CDDP. CDDP+5-FU+Radiation. 20 pathological. CR pathological PR NC PD. follow up. 106 rec RT-PCR PD NC. 106 rec CT MRI. Induction chemoradiotherapy:crt

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Eleanore Small
5 years ago
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1 CDDP+5-FU+Radiation 20 pathological CR 1-7 pathological CR pathological PR NC PD follow up T4 106 rec CT MRI CT / 62/ CDDP 5-FU CR PR NC rec RT-PCR 1 PD NC Induction chemoradiotherapy:crt 5FU CDDP Liniac 350mg/m2 7mg/m2 2Gy/day 1W 2W 3W 4W Induction chemotherapy:fap day1 day7 day28 5FU CDDP ADR 1000mg/day 70mg/m 2 30mg/m 2

2 34 3 CT CDDP+5-FU+Radiation 40Gy 66 CT UGI CR2/66 3 PR49/66 74 NC+PD 15/66 23 CR 2 Grade Grade3 7/35 20 Grade2 20/ Grade1 8/35 23 T4 20 CR CR+PR 5 40 NC+PD 3 Grade3 5 75Grade2 36Grade1 2 2 Grade3 2 p= Grade3 2 Grade / Grade3 30 grade 3 grade 2 grade 1 CR n= PR n= NC/PD n= p53 p53 SSCP-sequence 67 p53 DO7 Novocastra 1010 p / Grade3 SSCP-sequence p53 p Grade3 1 2

3 1 p53 p53 status IHC IHC grade n=15 grade n=19 grade n=33 n= p=0.071, wild type vs mutant by Mann-Whitney's U test 2 p53 mutation p53 status wild type mutant grade n=15 grade n=19 grade n=33 n= p 0.001, wild type vs mutant by Mann-Whitney's U test p-53 CyclinD1 8 s-vgef 9 10Bax 11microvessel density 12 methalothionein 13CDC25B 14 QOL CR 2 Grade2 PR 49 Grade Grade Grade NC/PD 15 Grade CT MRI 18 F-FDG PET 18 F-FDG SUVmax SUVmax 2.5 PET Grade2, 3 PET Grade0,1 3 SUVmax 2.5 PET - 18 F- FDG PET PETSUVmax 2.5 range: mm 2 median:180.0mm 2 Grade 0 1b 9/11 (82%) PETSUVmax 2.5 range:0 32.6mm 2 median:7.0mm 2 Grade 2/3 : 11/12 (92%)

4 76 Grade3 22 Grade Grade QOL QOL Grade3 4 CT FDG-PET CT PET

5 T4 pathological CR T4 CR pathological CR neoadjuvant adjuvant therapy CDDP+5-FU CDDP+5-FU+ADR FAP 1 T FAP LN CR 1 PR 13 NC 4 PD LN CR 27 PR 49 NC 60 PD n=0 8 1 n n n 2

6 2 1 Ultrafulex Covered Stent QOL Stent Stent Stent Stent T2 T2 T Ce M(-)&low risk sm2-t3 Th T4 M(+)&high risk N 3 N 4 N(+) N(-) CR CR PR NC CR follow Salvage Salvage Salvage follow

7 QOL QOL 1 Tsujinaka T, Shiozaki H, Kido Y, et al: Concurrent chemotherapy (5-fluorouracil and cisplatin) and radiation therapy for inoperable squamous cell carcinoma of the esophagus potentially followed by surgery. J Surg Oncol 58:50-56, Hsu CH, Yah KH, Lui LT, et al: Concurrent chemoradiotherapy for locally advanced esophageal cancer -a pilot study by using daily low-dosed cisplatin and continuous infusion of 5-fluorouracil. Anticancer Res 19: , Triboulet JP, Amrouni H, Guillem P, et al: Long term results of esophageal epidermoid cancers in complete remission after preoperative chemoradiotharapy. Ann Chir 52: , Heath EL, Burtness BA, Heitmiller RF, et al: Phase II evaluation of preoperative chemoradiation and postoperative adjuvant chemotherapy for squamous cell and adenocarcinoma of the esophagus. J Clin Oncol 18: , Posner MC, Gooding WE, Lew JI, et al: Complete 5-year follow-up of a prospective phase II trial of preoperative chemoradiotherapy for esophageal cancer. Surgery 130: , Hennequin C, Gayet B, Sauvanet A, et al: Impact on survival of surgery after concomitant chemoradiotherapy for locally advanced cancers of the esophagus. Int J Radiat Oncol Biol Phys 49: , Yano M, Inoue M, Shiozaki H, et al: Preoperative concurrent chemotherapy and radiation therapy followed by surgery for esophageal cancer. Ann Thorac Cardiovascul Surg, 8: , Samejima R, Kitajima Y, Yunotani S, et al: Cyclin D1 is a possible predictor of sensitivity to chemo radio therapy for esophageal squamous cell carcinoma. Anticancer Res 19: , Shimada H, Takeda A, Nabeya Y, et al: Clinical significance of serum vascular endothelial growth factor in esophageal squamous cell carcinoma. Cancer 92: , McDonnell CO, Hermay JH, Bouchier-Hayes DJ, et al: Effect of multimodality therapy on circulating vascular endothelial growth factor levels in patients with oesophageal cancer. Br J Cancer 88: , Ikeguchi M, Maeta M and Kaibara N: Bax expression as a prognostic marker of postoperative chemoradiotherapy for patients with esophageal cancer. Int J Mol Med 7: , Hironaka S, Hasebe T, Kamijo T, et al: Biopsy specimen microvessel density is a useful prognostic marker in patients with t(2-4) esophageal cancer treated with chemoradiotherapy. Clin Cancer Res 8: , Yamamoto M, Doki Y, Shiozaki H, et al: Evaluation of the histologic effect of chemoradiation therapy for squamous cell carcinomas of the esophagus by assessing morphologic features of surgical specimens. Dis Esophagus 13: , Miyata H, Doki Y, Yamamoto H, et al: Overexpression of CDC25B overrides radiation-induced G2- M arrest and results in increased apoptosis in esophageal cancer cells. Cancer Res 61: , Okamoto Y, Murakami M, Kuroda M, et al: Mismatched clinicopathological response after concurrent chemotherapy for thoracic esophageal cancer. Dis Esophagus 13:80-86, 2000

8 16 Beseth BD, Bedford R, Isacoff WH, et al: Endoscopic ultrasound does not accurately assess pathologic stage of esophageal cancer after neoajuvant chemoradiotherapy. Am Surg 66: , Kitamura K, Saeki H, Kawaguchi H, et al: Immunohistochemical status of the p53 protein and Ki-67 antigen using biopsied specimens can predict a sensitivity to neoadjuvant therapy in patients with esophageal cancer. Hepatogastroenterology 47: , 2000

Are we making progress? Marked reduction in operative morbidity and mortality

Are we making progress? Marked reduction in operative morbidity and mortality Are we making progress? Surgical Progress Marked reduction in operative morbidity and mortality Introduction of Minimal-Access approaches for complex esophageal cancer resections Significantly better functional