2006 2 17 52
Daly JM, et al. J Am Coll Surg 2000;190:562-573
Esophageal Cancer: Results of an American College of Surgeons Patient Care Evaluation Study Daly JM, et al. J Am Coll Surg 2000;190:562-573
Esophageal Cancer: Results of an American College of Surgeons Patient Care Evaluation Study Daly JM, et al. J Am Coll Surg 2000;190:562-573
Esophageal Cancer: Results of an American College of Surgeons Patient Care Evaluation Study Daly JM, et al. J Am Coll Surg 2000;190:562-573
Esophageal Cancer: Results of an American College of Surgeons Patient Care Evaluation Study Daly JM, et al. J Am Coll Surg 2000;190:562-573
Esophageal Cancer (PDQ ): Treatment Stage III Esophageal Cancer Treatment of stage III esophageal cancer may include the following: Surgery. Clinical trials of chemotherapy plus radiation therapy, with or without surgery. Clinical trials of new therapies used before or after surgery.
Esophageal Cancer (PDQ ): Treatment Stage III Esophageal Cancer Standard treatment options: Surgical resection of T3 lesions. Treatment options under clinical evaluation: Chemotherapy plus radiation therapy with or without subsequent surgery.[1,2] Information about ongoing clinical trials is available from the NCI Web site.
Comprehensive Registry of Esophageal Cancer
Comprehensive Registry of Esophageal Cancer in 2000
2005 1 12005 12 31 15 23 33 25 61 18 5 5 35 114 106
Stage II Stage III
2005 1 12005 12 31 8 7 35 13 Stage II, III: T4 2 4 1 34 23 22 4 5
1?
1998 2003 EMR (T4) M1-org)
Number (n=259) Male : female 225 : 34 Age (mean+sd) 34-82 (63.0 8.6) Upper 39 Middle 141 Lower 79 Squamous 254 Adenocarcinoma 2 Others 3
ctnm staging Number (n=259) T1 147 T2 17 T3 95 N0 158 N1 101 Stage I 130 Stage II, III 101 Stage IV(Lym) 28 Stage IV(LYM): metastasis in cervical or celiac lymph node
Stage I CDDP 80mg/mm 2 5FU 800mg/mm 2 Radiation 2Gy 1 2 3 4 5 6 7 8 9 10 1112 1314 15161718 1920 2122 - - 28 29 - - -35 x2
Stage II, III, IV(LYM) CDDP 40mg/mm 2 5FU 400mg/mm 2 Radiation 2Gy 1 2 3 4 5 6 7 8 9 10 111213141516171819202122 - - 28 29 - - -35 + x 2 CDDP 80mg/mm 2 5FU 800mg/mm 2 1 2 3 4 5 6 7 8 9 10 111213141516171819202122 - - -28 x 2 -
Survival rate Stage I (n=130) Stage II, III (n=101) Stage IV (Lym) (n=28) year Kaplan-Meier)
Stage I Surgery (n=72) Survival rate Chemoradiotherapy (n=130) year Kaplan-Meier)
Stage I Chemorad 130 CR 123 95% Rec(-) 88 68% Rec(+) 35 Salvage(+) 25 Esophagectomy: 6 Dissection 1 EMR: 18 Salvage(-) 10 Alive 74 Died 14 Alive 17 Died 8 Alive 0 Died 10 Non-CR 7 Chemorad: chemoradiotherapy, CR: complete response, Rec: recurrence, EMR: endoscopic mucosal resection Salvage(+) 5 Esophagectomy: 4 EMR: 1 Salvage(-) 2 Alive 3 Died 2 Alive 1 Died 1
Stage II, III Survival rate Surgery (n=350) Chemoradiotherapy (n=101) year Kaplan-Meier)
Stage IV(Lym) Survival rate year Surgery (n=97) Chemoradiotherapy (n=28) Kaplan-Meier)
1
JCOG9708 (phase II) Stage I (T1N0M0) (CDDP/5-FU)II T1N0M05FU CDDP JCOG 0502 (phase III) cstage I ct1n0m0
2?
