演題抄録

基調講演

開催概要
開催回
第51回・2013年・京都
 

Multidisciplinary treatment of esophageal cancer: A Surgical Oncologist's View

演題番号 : KL-4

[筆頭演者]
Mitchell C. Posner:1 

1:Section of General Surgery and Surgical Oncology, University of Chicago Medicine, USA

 

Controversy continues to exist regarding the optimal surgical approach for patients with esophageal cancer(EC). No firm evidence exists favoring one surgical approach over another however, postoperative mortality is inversely related to both surgeon and hospital esophagectomy(E) volume. Preoperative chemoradiotherapy (CRT) or chemotherapy(C) is now considered standard of care in patients with EC. It has been demonstrated that the most important predictor of improved survival is achieving an R0 resection. The recently reported CROSS trial provided further justification for a multipronged approach to this lethal disease. Operative mortality was less than 4% in both groups, and the R0 resection rate and median survival was significantly improved in those patients receiving CRT plus E versus the E-alone arm. The MRC OEO2 trial noted a significant improvement in overall survival with preoperative C; INT-0113 showed no difference. Both the MRC and the INT trial emphasized the critical importance of achieving an R0 resection that resulted in prolonged median survival of more than 2 years. Preoperative CRT is now accepted as a standard of care in the U.S.;outside the U.S, preoperative C is more routinely applied. Exploring novel agents, targets and therapeutic approaches is justified in a highly lethal malignancy such as EC. The ACOSOG Z4051 trial completed accrual to a phase II study that examined the combination of C with a human monoclonal antibody specific to the EGFR plus external beam RT followed by E. RTOG-1010 which randomly assigns patients with HER-2 positive EC to standard CRT followed by E versus CRT plus trastuzumab followed by E is now open to accrual. The newly formed ALLIANCE clinical trials group randomizes patients to one or another C regimen and, based on PET response, either continue the same C combined with RT or if nonresponders cross over to the alternative C regimen combined with RT prior to E.

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