Carcinoma de esofago

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Dr. Luis M. Zetina Toache
Cancer Consultants GT

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  • Figure 2. Kaplan–Meier Plots of Estimated Overall 5-Year Survival. Panel A shows a Kaplan–Meier plot of the estimated overall 5-year survival among patients with esophageal or esophagogastric-junction cancer who underwent neoadjuvant chemoradiotherapy (CRT) followed by surgery (178 patients) or surgery alone (188), according to an intention-to-treat analysis. Panel B shows a Kaplan–Meier plot of the estimated overall 5-year survival among the 134 patients with adenocarcinoma (AC) treated with neoadjuvant chemoradiotherapy followed by surgery and the 141 treated with surgery alone, and the 41 patients with squamous-cell carcinoma (SCC) treated with chemoradiotherapy followed by surgery and the 43 treated with surgery alone, according to an intention-to-treat analysis. Other tumor types were excluded from this analysis.
  • Carcinoma de esofago

    1. 1. Carcinoma de Esofago Tratamiento Medico Dr. Luis Miguel Zetina Toache Oncología Medica Cáncer Consultants GT
    2. 2. Carcinoma de Esofago (Epidemiologia)
    3. 3. Cancer de Esofago Tratamiento MedicoADYUVANTE : TODO TRATAMIENTO ADMINISTRADO POSTERIOR A CIRUGIA EN BUSCA DE AUMENTAR SOBREVIDA GLOBAL Y SOBREVIDA LIBRE DE RECAIDANEO 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)
    4. 4. Tratamiento medico Cancer de EsofagoAdyuvante: RT vrs QT QT vrs RT vrs QT/RT NO TRATAMIENTO ADYUVANTENeo Adyuvante: RT vrs QT QT vrs RT vrs QT/RT NO TRATAMIENTO NEO ADY
    5. 5. EL PORQUE DEL TRATAMIENTONeoadjuvante/AdjuvanteVentajas 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 tratamiento Retrasa la cirugia Possibilidad de seleccionar clonas resistentes a drogas
    6. 6. RT NEO NO INDICADA RT/QT MEJOR QUE RT QT NEO MEJOR C SOLA?QT NEO MEJOR EN ADENO
    7. 7. Walsh et al Kaplan–Meier Plot of Survival of Patients with Esophageal Adenocarcinoma, According to the Intention- to-Treat Analysis.
    8. 8. Posted: 10/25/2011Guidelines for the Managementof Oesophageal and GastricCancerWilliam H Allum; Jane M Blazeby; S Michael Griffin; David Cunningham; Janusz AJankowski; Rachel Wong Gut. 2011;60(11):1449-1472 | © 2011 BMJ Publishing Group Ltd and British Society of Gastroenterology http://www.medscape.com/oncology
    9. 9. Guidelines. Esophageal CancerGut. 2011;60(11):1449-1472 RT neo adyuvante: RT PRE OP NO INDICADA 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) QT NEO ADYUVANTE STANDARD OF CARE PTE CON ADENOCARCINOMA ESO Y UGE
    10. 10. Guidelines. Esophageal CancerGut. 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 SCCYchou M, Boige V, Pignon J-P, et al. Perioperative chemotherapy compared with surgery alone forresectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol 2011;29:1751–21.
    11. 11. N Engl J Med 2012;366:2074-84.Copyright © 2012 Massachusetts Medical Society.
    12. 12. N Engl J Med 2012;366:2074-84.
    13. 13. 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.
    14. 14. Kaplan–Meier Plots of Estimated Overall 5-Year Survival. van Hagen P et al. N Engl J Med 2012;366:2074-2084.
    15. 15. 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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