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E

(EVIDENCE-BASED)

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2010 : 16 640
14 500 .
2009: 1768 1311
.
50% /
.
40%

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12

(2)
5- ,
,
15 20%
5-
,
, 10 20%
O'Reilly S, Forastiere A. Is surgery necessary with multimodality treatment
of oesophageal cancer. Ann Oncol. 1995;6(6):519-21.
Coia LR. Esophageal cancer: is esophagectomy necessary? Oncology
(Williston Park). 1989;3(4):101-10; discussion 110-1, 114-5.

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: 5-
1999-2005

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14

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15

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30%
NCCTG-884051, SWOG-8598, RTOG-85-01
Herskovic et al. NEJM; 1992 , Cooper JS et al. JAMA; 1999;

(64)
(50.4)
.
RTOG 94-05; Minsky et al. J Clin Oncol; 2002

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8 , 1729 (
INT/MRC)
.
, ,

Cochrane Meta-analysis; 2006

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10 , 1209
CR = 16 40%
S 19% (HR = 0.81)
C > :
R 0.75 vs 0.9
SCC .
Urschel JD et al. Am J Surg. 2003
Gebski et al; Lancet Oncol 2007

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. vs. .XT
1 :
126 ( 500 )
-
pCR = 2.5%, MS=21
- pCR = 17%, MS=33
S - -
Stahl et al; ASCO 2007

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Effect of preoperative concurrent radiochemotherapy on survival of patients with


resectable esophageal or esophago-gastric junction cancer: Results from a
multicenter randomized phase III study.
A. V. Gaast, P. van Hagen, M. Hulshof, D. Richel, M. I. van Berge Henegouwen, G. A.
Nieuwenhuijzen, J. T. Plukker, J. J. Bonenkamp, E. W. Steyerberg, H. W. Tilanus,
CROSS Study Group; Erasmus University Medical Center, Rotterdam, Netherlands;
Academic Medical Center, Amsterdam, Netherlands; Catharina Hospital, Eindhoven,
Netherlands; University Medical Center Groningen, Groningen, Netherlands; Radboud
University Medical Centre, Nijmegen, Netherlands; Department of Public Health,
Erasmus Medical Center, Rotterdam, Netherlands
2010 ASCO Annual Meeting, J Clin Oncol 28:15s, 2010 (suppl; abstr 4004)

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363 pts.
T2-3N0-1M0 resectable SCC/Adeno
Esophageal & EGJ

RCHT + SURGERY
175 pts.
RADIOTHERAPY
41.4 Gy in 23 fractions,
5 days per week
CHEMOTHERAPY
paclitaxel 50 mg/m2 +
carboplatin AUC = 2
weekly for 5 weeks

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RANDOMIZATION

SURGERY ALONE
188 pts.

Stratification
PS
Histology
LN Status
male/female 284/79, median age 60 years (36-79),
median WHO performance status 0 (0-1),
adeno/squamous/other carcinoma 273/86/4
median follow-up - 32 months
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Parameters

RCHT+Surgery

Surgery Alone

P-value

Resectability

86%

90%

NS

R0 resection

92.3%

64.9%

0.002

pCR

32.6%

Hosp. mortality

38%

37%

NS

Median survival

49 mo.

26 mo.

0.011

1-y survival

82%

70%

<0.01

2-y survival

67%

52%

<0.01

3-y survival

59%

48%

<0.01

Summary: Radiotherapy with concurrent of carboplatin and paclitaxel can be considered the
standard of care for patients with resectable esophageal or esophagogastric junction cancer.

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RTOG 8501

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EORTC

29

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RTOG 8501 (92)

12.5

RTOG 8501 (99)

14.1

RTOG 9405 (02)

18.1

U Michigan (01)

16.9

Ireland (97)

11

TROG (05)

19.1

EORTC (97)

18.6

CALGB 9781 (06)

21.6

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:
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Kaplan-Meier plots showing the freedom from locoregional


progression

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Kaplan-Meier plots showing overall survival

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Conclusion
Adding surgery to chemoradiotherapy
improves local tumor control but does not
increase survival of patients with locally
advanced esophageal SCC. Tumor response to
induction chemotherapy identifies a favorable
prognostic group within these high-risk
patients, regardless of the treatment group.

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;
;
R .
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(
),
,

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