LWBK1006-20 LWW-Govindan-Review December 12, 2011 19:4
240 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Reviewfollowed by surgery in squamous cancer indicate that improvement in
local control with the addition of surgery failed to improve survival.
These patterns of relapse suggest that any further improvement in overall
outcome for patients with esophageal cancer will be achieved through
advances in systemic therapy.Answer 20.1.8. The answer is D.
The addition of CT to PET improves sensitivity and specificity, which
translates into the detection of unsuspected metastatic disease (upstag-
ing) in approximately 15% of patients and refutation of suspected dis-
ease (downstaging) in 10% of patients, which leads to alteration of the
intended treatment plan in at least 20% of patients. Weber et al. demon-
strated that decreased FDG uptake significantly correlated with patholog-
ically confirmed response in patients treated with induction chemotherapy
before esophagectomy for esophageal adenocarcinoma.Answer 20.1.9. The answer is A.
The available data for postoperative adjuvant chemotherapy suggest a
possible prolongation of survival for patients who have had a poten-
tially curative (R0) resection and have lymph node-positive (N1) disease.
There are no data to indicate or suggest that administration of postoper-
ative adjuvant chemotherapy will prolong survival for patients who have
undergone a curative resection and have negative nodes (N0). Patients
who have positive margins of resection should be considered for postop-
erative radiation. Those who have had R0 resections but have regional
nodal metastases (stages IIB and III) should be enrolled in clinical trials
evaluating adjuvant therapies.Answer 20.1.10. The answer is B.
Stage IIA.Answer 20.1.11. The answer is B.
A large phase III trial comparing four chemotherapy arms including
epirubicin, cisplatin or oxaliplatin, and 5FU or capecitabine, showed
non-inferiority for oxaliplatin compared to cisplatin and capecitabine
compared to 5FU. In a planned comparison between EOX (epirubicin,
oxaliplatin and capecitabine) and ECF (epirubicin, cisplatin and 5FU), the
former was associated with a significant improvement in median overall
survival (11.2 vs. 9.9 months).Answer 20.1.12. The answer is D.
Although two of the five randomized trials demonstrated a survival advan-
tage for combined modality therapy, they are limited by small numbers
of patients. The efficacy of preoperative combined modality treatment
for patients with resectable esophageal cancer remains controversial. The
accumulated experience from phase II and III trials support all of the
statements listed here concerning chemoradiotherapy using cisplatin and