Definitive Chemo-radiotherapy for Esophageal Cancer;Failure….ppt

Definitive chemo-radiotherapyfor esophageal cancer;failure pattern and salvage treatmentsRyuta Koike, Y. Nishimura, K. Nakamatsu, S. Kanamori, M. Okubo, K. Hiroi, T. ShibataT. Nishikawa,H. Shiozaki*Department of Radiation Oncology and Surgery*, Kinki University School of Medicine?Failure pattern in definitivechemoradiotherapy (CRT) for esophageal cancer were analyzed to evaluate the appropriateness of our RT CharacteristicsFrom 1999 to 2006, 136 consecutive patients with esophageal cancer with localized esophageal cancer were treated with definitive CRT at our ;38 ~ 82 years old (median; 64 years)Gender; men:females =116:20PS 0/ 1/ 2 /3= 58/ 66/ 11/ 1Histology; 135 pts squamous cell carcinomas 1 pt adenocarcinomaStage; I:II:III: IV= 8:25:76: 27 (2002 ) T Factor T1:T2:T3:T4 =15:20:27:74, N Factor N0:N1 = 27:109Location of primary tumor: Ce: Ut: Mt: Lt = 19: 27: 71: 19Tumor length:1 ~ 19cm (median )Initial RT Fields according to the primary site?Cervical esophagus (Ce)Bilateral neck and subcarinal LNs (Short T-shaped Field)?Upper (Ut) and middle (Mt) esophagusBilateral neck and whole mediastinal LNs (T-shaped Field)?Lower esophagus (Lt)Whole mediastinal LNs and perigastric LNs (I-shaped Field)Initial RT FieldsCeUt, Mt LtRadiation and Chemotherapy?Radiationtherapy 60 Gy/30 fr/7 w (one-week split) for the both groups. Either a 6 MV or 10 MV X-ray was was given following 40 Gy.?Two courses of concurrent CT bined with RT Ⅰ、low-dose protracted pattern102 pts(75%)CDDP 7mg/m2×10 days5-FU 250-300mg/m2×14 daysⅡ、high-dose pattern 34 pts(25%)CDDP 70mg/m2×1 day5-FU 700mg/m2×5 daysAfter CRT, 1-2 courses of adjuvant CT of cisplatin/5-FU were given for 75 pts (55%).Results? A total dose of 60 Gy could be delivered for 133 pts (98%). ? 2 courses of planned CT could bined concurrently with RT for 118 pts (87%). ? Complete response(CR)in the RT field