NCCN Guidelines for Patients® | Esophageal Cancer - page 66

66
NCCN Guidelines for Patients
®
: Esophageal Cancer
Version 1.2013
Part 6: Adenocarcinomas
This chart maps a possible third treatment course for
people healthy enough for surgery. Instead of having
surgery first, concurrent chemoradiation to cure the cancer
is recommended. The recommended chemotherapy
regimens for chemoradiation are:
Preferred regimens
• Cisplatin and fluoropyrimidine (5-FU or capecitabine)
• Oxaliplatin and fluoropyrimidine (5-FU or
capecitabine)
• Paclitaxel and carboplatin
Other regimens
• Paclitaxel and cisplatin
• Docetaxel and cisplatin
• Irinotecan and cisplatin
• Paclitaxel and fluoropyrimidine (5-FU or capecitabine)
• Docetaxel and fluoropyrimidine (5-FU or capecitabine)
How the tumor responds to treatment will be assessed
with 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 6.3 for follow-up testing. If you will receive
supportive care, read Part 6.5 next.
TNM scores
Primary treatment
Chemoradiation
Results
No signs of cancer
T1 – T4a disease
T4b or M1 disease
Adjuvant treatment
Supportive care
Esophagectomy, or
Supportive care
Option 3
Start follow-up testing
T2, N0, M0
T3, N0, M0
T4a, N0, M0
T1b, N+, M0
T2, N+, M0
T3, N+, M0
T4a, N+, M0
1...,56,57,58,59,60,61,62,63,64,65 67,68,69,70,71,72,73,74,75,76,...100
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