tailieunhanh - Carcinoma of the Esophagus - part 9

Đối với bệnh sớm, 85-01 RTOG thử nghiệm cho thấy rõ ràng là thấp hơn liều xạ trị kết hợp với hóa trị liệu là một phương pháp điều trị hiệu quả hơn so với xạ trị liều cao hơn một mình và đây là tiêu chuẩn điều trị [3,4]. Phát triển trong công nghệ xạ trị nói chung đã dẫn đến định nghĩa mục tiêu cải thiện cho phép chiếu xạ thực quản như | Chemotherapy and Radiotherapy in Esophageal Cancer 123 Year of diagnosis not age-standardized and period analysis Figure Five- and ten-year relative age-standardized survival for esophageal cancer patients aged 15-99 England and Wales 1971-2001. CRUK 2004 with permission 1 . although recent trials have shown at least equivalent activity with reduced toxicity with some new agents. Development of radiotherapy For early disease the RTOG 85-01 trial showed clearly that lower dose radiotherapy combined with chemotherapy was a more effective treatment than the higher dose radiotherapy alone and this is now standard treatment 3 4 . Developments in radiotherapy technology in general have led to improved target definition for esophageal irradiation as well as improved treatment delivery. The next anticipated step forward is the use of targeted radiosensitizing agents that will hopefully further widen the therapeutic window. No definitive randomized study has been published comparing surgery with chemoradiotherapy as the local modality of treatment. There remain therefore a significant number of patients for whom either surgery or chemoradiation might be indicated. Which treatment is chosen will often have more to do with local biases and available skills than with the evidence base. In each section of this chapter there is a review of evidence behind current best practice current controversies and promising areas of research. All members of the multidisciplinary team should have knowledge of the evidence that drives the decision-making process. 124 P. Harper and D. Landau Radical treatment Neoadjuvant chemotherapy The aim of using chemotherapy prior to surgery is twofold first to try and shrink the tumor prior to resection and so achieve higher complete resection rates and second to treat any potentially eradicable microscopic metastases as early as possible in order to improve overall survival. Current best practice In 2002 Urschel et al. performed a meta-analysis of .