23. Esophageal Carcinoma
23.1 General considerations
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Stage grouping (AJCC/UICC) |
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Stage 0 Tis N0 M0 |
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Stage 1 T1 N0 M0 |
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Stage IIA T2,3 N0 M0 |
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Stage IIB T1,2 N1 M0 |
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Stage III T3,4 N1 M0 |
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Stage IV any T any N M1 |
Therapeutic options for esophageal carcinoma are governed by the extent of the tumor and the general condition/concomitant diseases of the patients.
Localized esophageal carcinoma can be managed with a surgical or a radiotherapeutic approach. No strong evidence for a survival advantage has been seen with preoperative or postoperative radiotherapy or chemotherapy alone. On the other hand a combined modality approach of concomitant chemoradiotherapy given either pre-or postoperatively or as a definitive therapy in selected patients with localized disease reveals encouraging results. Acute treatment- related toxicity is also increased with chemoradiotherapy, however.
Most patients present with an advanced stage of disease and in the majority of cases only palliative treatment can be offered with either surgery, radiotherapy,chemotherapy or symptomatic treatment.
Literatur: for review e.g.
EDELMAN, Chest Surg.Clin.N.Am.10(2000):561-567 (chemothe-
rapy of advanced esophageal cancer).
GAMLIEL and KRASNA, Curr. Oncol. Rep.1(1999):149-154
(combined modality therapy).
GEH, Eur.J.Cancer 38 (2002): 300-313 (use of chemoradiotherapy)
LERUT et al,Chest 116(Suppl 6) (1999):463-465)
MILLER, Chest Surg. Clin.N. Am. 10(2000): 583-590(clinical
trials for esophageal carcinoma)
MINSKY, Oncology 13 (1999):1225-1232, 1235-1236 (primary
therapy ) and 1415-1427(adjuvant therapy).
23.2 Single agent chemotherapy
Palliative treatment with e.g.
23.2.1 Vindesine
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Vindesine 3 mg/mē i.v.(bolus) d 1, 8, 15 |
Afterwards every 2 weeks
Literature:
BEZWODA et al,Cancer Treat. Rep.68(1984): 783-785
23.2.2 Paclitaxel
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Paclitaxel 250 mg/mē i.v.(24 h inf) d1 |
To be repeated every 3 weeks (withG-CSF support)
Literature:
AJANI et al, J.Natl. Cancer. Inst.86 (1994): 1086-1091
WEINER , Semin.Oncol. 26(Suppl 2)(1999):106-108 (review)
23.3 Combination chemotherapy
23.3.1 Cisplatin + 5-fluorouracil
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Cisplatin 100mg/mē i.v.(2 h inf) d1 |
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5-Fluorouracil 1000mg/mē i.v.(cont inf) d1-5 |
To be repeated every 3-4weeks
Literature:
LEICHMAN and BERRY, Semin.Oncol.18(Suppl 3)(1991):64-72
23.3.2 Paclitaxel + cisplatin
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Paclitaxel 180mg/mē i.v.(3 h inf) d1* |
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Cisplatin 60mg/mē i.v.(3 h inf) d1 |
To be repeated every 2 weeks(max 6 cycles)
* Highest tolerable dose of paclitaxel from a phase I study
Literature:
Van der GAAST et al, Br.J.Cancer 80(1999): 1052-1057
WEINER., Semin. Oncol.26(Suppl 2)(1999):106-108(review)
23.3.3 TPE
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Paclitaxel 50mg/mē i.v.(1 h inf) d 1+4* |
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Cisplatin 15mg/mē i.v.(1 h inf) d 1+4* |
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Etoposide 50mg/mē i.v.(1 h inf) d 1+4* |
Weekly for 3 consecutive weeks followed by 1 week of rest. To
be repeated every 4 weeks. Paclitaxel is administered over the
first hour followed by admixed infusion of cisplatin + etoposide
in the second hour.
* Either Monday + Thursday or Tuesday + Friday
Literature:
LOKICH et al, Cancer 85(1999):2347-2351
23.3.4 ECF
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Epirubicin 50mg/mē i.v.(bolus) d1* |
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Cisplatin 60mg/mē i.v.(bolus) d1* |
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5-Fluorouracil 200mg/mē i.v.(cont inf) d1-21 |
* To be repeated every 3 weeks with 5-fluorouracil given continuously
Literature:
BAMIAS et al, Cancer 77(1996): 1978-1985
WEBB et al, J. Clin. Oncol.15(1997):261-267(randomized trial
comparing ECF with FAMTX in advanced esophagogastric cancer)
23.4 Chemoradiotherapy
E.g. cisplatin + 5-fluorouracil + radiation
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Cisplatin 75mg/m i.v.(2 h inf) d1 |
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5-Fluorouracil 1000mg/m i.v.(cont inf) d1-4 |
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Weeks 1, 5, 8, 11 |
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Radiotherapy 50mg/m in 25 fractions over 5 weeks |
Literature:
COOPER et al,JAMA 281(1999):1623-1627(long-term follow-up of
the randomized trial RTOG 85-01comparing chemoradiotherapy
with radiotherapy)