NCCN Guidelines for Patients® | Esophageal Cancer - page 48

NCCN Guidelines for Patients
: Esophageal Cancer
Version 1.2013
Part 5: Squamous cell carcinomas
This chart maps the treatment options for T4b
esophageal tumors. These tumors can’t be first treated
with surgery even if you are able to undergo surgery.
Instead, concurrent chemoradiation to cure the cancer
is recommended. If the tumor has invaded the trachea,
heart, or major blood vessels, chemotherapy alone may
be given. Chemotherapy regimens are listed in Part 5.5.
The recommended chemotherapy regimens for
chemoradiation are:
Preferred regimens
• Cisplatin and fluoropyrimidine (5-FU or capecitabine)
• Oxaliplatin and fluoropyrimidine (5-FU or
• Paclitaxel and carboplatin
Other regimens
• Paclitaxel and cisplatin
• Docetaxel and cisplatin
• Irinotecan and cisplatin
• Paclitaxel and fluoropyrimidine (5-FU or
• Docetaxel and fluoropyrimidine (5-FU or
How the tumor responds to treatment will be assessed by
a CT scan with contrast, PET/CT, or upper GI endoscopy.
These tests are described in Parts 2.1 and 3.1. If there
are no signs of cancer, you can start follow-up testing. If
cancer is found in or near the esophagus, then surgery
can be done. An esophagectomy is recommended.
Otherwise, supportive care can be started. Supportive
care is also recommended if tests show a T4b tumor or
M1 disease.
Next steps:
When you are finished with cancer
treatment, read Part 5.3 for follow-up testing. If
you will receive supportive care, read Part 5.5 next.
TNM scores
Primary treatment
Chemoradiation, or
T4b, N+, M0
Treatment results
No signs of cancer
T1 – T4a disease
T4b or M1 disease
Adjuvant treatment
Supportive care
Esophagectomy, or
Supportive care
T4b tumors
Start follow-up testing
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