Updates in version 2.2018 of the NCCN guidelines for esophageal and esophagogastric junction cancers

Abstract

Comment Preferred Regimens provide by expert group were adjusted: (1) Fluorouracil and cisplatin was no longer the Preferred Regimen for Preoperative Chemoradiation and Perioperative Chemotherapy (recommended as the other regimens); (2) DCF modifications were no longer the Preferred Regimens for First-Line Therapy (recommended as the other regimens); (3) Pembrolizumab (For second-line or subsequent therapy for MSI-H or dMMR tumors) was recommended as the Preferred Regimen for Second-Line or Subsequent Therapy; (4) Ramucirumab for adenocarcinoma (category 1 for EGJ adenocarcinoma; category 2A for esophageal adenocarcinoma) was no longer the Preferred Regimen for Second-Line or Subsequent Therapy. Survivors who underwent esophagectomy are at particular risk for clinically relevant long-term health issues, especially GI-related issues, such as malnutrition, dysphagia, dumping syndrome, delayed gastric emptying, reflux, and fatigue, which have been shown to negatively impact survivors' quality of life. This update proposes the following specific management and monitoring solutions for esophageal cancer survivors: Weight monitoring and the nutritional status in patients with esophageal cancer who underwent surgery are important. Intervention by nutrition specialists is recommended. Treatment of postoperative complications, such as delayed gastric emptying, dumping syndrome, esophageal bile reflux, and dysphagia should be carefully considered, and nursing advice should also be provided. In patients who previously had hypertension, the blood pressure condition may be improved after weight loss. Therefore, blood pressure should be monitored, and the original antihypertensive regimen adjusted as appropriate. Patients who previously had diabetes and hyperlipidemia may also need similar adjustments. Complications caused by chemoradiotherapy, such as radiation-induced heart injuries and chemotherapy-induced neuropathy, should be managed. Patient's psychological and physical states should be evaluated. Healthy lifestyle: Specific advice on dietary habits, living habits, physical activities, smoking cessation, and alcohol abstinence is necessary.