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1、关于食管癌最新化疗关于食管癌最新化疗第一页，本课件共有15页化疗原则化疗原则n nT1aN0的食管癌不需术后辅助化疗n nT1b（侵及粘膜下层）尤其分化差的鳞癌术后应作适当辅助化疗n nII、III期最好行新辅助放化疗或放疗或化疗n nIV期：放化疗n n转移：化疗n n颈段环咽肌5cm以内的食管癌：放化疗第二页，本课件共有15页化疗有效药物及方案化疗有效药物及方案第三页，本课件共有15页Preoperative chemotherapy n nRTOG8911 FP+surgery VS surgery alone FP+surgery VS surgery alone R0切除率提高（64
2、 vs 59%）但 OSOS无差异无差异n nMRCOEO2 2周期周期FP+surgery VS surgery alone总生存提高总生存提高3.5月（月（16.8 VS 13.316.8 VS 13.3）n nMeta分析分析 5 5年生存及DFS提高4%4%（small but significant）第四页，本课件共有15页Preoperative chemotherapyn nAbstract 180：Outcomes associated with T4 esophageal cancern n3(7.9%)pCR,17(44.7%)pPR,18(47.4%)NR 3(7.9%)
3、pCR,17(44.7%)pPR,18(47.4%)NR n nR0 resections were accomplished in 37(R0 resections were accomplished in 37(94.9%)94.9%)n n14 14 例术后复发：例术后复发：pCR 1(7.1%),pPR 6(42.9%),NR 7 pCR 1(7.1%),pPR 6(42.9%),NR 7(50%)(50%)n nmedian time to recurrence of median time to recurrence of 19.519.5(4-71)months(4-71)mon
4、thsn nPatients achieving aPatients achieving a pCR pCR had a 5-year overall and had a 5-year overall and disease free survival of disease free survival of(43%and 47%),(43%and 47%),compared to compared to pPR(30%and 21%)while there were pPR(30%and 21%)while there were no 5-year survivors no 5-year su
5、rvivors in the NR cohort in the NR cohort we have demonstrated that neoadjuvant therapy and down staging of T4 tumors leads to increased R0 resections and improvements in overall and disease free survival 第五页，本课件共有15页Preoperative chemotherapyn nAbstract 4060Abstract 4060 ：Final results of feasibilit
6、y study of Final results of feasibility study of neoadjuvant chemotherapy with neoadjuvant chemotherapy with DCFDCF for clinical for clinical stage II/III esophageal squamous cell carcinoma stage II/III esophageal squamous cell carcinoma（JapanJapan）RR 60%RR 60%，pCR 22%pCR 22%most common grade 3 or 4
7、 toxicities were most common grade 3 or 4 toxicities were neutropenia(83%),febrile neutropenia(2%),neutropenia(83%),febrile neutropenia(2%),anorexia(7%),and stomatitis(5%).anorexia(7%),and stomatitis(5%).第六页，本课件共有15页chemoradiationn nRTOG85-01 trial(randomized)RTOG85-01 trial(randomized)5-Fu+DDP RT 5
8、-Fu+DDP RT +RT +RT（50Gy50Gy）（60Gy60Gy）中位生存中位生存 1414月月 9 9月月 5年生存率年生存率 27%027%0n nINT0123 trial 不同放疗剂量联合相同化疗方案，中位生存、2年生存率及局部复发率无统计学差异VS第七页，本课件共有15页chemoradiationAbstract 4034（2011 ASCO2011 ASCO）Phase II trial Phase II trial （JapanJapan）RT 30Gy/3wks+S1 S1 80mg/m2/d d1-14 80mg/m2/d d1-14 DDP 70mg/m2 d8
