
## Footnote
50% of patients develop locoregional disease.
123
What has been the result of attempts to increase the radiotherapy dose?
Increased treatment-related deaths without improvement in local control or survival
## Footnote
Indicates the risks of escalating treatment intensity.
124
Did studies show a difference in overall survival between CRT and CRT followed by surgery?
No, they showed similar overall survival
## Footnote
However, surgery was associated with high treatment-related mortality.
125
What is the recommended patient position for radiotherapy targeting the middle and lower thirds of the oesophagus?
Supine with arms above head
126
What is the recommended patient position for radiotherapy targeting the upper third of the oesophagus?
Supine with arms by side
127
What imaging technique is used for localization in radiotherapy for oesophageal cancer?
CT planning with information from EUS
128
What does GTV stand for in the context of radiotherapy target volume?
Gross Tumour Volume
129
What is included in the CTV for tumours above the carina?
GTV + 2 cm and bilateral supraclavicular nodes
130
What is the CTV margin for the middle third of the oesophagus?
GTV + 2 cm margin
131
What additional nodes are included in the CTV for the lower third of the oesophagus?
Coeliac axis basin nodes and gastrohepatic ligament (lesser curve, paracardial and left gastric nodes)
132
What is the lateral and anterior margin for the CTV?
GTV + 1 cm
133
What is the posterior margin for the CTV?
GTV + 0.5–1 cm
134
How is the PTV defined in relation to the CTV?
CTV + 1 cm
135
What is the phase I CTV definition in a two-phase treatment?
GTV + 3–5 cm superio-inferior margin and 1.5–2 cm axial margin
136
What is the phase II CTV definition in a two-phase treatment?
GTV with 2 cm margin superoinferiorly and 1.5–2 cm axially
137
What is the PTV definition for radical radiotherapy?
5 cm superior inferior margin for phase I and 2.5–3 cm for phase II and 2.5 cm axial margin
138
What is the PTV definition for palliative radiotherapy?
Tumour and node + 3 cm margin
139
What is the dose for radical chemoradiotherapy in a single phase?
50–50.4 Gy in 25–28 fractions
140
What is the dose for phase I in radical chemoradiotherapy?
30 Gy in 15 fractions
141
What is the dose for phase II in radical chemoradiotherapy?
20 Gy in 10 fractions
142
What is the dose for radical radiotherapy in a single phase?
55 Gy in 20 or 66 Gy in 33 fractions
143
What is the dose for phase I in radical radiotherapy?
33 Gy in 12 fractions
144
What is the dose for phase II in radical radiotherapy?
22 Gy in 8 fractions
145
What is the dose for preoperative chemoradiotherapy?
45 Gy in 25 fractions
146
What is the dose for palliative radiotherapy?
30 Gy in 10 fractions or 20 Gy in 5 fractions
147
What is the lung V20 tolerance level?
Volume receiving 20 Gy <25%
148
What is the heart V30 tolerance level?
V30 <40%
149
What is the maximum total dose for the spinal cord?
Below 45 Gy
150
What care is recommended during radiotherapy?
Weekly blood test, keep Hb >12 gm%, avoid significant weight loss
151
Fill in the blank: To avoid significant weight loss during radiotherapy, consider _______.
PEG/RIG feeding
152
What is the improvement in 2-year survival with preoperative chemotherapy followed by surgery compared to surgery alone?
7%
## Footnote
HR 0.90; CI 0.81–1.00
153
What chemotherapy regimen was used in the largest study (MRC OE02) for preoperative treatment?
Cisplatin (80 mg/m2 on day 1) and 5-fluorouracil (1 g/m2/day continuous infusion for 4 days)
## Footnote
Followed by surgery
154
What was the overall survival rate at 2 years with preoperative chemotherapy according to the MRC OE02 study?
Improved from 34% to 43%
## Footnote
p = 0.004
155
What is the effect of preoperative CRT followed by surgery on 2-year survival?
Improved by 13% compared to surgery alone
## Footnote
HR 0.81; 95% CI 0.70–0.93; p = 0.002
156
True or False: The benefit of preoperative CRT is seen with sequential therapy.
False
## Footnote
Only concurrent chemoradiotherapy shows benefit
157
What is the treatment aim for advanced and recurrent oesophageal cancer?
Palliative, aimed to improve symptoms and quality of life
## Footnote
Possibly extend life
158
What combination of chemotherapy is considered standard in the UK for advanced oesophageal cancer?
Epirubicin, cisplatin, and 5FU (ECF)
## Footnote
Used to improve survival compared to best supportive care
159
What symptom is primarily targeted for palliation in oesophageal cancer?
Dysphagia
160
List the methods to relieve dysphagia.
* Endoscopic dilatation
* Surgery
* Palliative chemotherapy
* Best supportive care
* Chemoradiotherapy (no prior RT)
* Chemotherapy (PS <3)
* Best supportive care (PS >2)
* Salvage surgery
161
What is the typical chemotherapy regimen for preoperative treatment?
Cisplatin 80 mg/m2 on day 1 and 5-FU 1 g/m2/day continuous infusion for 96 hours
## Footnote
Cycles repeated every 3 weeks for 2 cycles
162
What is the recommended dose for radical chemoradiotherapy?
50–50.4 Gy in 25–28 fractions
163
What is the PTV for radical radiotherapy?
5 cm superior-inferior margin for phase I and 2.5–3 cm for phase II and 2.5 cm axial margin
164
What is the role of screening for oesophageal cancer?
Not fully established; high-risk patients are regularly screened with endoscopy
165
What is the treatment for patients with Barrett’s oesophagus with mild dysplasia?
Acid suppression therapy followed by repeat endoscopy and multiple biopsies at 8–12 weeks
166
What is the median survival for patients with small cell carcinoma of the oesophagus?
12–18 months
167
What factors influence the prognosis of oesophageal cancer?
* Stage
* Depth of invasion
* Age
* Performance status
* Weight loss (>10% in 3 months)
168
What is the overall 5-year survival rate for oesophageal cancer?
<10%
169
What is the follow-up schedule after curative treatment for oesophageal cancer?
* 4-monthly for one year
* 6-monthly for two years
* Yearly thereafter
170
What trial is testing the addition of cetuximab to standard CRT?
UK SCOPE 1 trial
171
What is the EOX chemotherapy regimen?
* Epirubicin 50 mg/m2 day 1
* Cisplatin 60 mg/m2 day 1
* Capecitabine 625 mg/m2 orally twice daily
## Footnote
Cycle repeated 3-weekly
