Esophagus Flashcards
(67 cards)
What is the clinical relevance of RTOG 8501?
This trial showed a benefit to adding chemo to definitive RT for unresectable esophageal cancer.
What population was studied in RTOG 8501?
129 pts; T1-3, N0-1, mostly squamous
What regimens were studied in RTOG 8501?
“<span>50 Gy/25 fx + 5FU/cisplatin <br></br></span>vs. <br></br>64 Gy alone”
What were the outcomes of RTOG 8501?
<div>All outcomes improved with addition of CHT.</div>
<div><br></br></div>
<b>5-yr OS 26% CRT vs. 0% RT alone<br></br>Median OS 14.1 vs. 9.3 mos</b><br></br>5-yr LRF 53% vs. 38%<br></br>5-yr DM 16% vs. 30%
What is the clinical relevance of RTOG 9405/INT 0123 (esophageal trial)?
This trial examined whether dose escalation is beneficial for definitive chemoradiation for inoperable pts with esophageal cancer.
What population was studied in RTOG 9405/INT 0123 (esophageal trial)?
236 pts; inoperable SCCa or adeno
What regimens were studied in RTOG 9405/INT 0123 (esophageal trial)?
“<span>→50.4 Gy + 5FU/cisplatin <br></br></span>vs. <br></br>→64.8 Gy + 5FU/cisplatin”
What were the results of RTOG 9405/INT 0123 (esophageal trial)?
Closed and reached futility early due to deaths in high dose arm (but prior to recieving 50.4 Gy).<div><br></br>No difference in any outcomes<br></br><br></br></div>
What is the clinical relevance of the ARTDECO trial (esophageal trial)?
This trial examined whether dose escalation would be helpful or pts with unresectable/inoperable esophageal cancer. This trial utilized IMRT for escalating dose.
What population was studied in the ARTDECO trial (esophageal trial)?
260 pts; T2-4, N0-3 esophageal cancer, inoperable (either medically or anatomically)
What regimens were studied in the ARTDECO trial (esophageal trial)?
“<span>→50.4 Gy + carbo/taxol<br></br></span>vs.<br></br>→61.6/50.4 Gy SIB + carbo/taxol”
What were the results of the ARTDECO trial (esophageal)?
No improvement in outcomes with IMRT dose escalation for unresectable/inoperable esophageal cancer.
What regimens were studied in the Japanese cervical esophageal cancer study?
60 Gy and concurrent cisplatin and 5FU
What was the outcome of the Japanese cervical esophageal cancer study?
Favorable results:<div><br></br></div><div>3 yr OS 67% and 3 yr laryngectomy free survival 53%</div><div><br></br></div><div>(Outcomes worse for T4 tumors)</div>
What is the clinical relevance of the Japanese cervical esophageal cancer study?
This study showed that definitive chemoRT is feasible and has relatively favorable outcomes.
What is the clinical relevance of the CROSS trial?
This trial showed the neoadjuvant chemoRT improves outcomes for resectable esophageal cancer.
What population was studied in the CROSS trial?
368 pts with resectable T1N1 and T2/3 N0/1 adeno (75%) or squamous (25%) of esophagus (75%) or GEJ (25%)
What regimens were studied in the CROSS trial?
“→surgery alone <br></br>vs. <br></br><span>→pre-op chemoRT to 41.4 Gy + carbo/paclitaxel weekly</span><br></br><br></br>RT did not include SCV or celiac”
What were the results of the CROSS trial?
“<span>Improved OS with chemoRT<br></br>Median OS 49 vs. 24 mos <br></br>Median OS SCC 82 vs. 21 mos<br></br>Median OS adeno 43 vs. 27 mos<br></br>5-yr OS 47% vs. 34%</span><br></br><br></br><div><br></br></div>”
What were the findings at surgery after chemoRT in the CROSS trial?
R0 resections better with chemoRT: 92% vs. 69%<br></br><br></br><div>pCR rate of 29% (23% in adeno, 49% in SCC)</div>
What were the recurrence patterns from the CROSS trial?
Pre-op chemoRT reduced LRR and peritoneal carcinomatosis.<br></br><br></br>Most LRRs were concominant with outfield recurrences.
What is the clinical relevance of NEOCRTEC5010 (esophageal study)?
It provided additional evidence that neoadjuvant chemoRT improves outcomes.
What population was studied in NEOCRTEC5010?
451 pts; Resectable esophageal cancer T1-4N1M0 or T4N0M0
What regimens were studied in NEOCRTEC5010?
→surgery alone <br></br>vs. <br></br>→pre-op RT to 40 Gy/2 Gy fx + cisplatin vinorelbine q3 wks
Median DFS 42 mos vs. 100 mos
thoracic esophagus to GEJ with less than 2 cm to cardia
T1-3, N0-1. Nodes <1.5 cm
vs
→pre-op RT to 50.4 Gy + cis/5FU
Optional inclusion of SCV or celiac
Surgery in 3-8 weeks, Ivor-Lewis"
5-yr OS 39% vs. 16%
PFS 3.5 yrs vs. 1
vs.
→pre-op chemoRT to 40 Gy/15 fx + cis/5FU"
3-yr OS 6% vs. 32%
Median OS 16 vs. 11 mos
→pre-op 45 Gy 1.5 BID + cisplatin/vinblastine/5FU
→pre-op RT 45 Gy + cis/5FU
→pre-op chemo alone
RT to cardiac, gastric, celiac, splenic, hepatic nodes"
3-yr OS 47% vs. 28%, p=0.07
vs.
→pre-op cis/5FU/LV x2.5
→chemoRT (total dose 66 Gy)
2-yr LC 65% vs. 57% (ss)
Also more stents with chemoRT:
stents 5% vs. 32%
→chemoRT (HDR or EBRT boost to 64-65 Gy)
2-yr FFLP 64% surgery vs. 41% chemoRT.
Treatment mortality 4% vs. 13%"
3-yr OS 43% vs. 40%, p=0.542
3-yr DFS 39% salvage vs. 33% planned, p=0.046
If persistent disease, OS and DFS were worse
→ eval response with CT, EUS, and optional PET → observe CR and resect PR or PD
If CR: 5-yr OS 53%
IMRT 50.4 Gy
vs.
protons 50.4 Gy