9、 S1S1 80mg/m2/d d1-14 80mg/m2/d d1-14 DDPDDP 70mg/m2 d82wks later第八页，本课件共有15页chemoradiationn nAbstract 4034 Abstract 4034（2011 ASCO2011 ASCO）Phase II trialPhase II trial（JapanJapan）stage II III IVstage II III IV patient 12 61 29 patient 12 61 29 CR(%)92 64 24 CR(%)92 64 24 PR(%)100 85 66 PR(%)100 85
10、 66 OS 100%795d 369d OS 100%795d 369d 主要不良反应：主要不良反应：3/43/4度骨髓抑制（度骨髓抑制（36/14%36/14%）2 2度恶心呕吐，口腔黏膜炎等度恶心呕吐，口腔黏膜炎等第九页，本课件共有15页chemoradiationn nAbstract 4072 Abstract 4072（2011 ASCO2011 ASCO）（FranceFrance）Chemoradiation with FOLFOX plus cetuximab in Chemoradiation with FOLFOX plus cetuximab in locally ad
11、vanced cardia or esophageal cancer:locally advanced cardia or esophageal cancer:Final results of a GERCOR phase II trial Final results of a GERCOR phase II trial(ERaFOX).(ERaFOX).（Stage IIIStage III）FOLFOX6+C225 2FOLFOX6+C225 2周期周期 FOLFOX6+C225+RTFOLFOX6+C225+RT（50.4Gy50.4Gy）（5-Fu 1800mg/m2/d1-25-Fu
12、 1800mg/m2/d1-2）第十页，本课件共有15页chemoradiationn nAbstract 4072 Abstract 4072（2011 ASCO2011 ASCO）Phase II trialPhase II trial（FranceFrance）male/female 60/19male/female 60/19 median age 63(23-79)median age 63(23-79)PS 0/1/ND 47/31/1 PS 0/1/ND 47/31/1 SCC/adeno/undifferentiated 53/25/1 SCC/adeno/undifferen
13、tiated 53/25/1 esophagus/cardia 74/5 esophagus/cardia 74/5 ORR(ITT)was achieved in 61 pts(77.2%ORR(ITT)was achieved in 61 pts(77.2%）median PFS/OS were 13.8/21.6 months.median PFS/OS were 13.8/21.6 months.Most frequent grade 3-4 toxicities were:neutropenia Most frequent grade 3-4 toxicities were:neut
14、ropenia(28.4%),dysphagia-esophagitis(13.5%),rash(10.8%)(28.4%),dysphagia-esophagitis(13.5%),rash(10.8%)and allergy(8.9%).and allergy(8.9%).第十一页，本课件共有15页Chemotherapy for metastatic diseasen nFluoropyrimidine/platinum-based first-line Fluoropyrimidine/platinum-based first-line chemotherapy in metastat
15、ic esophageal squamous chemotherapy in metastatic esophageal squamous cell carcinoma:Prognostic factor analysis in 239 cell carcinoma:Prognostic factor analysis in 239 patientspatients（Abstract 4088Abstract 4088，韩国，韩国）n nXP与FPFP方案 ORRORR，PFS,OS 无统计学差异无统计学差异n nECOG2,albumin level 3.5g/dL and weight l
16、oss(10%of the weight loss for 3 months)at the time of chemotherapy were significantly associated with both worse PFS worse PFS(P0.05)and OS(P0.05).(P0.05)and OS(P0.05).第十二页，本课件共有15页Target therapyn nToGA studyToGA study 曲妥珠单抗曲妥珠单抗+化疗 VS VS 化疗在Her-2Her-2过表达的胃-食管交界腺癌，OS 提高（13.5 VS 11.1 月）月）n nC225、特罗凯、
17、贝伐单抗、特罗凯、贝伐单抗n nPhase II trial of sorafenibsorafenib in esophageal(E)and gastroesophageal junction(GEJ)cancer:Response and protracted stable disease observed in adenocarcinoma（abstract 4100）第十三页，本课件共有15页研究方向n n不同的化疗方案与放化疗的合理应用n n新的靶向药物在食管癌的疗效n n食管鳞癌与腺癌的区别n n食管癌的预后及预测因子第十四页，本课件共有15页感感谢谢大大家家观观看看第十五页，本课件共有15页