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N JMS JW L NV JMR N J b O UU NM KbN JPNL Vb RW J RNW R U LJUUb JM JWLNMN JPNJU LJWLN 1 N Na N RNWLN O MN J VNWO JMRJ R W WL U Pb ;C55D 3D CNPPR 7VRURJ
FWR d A N J R J CJMR N J RJ 3D ;C55D CNPPR 7VRURJ
6R N N 5RWcRJ ; R
6 % J 5UJ MRJ 9 WMNUUR
Purpose E N JU J N N NL R NUb N N JUU R JU AD MR NJ N O NN
R JU 68D JWM aRLR b RW J RNW R U LJUUb JM JWLNMN JPNJU LJWLN 75 WMN NW WN JMS JWL NV JMR N J b 5CE O UU NM Kb N JPNL Vb
BJ RNW f L J JL N R RLNJW 3PN - bNJ JWPN ) ./
8 UU )( V W JWPN - -9NWMN )) VJUN JWM ONVJUN
:R U Pb 36 1 (02 D551 -
E V U LJ R W 97 1((2 U N N JP 1 /2 VRM N JP 1 -
LE D JPN E 1 ) 2 E)1 ,
L D JPN (1 (+2 )1 .2 1 +
E D JPN ;;;3 ( E (1 (( 2 E) )1 ) ;;; 4 , E )1 ,;;4 . E 1 + 2 E) (1
N M JWM J N RJU ), J RNW ONVJUN JWM )) VJUN LJWMRMJ NM Kb N V U RMR LR URWJ b NJV
5CE O UU NM Kb N JPNL Vb KN NNW ) 0 JWM ) (+%
3UU RWLU MNM J RNW JM U LJUUb JM JWLNM MR NJ N L E E+ ( O JLRLJKM VRWJU N JP MRJPW NM R 796D JWM KR b JWM JPNM R 7FD 5E
O N L N JWM JKM VNW JWM (/8 869 B7E E5%
Target volume delineation
GTV includes visible primary tumor and pathological nodes (5E LJW B7E 7WM L b JWM 7FD%
CTV: area of subclinical involvement around GTV , defined with a radial expansion of 1-1,5 cm, and 3-5 cm longitudinally, along the length of esophagus and cardia. Including Elective lymph node stations. PTV: CTV + isotropic expansion of 0,6 – 1 cm
PTV
GTV CTV PTV
Planning and Delivery
CE J MNUR N NM RWP RW NW R b V M UJ NM JMRJ R W N J b ; CE R MROON NW NL WR N 1
M 5 ; CE NL WR N O (, J RNW - :NURLJU E V N J b O ( J RNW +RWP ; 35 - 56 e ; 35 )( 56
E N N L RKNM M N J +, , %+ 9b JMVRWR N NM RW ), )/ MJRUb O JL R W (%/ 9b O JL R W ( M N N L RKNM J UNJ 0, BEG
Trimodality treatment Chemotherapy was administered concurrently using platinum based regimen in association with fluoropyrimidine or taxanes. g 5R UJ RW ., ( VP V) W MJb ( JWM )0 8U JLRU ., ( VP V) L W RW RWO R W
N )+ MJRUb W MJb ( + JWM )0 ) , e MJb LbLUN%g BJLUR JaNU , VP V) W MJb ( 5J K UJ RW 3F5) W MJb ( HNNTUb O , NNT % Esophagectomy was performed in 20 patients; in 5 cases surgery was excluded because of disease progression, worsening of clinical conditions or patient refusal.
; N R 7 JPNL Vb
1 – year DFS: 94.4% 3 – year DFS: 74.4%
CN U
1 – year OS: 94.7% 3 – year OS: 63.3%
E N ORWJU JV UN RcN RWLU MNM ) J RNW L V UN NM RV MJUR b NJ VNW
Clinical response (cR) to NCRT was evaluated with esophagoscopy, CECT, EUS and
PET, if necessary, before surgery, comparing pre-NCRT data with those obtained post-
NCRT.
Partial or complete clinical response(cR) was achieved in 16 patients (80%).
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Pathologic response (pR) evaluation was performed by analyzing surgical specimens
and was achieved in 15 patients (75%). In particular pathological complete response
was obtained in 3 of them (15%).
CN U
! 1 patient (5%) experienced loco-regional failure and synchronous
distant metastases.
! 3 patients (15%) developed distant metastases
4 patients died (20%): 3 from esophageal cancer (15%) and 1 from
hematological toxicity related to chemotherapy (5%).
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