Behandelmogelijkheden
Lokale behandeling
Resectabel en irresectabel oesofaguscarcinoom. lees meerLokale behandeling
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‘Locally advanced’ oesofaguscarcinoom of oesofagogastric junction tumor (cT1N1M0 of T2-3N0-1M0).
Neoadjuvante chemoradiotherapie met paclitaxel en carboplatin: “CROSS” (van Hagen 2012).
Behandelschema:
Paclitaxel 50 mg/m2 in 250 ml NaCl 0,9% in 1 uur en Carboplatin AUC = 2 in 250 ml gluc 5% in 1 uur. Intraveneuze infusie op dag 1, 8, 15, 22, en 29.Radiotherapeutische behandeling:
Totaal dosis van 41.4 Gy in 23 fracties van 1.8 Gy en 5 fracties per week, te starten op de eerste dag van de chemotherapie. -
‘Definitieve chemoradiatie’ (oncoline).
Bij irresectabele tumoren (locatie: cervicaal, histologie: plaveiselcelcarcinoom) en bij niet- operabele patient (KI<80, veel comorbiditeit): carboplatin/taxol vlgs cross maar dan gedurende 6 weken ipv 5.
Behandelschema
Paclitaxel 50 mg/m2 in 250 ml NaCl 0,9% in 1 uur en Carboplatin AUC = 2 in 250 ml gluc 5% in 1 uur. Intraveneuze infusie op dag 1, 8, 15, 22, 29 en 36.
Radiotherapeutisch behandeling
Totaal dosis van 50.4 Gy in 28 fracties van 1.8 Gy en 5 fracties per week, te starten op de eerste dag van de chemotherapie.
Gemetastaseerd oesofaguscarcinoom
lokaal recidief of metastasen: Her2Neu bepalen lees meerLiteratuur lokale behandeling
- van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. The New England journal of medicine. 2012;366(22):2074-84.
Literatuur gemetastaseerd oesofaguscarcinoom
Bang YJ, Van Cutsem E, Feyereislova A, Chung HC, Shen L, Sawaki A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet (London, England). 2010;376(9742):687-97.
Dijksterhuis WPM, Verhoeven RHA, Slingerland M, Haj Mohammad N, de Vos-Geelen J, Beerepoot LV, et al. Heterogeneity of first-line palliative systemic treatment in synchronous metastatic esophagogastric cancer patients: A real-world evidence study. Int J Cancer. 2019.
Cunningham D, Starling N, Rao S, Iveson T, Nicolson M, Coxon F, et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. The New England journal of medicine. 2008;358(1):36-46.
van Zweeden AA, van Groeningen CJ, Honeywell RJ, Giovannetti E, Ruijter R, Smorenburg CH, et al. Randomized phase 2 study of gemcitabine and cisplatin with or without vitamin supplementation in patients with advanced esophagogastric cancer. Cancer Chemother Pharmacol. 2018;82(1):39-48.
Wilke H, Muro K, Van Cutsem E, Oh SC, Bodoky G, Shimada Y, et al. Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW): a double-blind, randomised phase 3 trial. The Lancet Oncology. 2014;15(11):1224-35.
Shitara K, Doi T, Dvorkin M, Mansoor W, Arkenau HT, Prokharau A, et al. Trifluridine/tipiracil versus placebo in patients with heavily pretreated metastatic gastric cancer (TAGS): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2018;19(11):1437-48.
Janjigian Y, Shitara K, Moehler M et al. First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastrooesophageal junction and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial. Lancet. 2021