食管癌-英文-课件.ppt

1、220 patientsAdeno CaTransthoracic Esophagectomy(TTE)N=114Included 2 field lymphadenectomyTranshiatal Esophagectomy(THE)N=106RandomizeNEJM 2003Br J Surg 1996 Jan;83(1):107-11 NEJM 12/98Lancet 359(2002),pp.17271733 Two 4-day cycles,3 weeks apart,of cisplatin 80 mg/m(2)by infusion over 4 h plus fluorou

2、racil 1000 mg/m(2)daily by continuous infusion for 4 days followed by surgical resection.Clinicians could choose to give preoperative radiotherapy to all their patients irrespective of randomization.Int J Radiat Oncol Biol Phys 1998 1;41(3):579-83 Comprehensive text book of Thoracic Oncology,William

3、s&WilkinsRandomizeN=113AdenoSurgeryN=55Cis/5FUXRTSurgeryN=58Median Survival:11m1 yr survival:44%2 yr survival:26%3 yr survival 6%Median Survival:16m 1 yr survival 52%2 yr survival37%3 yr survival 32%Two courses of chemotherapy in weeks 1 and 6 5 FU 15 mg per kg daily for five daysCisplatin,75 mg per

4、 square m2 on day 7Radiotherapy,40 Gy,administered in 15 fractions over a 3-week period,beginning concurrently with the first course of chemotherapy.NEJM Vol 335:462-467RandomizeN=282SCC T1N1,T2N0,T2N1,T3N0 SurgeryN=139Cis&XRTSurgeryN=143Cisplatin 80 mg/m2 0-2 days before XRT q weekly x 2.XRT:37 Gy

5、over 2 weeksRandomizeN=100Adeno 75%SCC 25%SurgeryN=50Cis/5FU/VindesineXRTSurgery N=50Median survival:17.6m3 yr survival:16%Median survival:16.9m3yr survival:30%(P=0.15)Cisplatin 20 mg/m2/d on days 1 through 5 and 17 through 21,5FU 300 mg/m2/d on days 1 through 21,and vinblastine 1 mg/m2/d on days 1

6、through 4 and 17 through 20.XRT:1.5-Gy fractions twice daily,Mon through Fri over 21 days,to a total dose of 45 Gy.Transhiatal esophagectomy was performed around day 42.Staging:CT head,chest abd,endoscopy,barium swallow,bone scan.J Thorac Cardiovasc Surg 1997 Aug;114(2):205-9Randomize Post SurgeryN=

7、258RadiationCis/Vindesinex25 yr survival:44%5 yr survival:42%No difference in time to recurrence or sites of recurrence Radiotherapy(50 Gy)2 courses of chemotherapy consisting of cisplatin(50 mg/m2)and vindesine(3 mg/m2)following curative resection Chest 1993 Jul;104(1):203-7 RandomizeN=205SurgeryN=

8、100Surgery&Cis/Vindesinex2N=1055 yr survival:44.9%5 yr survival:48.1%No significant differences in survival were detected between the two groups,even with lymph node stratification Transthoracic esophagectomy with lymphadenectomy Cisplatin(70 mg/m2)and Vindesine(3 mg/m2)J Thorac Cardiovasc Surg 1997

9、 Aug;114(2):205-9Surg Gynecol Obstet 1991 Aug;173(2):123-30 RandomizeRadiation64GyN=62Cis/5 FUx4Radiation50GyN=61Median follow up 5 yrs for all ptsMedian Survival 9.3m5 yr 0%Median Survival 14.1m5 yr survival 27%P 0.00018 yr 22%Locally advanced adeno or squamous esophageal carcinoma.Cisplatin,75 mg/m2 intravenously,on the first day of weeks 1,5,8,and 11.The patients were given a continuous infusion of fluorouracil,1 g/m2,for the first 4 days of weeks 1,5,8,and 11.Radiation was delivered at 30 Gy in 15 fractions over 3 weeks starting on day 1,followed by 20 Gy in 10 fractions over 2 weeks