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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，讲稿共十五页哦化疗原则化疗原则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，讲稿共十五页哦化疗有效药物及方案化疗有效药物及方案第三页，讲稿共十五页哦Preoperative chemotherapy n nRTOG8911 FP+surgery VS surgery alone R0切除率提高（切除率提高（64 vs 59%64 vs 59%）但 OS无差异n
2、 nMRCOEO2MRCOEO2 2 2周期FP+surgery VS surgery alone总生存提高3.5月（16.8 VS 13.3）n nMeta分析分析 5 5年生存及DFSDFS提高4%4%（small but significant）第四页，讲稿共十五页哦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%)pCR,17(44.7%)pPR,18(47.4%)NR n
3、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)monthsn nPatients achieving aPatie
4、nts 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 pPR compared to pPR(30%and 21%)while there were(30%and 21%)while there were no 5-year survivors in no 5-year survivors in the NR cohort the
5、 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，讲稿共十五页哦Preoperative chemotherapyn nAbstract 4060Abstract 4060 ：Final results of feasibility study of Final results of feas
6、ibility study of neoadjuvant chemotherapy with neoadjuvant chemotherapy with DCFDCF for clinical stage for clinical stage II/III esophageal squamous cell carcinoma II/III esophageal squamous cell carcinoma（JapanJapan）RR 60%RR 60%，pCR 22%pCR 22%most common grade 3 or 4 toxicities were neutropenia(83%
7、),febrile neutropenia(2%),anorexia(7%),and stomatitis(5%).第六页，讲稿共十五页哦chemoradiationn nRTOG85-01 trial(randomized)5-Fu+DDP RT 5-Fu+DDP RT +RT +RT（50Gy50Gy）（60Gy60Gy）中位生存中位生存 14月 9 9月月 5 5年生存率 27%0n nINT0123 trialINT0123 trial 不同放疗剂量联合相同化疗方案，中位生存、2 2年生存率及局部复发率无统计学差异VS第七页，讲稿共十五页哦chemoradiation Abstract
8、 4034 Abstract 4034（2011 ASCO2011 ASCO）Phase II trial （JapanJapan）RTRT 30Gy/3wks+S1 80mg/m2/d d1-14 80mg/m2/d d1-14 DDP 70mg/m2 d8 70mg/m2 d8 S1 80mg/m2/d d1-14 DDPDDP 70mg/m2 d8 70mg/m2 d82wks later第八页，讲稿共十五页哦chemoradiationn nAbstract 4034 Abstract 4034（2011 ASCO2011 ASCO）Phase II trialPhase II tri
9、al（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 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，讲稿共十五页哦chemoradiationn nAbstract 4072 Abstract 4072（2
10、011 ASCO2011 ASCO）（FranceFrance）Chemoradiation with FOLFOX plus cetuximab in locally advanced cardia or esophageal cancer:Final results of a GERCOR phase II trial(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 1800mg/
11、m2/d1-2）第十页，讲稿共十五页哦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/undifferentiated 53
12、/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(28.4%),Most frequent grade 3-4 toxicities were:neutro
13、penia(28.4%),dysphagia-esophagitis(13.5%),rash(10.8%)and allergy dysphagia-esophagitis(13.5%),rash(10.8%)and allergy(8.9%).(8.9%).第十一页，讲稿共十五页哦Chemotherapy for metastatic diseasen nFluoropyrimidine/platinum-based first-line chemotherapy in Fluoropyrimidine/platinum-based first-line chemotherapy in me
14、tastatic esophageal squamous cell carcinoma:Prognostic metastatic esophageal squamous cell carcinoma:Prognostic factor analysis in 239 patientsfactor analysis in 239 patients（Abstract 4088Abstract 4088，韩国，韩国）n nXPXP与与FPFP方案方案 ORRORR，PFS,OS 无统计学差异n nECOG2,albumin level 3.5g/dL and weight loss(10%of t
15、he weight loss for 3 months)at the (10%of the weight loss for 3 months)at the time of chemotherapy were significantly associated time of chemotherapy were significantly associated with both with both worse PFS(P0.05)and OS(P0.05).worse PFS(P0.05)and OS(P0.05).第十二页，讲稿共十五页哦Target therapyn nToGA studyT
16、oGA study 曲妥珠单抗曲妥珠单抗+化疗化疗 VS 化疗在化疗在Her-2Her-2过表达的胃-食食管交界腺癌，管交界腺癌，OS OS 提高（提高（13.5 VS 11.1 13.5 VS 11.1 月）月）n nC225C225、特罗凯、贝伐单抗、特罗凯、贝伐单抗n nPhase II trial of Phase II trial of sorafenibsorafenib in esophageal(E)and in esophageal(E)and gastroesophageal junction(GEJ)cancer:gastroesophageal junction(GEJ)cancer:Response and protracted stable disease observed Response and protracted stable disease observed in adenocarcinoma in adenocarcinoma（abstract 4100abstract 4100）第十三页，讲稿共十五页哦研究方向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，讲稿共十五页哦感谢大家观看第十五页，讲稿共十五页哦