Pogled internista onkologa na sistemsko zdravljenje raka požiralnika Treatment of oesophageal cancer from the medical oncologists’ point of view

Abstract

Ni abstrakta.

Abstract (Eng)

The incidence of carcinoma of the oesophagus in Slovenia is small and has not changed in years. The prognosis of patients with metastatic carcinoma of the oesophagus is poor, with less than 10% 5-year survival. In the early stages of the disease, we recommend surgical treatment in combination with neoadjuvant chemoradiation for squamous cell carcinoma or perioperative systemic chemotherapy for adenocarcinoma of the gastroesophageal junction. In locoregionally advanced carcinoma, we recommend neoadjuvant chemoradiation. In the case of cervical carcinoma of the oesophagus or in high-risk patients not fit for surgery, we recommend definitive chemoradiation. The most optimal systemic therapy for metastatic disease is selected based on the general state of the patient, his concurrent diseases, the expected toxicity of systemic therapy, and HER2 status in patients with adenocarcinoma. For first-line treatment, we recommend doublet chemotherapy, mainly due to a better toxicity profile. In the case of HER2-positive adenocarcinoma, doublet may be combined with trastuzumab. In patients who are in good general condition, we can try with a combination of three cytostatics. For patients in poor general condition, only palliative supportive care is recommended, since the benefit of such treatment outweighs the potential treatment complications. We are eagerly awaiting the results of the ongoing clinical trials of new combinations of cytostatics and targeted drugs, hoping for more effective combinations of drugs that would enable us to treat patients with metastatic carcinoma of the oesophagus and gastroesophageal junction more effectively