Oesophageal Flashcards
Oesophageal cancer
Staging
SCF to coeliac are regional nodes
Nodes 3 split staging
Surgeons can’t reach above aortic arch
3 stage oesophagectomy non standard to clear higher
Can clear down to coeliac axis. About L1. Can compromise kidneys.
Splenic nodes and common hepatic can’t reach with RT, surgically accessible.
EUS sensitive for T and N more than PET which is useful for metastasis.
Adenocarcinoma
Magic STO2 3 cycles ECX before and after 13% survival gain. High metastatic relapse
SCC
Higher localised relapse
No sandwich chemo- trimodality (carbo/paclitaxel - CROSS regime) 10% gain against surgery alone. R0 resection from 60 to 90%. 30% complete resection. Exclude tumour > 10cm
Mandard scale- fibrotic response to chemotherapy.
FLOT regimen upcoming- possibly replacing
NEOSCOPE criteria phase II adenocarcinoma. 8 cm criteria.
Cervical oesophagus
63-66 in 33 #. Cisplatin only 4 doses, 2 lead in.
vs. Definitive chemo rad
Her2 stomach and goj
ToGa trial
CPEX standard
Palliative EOX compared ECF compared. REAL2 trial. REAL3 panitumab worse as dropped doses of other chemotherapy.
<25% V20 lung oesophageal cancer
<35%
V40 <30
V30 < 40 heart dose in oesophageal.
44 Gy for canal plus halfcm point dose
40 Gy 1cc dose
V20 <25% kidney
V30 <50/60 %