Salvage Survival rate Stage I (n=130) Stage II, III (n=101) Stage IV (Lym) (n=28) year Kaplan-Meier)
Stage I Chemorad 130 CR 123 95% Rec(-) 88 68% Rec(+) 35 Salvage(+) 25 Esophagectomy: 6 Dissection 1 EMR: 18 Salvage(-) 10 Alive 74 Died 14 Alive 17 Died 8 Alive 0 Died 10 Non-CR 7 Chemorad: chemoradiotherapy, CR: complete response, Rec: recurrence, EMR: endoscopic mucosal resection Salvage(+) 5 Esophagectomy: 4 EMR: 1 Salvage(-) 2 Salvage(+) 30 Esophagectomy:10 Dissection 1 EMR: 19 Alive 3 Died 2 Alive 1 Died 1
Stage II, III Chemorad 101 CR 66 65% Non-CR 35 Chemorad: chemoradiotherapy, CR: complete response, Rec: recurrence, EMR: endoscopic mucosal resection Rec(-) 38 38% Rec(+) 27 Salvage(+) 13 Esophagectomy: 5 Dissection 1 EMR: 7 Salvage(-) 14 Salvage(+) 10 Esophagectomy: 8 Dissection 1 EMR: 1 Salvage(-) 25 Salvage(+) 23 Esophagectomy:13 Dissection 2 EMR: 8 Alive 33 Died 5 Alive 9 Died 4 Alive 2 Died 12 Alive 4 Died 6 Alive 1 Died 24
Stage IV(Lym) CR 9 Rec(-) 4 15% Alive 4 Died 0 32% Salvage(+) 0 Chemorad 28 Rec(+) 5 Salvage(-) 5 Alive 1 Died 4 Non-CR 19 Chemorad: chemoradiotherapy, CR: complete response, Rec: recurrence, EMR: endoscopic mucosal resection Salvage(+) 3 Esophagectomy: 3 Salvage(-) 16 Salvage(+) 3 Esophagectomy: 3 Alive 1 Died 2 Alive 0 Died 16
59 2 CRT CR- EMR Salvage Surgery
2 Salvage
Ishikura S, et al. J Clin Oncol 2003;21:2697-2702
Ishikura S, et al. J Clin Oncol 2003;21:2697-2702
2005 6 10
3 Salvage Salvage
59 1 CR non-cr
Stage I Chemorad 130 CR 123 95% Rec(-) 88 68% Rec(+) 35 Salvage(+) 25 Esophagectomy: 6 Dissection 1 EMR: 18 Salvage(-) 10 Alive 74 Died 14 Alive 17 Died 8 Alive 0 Died 10 Non-CR 7 Chemorad: chemoradiotherapy, CR: complete response, Rec: recurrence, EMR: endoscopic mucosal resection Salvage(+) 5 Esophagectomy: 4 EMR: 1 Salvage(-) 2 Alive 3 Died 2 Alive 1 Died 1
Stage I Chemorad 130 CR 123 95% Rec(-) 88 68% Rec(+) 35 Salvage(-) :10 PUL 2 HEP: 2 PLE: 1 LYM: 3 PS: 1 Reject: 1 Non-CR 7 Chemorad: chemoradiotherapy, CR: complete response, Rec: recurrence Salvage(-) : 2 Complication: 1 Reject: 1
Stage II, III Chemorad 101 CR 66 65% Non-CR 35 Chemorad: chemoradiotherapy, CR: complete response, Rec: recurrence, EMR: endoscopic mucosal resection Rec(-) 38 38% Rec(+) 27 Salvage(+) 13 Esophagectomy: 5 Dissection 1 EMR: 7 Salvage(-) 14 Salvage(+) 10 Esophagectomy: 8 Dissection 1 EMR: 1 Salvage(-) 25 Alive 33 Died 5 Alive 9 Died 4 Alive 2 Died 12 Alive 4 Died 6 Alive 1 Died 24
Stage II, III CR 66 65% Rec(-) 38 38% Rec(+) 28 PUL: 3 BON: 2 LYM: 5 T4: 1 Reject: 4 Chemorad 101 Non-CR 35 Chemorad: chemoradiotherapy, CR: complete response, Rec: recurrence Salvage(-) : 15 Salvage(-) : 26 PUL: 2 HEP: 1 BON: 2 PLE: 2 KID: 1 T4: 3 PS: 6 Complication: 1 Reject: 8
3 Salvage Salvage
59 3 Stage II,IIISurgery vs CRT Stage II, III (CRT) -Surgery vs CRT - EMR Salvage Surgery
