NCCN Guidelines Index Esophageal Table of Contents Discussion

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines )

Esophageal and Esophagogastric Junction Cancers(Excluding the proximal 5cm of the stomach)Version 2.2011 IMPORTANT NOTE REGARDING LEUCOVORIN SHORTAGE, PLEASE SEE MS-25

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Version 2.2011, 05/13/11© National Comprehensive Cancer Network, Inc. 2011, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN®.

Printed by Umesh Reddy on 5/20/2011 5:38:49 AM. For personal use only. Not approved for distribution. Copyright© 2011 National Comprehensive Cancer Network, Inc., All Rights Reserved.

NCCN Guidelines Version 2.2011 Panel Members Esophageal and Esophagogastric Junction Cancers* Jaffer A. Ajani, MD/Chair ¤The University of Texas MD Anderson Cancer Center James S. Barthel, MD¤Þ H. Lee Moffitt Cancer Center& Research Institute David J. Bentrem, MD¶ Robert H. Lurie Comprehensive Cancer Center of Northwestern University Thomas A. D’Amico, MD¶ Duke Cancer Institute Prajnan Das, MD, MS, MPH§ The University of Texas MD Anderson Cancer Center Crystal Denlinger, MD Fox Chase Cancer Center Charles S. Fuchs, MD, MPH Dana-Farber/Brigham and Women’s Cancer Center Hans Gerdes, MD¤Þ Memorial Sloan-Kettering Cancer Center Robert E. Glasgow, MD¶ Huntsman Cancer Institute at the University of Utah James A. Hayman, MD, MBA§ University of Michigan Comprehensive Cancer CenterNCCN Lauren Gallagher, RPh, PhD Nicole McMillian, MS Hema Sundar, PhD

NCCN Guidelines Index Esophageal Table of Contents Discussion

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Esophageal Table of Contents Discussion

Assessment of treatment response Response of the primary tumor to previous chemotherapy or radiation therapy should be reported. Residual primary tumor in the resection specimen following neoadjuvant therapy is associated with shorter overall survival for both adenocarcinoma 4-6 and squamous cell carcinoma of the esophagus. 7 Although grading systems for tumor response in esophageal cancer have not been uniformly adopted, in general, three-category systems provide good reproducibility among pathologists. 6,8 The following system developed specifically for esophagus by Wu, et al 6 is reported to provide good interobserver agreement, but other systems such as the one 8 suggested by the CAP Cancer Protocol for Esophageal Carcinoma (available at ), may also be used. Sizable pools of acellular mucin may be present after chemoradiation but should not be interpreted as representing residual tumor. TABLE 2 Tumor Regression Grade 0 (Complete response) 1 (Moderate response) Wu et al Description No residual cancer cells 1% to 50% residual cancer; rare individual cancer cells or minute clusters of cancer cells More than 50% residual cancer cells, often grossly identifiable at primary site Ryan et al Description No cancer cells Single cells or small groups of cancer cells

2 (Minimal response)

Residual cancer cells outgrown by fibrosis Minimum or no treatment effect; extensive residual cancer

3 (Poor response)

ContinueNote: All recommendations are category 2A unless otherwise indicated. Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.Version 2.2011, 05/13/11© National Comprehensive Cancer Network, Inc. 2011, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN®.

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