Carcinoma de esofago
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Dr. Luis Miguel Zetina Toache
Oncología Medica
Cáncer Consultants GT
Carcinoma de EsofagoTratamiento Medico
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Carcinoma de Esofago(Epidemiologia)
Carcinoma de Esofago(Epidemiologia)
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Cancer de EsofagoTratamiento MedicoCancer de EsofagoTratamiento Medico
ADYUVANTE : TODO TRATAMIENTO ADMINISTRADO POSTERIOR A CIRUGIA EN BUSCA DE AUMENTAR SOBREVIDA GLOBAL Y SOBREVIDA LIBRE DE RECAIDA
NEO ADYUVANTE: TODO TRATAMIENTO ADMINISTRADO PREVIO A CIRUGIA PARA AUMENTAR TASA DE CIRUGIA RO, MEJOR RESPUESTA, SVG Y SLR. (DA LA OPORTUNIDAD DE EVALUAR RESPUESTA A L TX)
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Tratamiento medicoCancer de Esofago
Adyuvante: RT vrs QT
QT vrs RT vrs QT/RT
NO TRATAMIENTO ADYUVANTE
Neo Adyuvante: RT vrs QT
QT vrs RT vrs QT/RT
NO TRATAMIENTO NEO ADY
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EL PORQUE DEL TRATAMIENTO Neoadjuvante/AdjuvanteEL PORQUE DEL TRATAMIENTO Neoadjuvante/Adjuvante
Ventajas En la mayoria de los casos el cancer de esofago YA es
una enfermedad sistemica al diagnostico.La cirugia sola es curativa solo en por pequeño grupo de
pacientes.El patron de recurrencia presenta recaida local y
sistemica.
Desventajas: Solo un 50 % de pacientes responde a tratamientoRetrasa la cirugiaPossibilidad de seleccionar clonas resistentes a drogas
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RT NEO NO INDICADART NEO NO INDICADA
RT/QT MEJOR QUE RT
QT NEO MEJOR C SOLA?
QT NEO MEJOR EN ADENO
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Walsh et al
Kaplan–Meier Plot of Survival of Patients with Esophageal Adenocarcinoma, According to the Intention-to-Treat Analysis.
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Guidelines for the Management of Oesophageal and Gastric Cancer
William H Allum; Jane M Blazeby; S Michael Griffin; David Cunningham; Janusz A Jankowski; Rachel Wong
Gut. 2011;60(11):1449-1472 |© 2011 BMJ Publishing Group Ltd and British Society of Gastroenterology
http://www.medscape.com/oncology
Posted: 10/25/2011
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Guidelines. Esophageal Cancer Gut. 2011;60(11):1449-1472
RT neo adyuvante:
Metaanalisis RT pre operatorio ptes con Ca. esofago resecable ( cualquier histologia), mejoria en 3-4% en SVG. (HR: 0.89, 95% CI, p=0.062
QT neoadyuvante: Trial 0E02 (802 ptes) QT vrs S. p= 0.004 (sva 2ª. 43%-34%) . Trial IS IG 0-113 no confirmatorio. Metaanalisis reciente confirman beneficio de QT pre op. Vrs S sola (HR 0.78. p=0.014)
RT PRE OP NO INDICADA RT PRE OP NO INDICADA
QT NEO ADYUVANTE STANDARD OF CAREPTE CON ADENOCARCINOMA ESO Y UGE
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Guidelines. Esophageal Cancer Gut. 2011;60(11):1449-1472
QT ADYUVANTE NO ESTA INDICADA EN PACIENTES CON CANCER DE ESOFAGO
META ANALISIS DE 1001 PTES EN 6 ESTUDIOS MO MOSTRO MEJORIA EN SOBREVIDA
LA MAYORIA DE ESTUDIOS CON SCC
Ychou M, Boige V, Pignon J-P, et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol 2011;29:1751–21.
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N Engl J Med 2012;366:2074-84.Copyright © 2012 Massachusetts Medical Society.
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N Engl J Med 2012;366:2074-84.Copyright © 2012 Massachusetts Medical Society.
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Characteristics of Patients with Resectable Esophageal or Esophagogastric-Junction Cancer, According to Treatment Group.
van Hagen P et al. N Engl J Med 2012;366:2074-2084.
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Kaplan–Meier Plots of Estimated Overall 5-Year Survival.
van Hagen P et al. N Engl J Med 2012;366:2074-2084.
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Adverse Events during Neoadjuvant Chemoradiotherapy and after Surgery.
van Hagen P et al. N Engl J Med 2012;366:2074-2084.
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