JCOG 9906 (phase II) Stage II,III II prospective Phase II Stage II,III +/-Salvage surgery
2005 1 12005 12 31 Surgeon A Surgeon B Surgeon C Non-Salvage 42 42 28 Salvage 1 14(25%) 2
Salvage
Salvage surgery CRT Salvage surgery n=62
Salvage surgery CRT Salvage surgery n=62 n=4 T4: 2 LYM: 2 n=58
Salvage surgery CRT Salvage surgery n=62 n=58 n=4 T4: 2 LYM: 2 n=7 T4: 6 n=51 PUL: 1 PER: 1
Salvage (n=62) (n=185) R0 51 (82%) 171 (92%) R1, R2 7 (11%) 14 (8%) Probe 4 (6%)
Salvage Esophagectomy Radical R1, R2 Probe ct1 13 ct2 6 ct3 38 5 3 T4: 4 T4: 2 PER:1 Lym:1 ct4 5 2 1 T4: 2 T4: 1 PUL:1
Salvage
Salvage surgery CRT Salvage surgery
Salvage Salvage 60Gy 1998 2005 5
Salvage 1998-2005 Salvage (n=58) Age mean SD 60.8 8.4 Male : female 55 : 2 Tumor location Upper 13 (22%) Middle 26 (45%) Lower 19 (33%) ctnm stage Stage I 12 (21%) Stage II 16 (28%) Stage III 22 (38%) Stage IV 8 (14%)
Chemoradiotherapy 1998-2005 Patients n=58) National Cancer Center Hospital 36 (62%) Other hospital 22 (38%) Radiation dose 60 Gy 55 (95%) 70 Gy 3 (5%) Chemotherapy Platinum+5FU 56 (97%) Platinum alone 2 (3%) Chemotherapy course 2 20 (34%) 3-4 33 (57%) 5-8 5 (9%)
1998-2005 Chemoradiotherapy Patients n=58) non-cr 34 (59%) Recurrence after CR 24 (41%) Duration after chemoradiotherapy 6 months 21 (36%) > 6 months 27 (47%) > 12 months 10 (17%)
Salvage Esophagectomy 1998-2005 Salvage (n=58) (n=185) Right thoracotomy 54 (93%) 184 (99%) Left thoracotomy 1 (.5%) Transhiatal 4 (7%) 3-field 25 (43%) 169 (91%) others 33 (57%) 16 (9%)
Reconstruction 1998-2005 Salvage (n=58) (n=185) 22 (38%) 161 (87%) 33 (57%) 22 (12%) 3 (5%) 2 (1%) 55 (95%) 163 (88%) 3 (5%) 22 (12%) 41 (71%) 175 (95%) 14 (24%) 9 (5%) 3 (5%) 1 (.5%)
1998-2005 Salvage (n=58) (n=185) 20 (34%) 51 (28%) 19 (33%) 34 (18%) 5 (9%) 7 (4%) 11 (19%) 21 (11%) 30 34 (59%) 147 (80%) 31 17 (30%) 32 (17%) 7 (12%) 6 (3%)
Salvage surgery CRT Salvage surgery n=58 n=7 Operative: 1 Hospital: 5 Salvage
Salvage
Salvage?
Salvage No.1 No.2 No.3 No.4 No.5 No.6 No.7 No.8 CV
Lateral longitudinal anastomosis Lateral longitudinal anastomosis
Salvage No.1 No.2 No.3 No.4 No.5
5 Salvage
Salvage surgery CRT Salvage surgery n=62 n=51 n=11 n=7 n=44
Salvage No.1 CO2 20M 14M No.2 CO2 21M 12M No.3 CO2 19M 12M
Salvage surgery CRT Salvage surgery n=62 n=51 n=11 n=7 n=3 n=44
Salvage surgery n=51 n=7 n=3 n=14 Local: 6 Lym: 5 Org: 3 n=44 Salvage
6 Salvage?
Without preoperative therapy (n=185) Survival rate Salvage esophagectomy (n=58) year Kaplan-Meier)
Salvage Survival rate Recurrence after CR (n=24) non-cr (n=34) year Kaplan-Meier)
Salvage Survival rate R0 (n=51) R1, R2 (n=7) year Kaplan-Meier)
Salvage Survival rate ct1 (n=13) ct2 (n=6) ct3 (n=35) ct4 (n=4) year Kaplan-Meier)
6 Salvage
Salvage surgery CRT Salvage surgery n=62 n=51 n=11 n=7 n=3 n=14 n=44
Salvage Salvage
Salvage Salvage
(
2003 4
QOL