Osteosarcopenia as a Predictor of Histopathologic Response to Neoadjuvant Chemoradiotherapy in Esophageal Cancer: a Retrospective Cohort Study

PURPOSE

Predicting chemoradiotherapy (CRT) response in esophageal cancer is essential as outcomes vary among patients. This study aimed to evaluate the impact of osteosarcopenia on the effectiveness of neoadjuvant CRT (NACRT).

METHODS

Ninety-five patients with advanced esophageal cancer who underwent surgical resection post-NACRT were included. Sarcopenia and osteopenia were determined using pre-NACRT skeletal muscle index and bone density at L3 and Th11 levels. Patients were categorized based on osteosarcopenia status.

RESULTS

Thirty-seven patients (39%) had osteosarcopenia. Among tumors, 49 (51.6%) were grade 1 (non-responders), 12 (12.6%) were grade 2, and 34 (35.8%) were grade 3 (responders). NACRT was significantly more effective in patients with above-median body mass index, shallow tumor depth, low squamous cell carcinoma antigen levels, and without osteosarcopenia. Osteosarcopenia was independently correlated with the histopathologic response to NACRT. No significant differences in overall or relapse-free survival were observed based on osteosarcopenia status.

CONCLUSION

Osteosarcopenia may predict NACRT response in esophageal cancer.

Successful thoracoscopic resection of an esophageal bronchogenic cyst

Esophageal bronchogenic cysts are rare, and since a limited number of cases has been reported, the treatment plan for asymptomatic patients is difficult. A 55-year-old man without any symptoms visited our hospital for further examination of an esophageal mass detected on simple computed tomography. Upper endoscopy showed the protruding, submucosal mass covered by normal mucosa, and endoscopic sonography confirmed hypoechoic lesions originating from the muscularis propria. The patient was diagnosed as having an esophageal duplication cyst and underwent thoracoscopic resection. Pathological findings were consistent with an esophageal bronchogenic cyst. The patient was discharged without any problems on the 6th postoperative day. Upper endoscopy was performed 6 months after surgery, and no evidence of esophageal diverticula or narrowing was present. In conclusion, early thoracoscopic resection of esophageal bronchogenic cysts, before appearance of the symptom, can be a considerable treatment option because it is less invasive and may be advantageous for obtaining a definitive diagnosis in patients who are candidates for safe surgical resection.

[A Case of Recurred Gastric Cancer of the Anastomosis Completely Responding to Docetaxel, Cisplatin, and S-1 Triplet Therapy]

A 51-year-old man who had undergone distal gastrectomy for gastric cancer was admitted in Kagoshima University Hospital under the diagnosis of anastomotic recurrence of gastric cancer. From abdominal CT results, the recurred tumor was suspected to invade into the pancreas with regional node metastases. Because of the intense radicality of surgical intervention, we planned 3 courses of docetaxel, cisplatin, and S-1 triplet therapy(DCS therapy). After the chemotherapy, the recurred tumor and lymph node metastases shrunk drastically. Segmental gastrectomy with lymph node dissection was performed with curative intent. Final pathology revealed complete regression of both the recurred tumor and lymph node metastases. The patient's postoperative course was uneventful without tumor relapse. DCS therapy seems to be suitable to obtain drastic tumor regression before surgical intervention as a neoadjuvant chemotherapy for locally advanced gastric cancer.

Clinical Outcomes of Fully Covered Self-expanding Metallic Stent Placement for Palliation of Incurable Esophageal Cancer With or Without Radiotherapy

BACKGROUND/AIM

A combination therapy of esophageal stent and chemoradiotherapy (CRT) is currently considered risky for severe complications. The aim of this study was to assess the safety and efficacy of a fully covered self-expandable metallic stent (FCSEMS) placement in palliating incurable esophageal cancer before and/or after CRT.

PATIENTS AND METHODS

We retrospectively reviewed clinical outcomes of 64 incurable advanced esophageal cancer patients with FCSEMS placement. Forty-two of 64 patients had FCSEMS placement with RT.

RESULTS

The rate of all of stent-related complications tended to be higher in patients who had RT, although no significant difference was observed. The stent-related deaths occurred in one patient due to hemorrhage after FCSEMS placement in the RT-negative group.

CONCLUSION

Palliation of dysphagia or fistulas with FCSEMS in patients with incurable esophageal cancer before and/or after RT is not associated with an increased risk of life-threatening complications.

Additional Effects of Docetaxel on Neoadjuvant Radiotherapy With Cisplatin/5-Fluorouracil for Esophageal Squamous Cell Carcinoma

BACKGROUND/AIM

To further improve the prognosis of locally advanced esophageal cancer patients, investigating new perioperative treatment strategies is necessary. The current study aimed to retrospectively investigate neoadjuvant radiotherapy with cisplatin and 5-fluorouracil (CF-RT) and radiotherapy with docetaxel and CF (DCF-RT) and compare their treatment outcomes in patients with locally advanced esophageal squamous cell carcinoma (ESCC).

PATIENTS AND METHODS

We retrospectively reviewed 95 patients with ESCC who received CF-RT or DCF-RT followed by esophagectomy. The CF-RT group received chemotherapy consisting of two courses of CF repeated every 4 weeks. The DCF-RT group received chemotherapy consisting of two courses of DCF repeated every 2 weeks. A radiotherapy dose of 1.8-2 Gy was administered per session, up to a total of 40-41.4 Gy. Adverse events of neoadjuvant chemoradiotherapy, surgical outcomes, pathological responses, prognosis, and recurrence patterns were evaluated.

RESULTS

Both the CF-RT and DCF-RT groups had equivalent pathological complete response rates of the primary tumor at 31.6% and 38.6%, respectively. However, the DCF-RT group had significantly better 5-year disease-free survival and 5-year overall survival than (HR=0.50, 95%CI=0.26-0.97, p=0.0392) than the CF-RT group.

CONCLUSION

DCF-RT may be a candidate neoadjuvant therapy for locally advanced ESCC.

[A Case of Advanced Gastric Cancer Showing Pathological Complete Response after Neoadjuvant Chemotherapy with S-1 and Oxaliplatin]

A 57-year-old woman was admitted to our hospital for treatment of gastric cancer presenting as a type 2 tumor in the lower third of the stomach. According to pre-therapeutic imaging examinations and laparoscopy, she was diagnosed with advanced gastric cancer, cT4a(SE)N2M0, Stage Ⅲ. Therefore, neoadjuvant chemotherapy was planned, and she received the SOX regimen. After 3 courses of chemotherapy, post-therapeutic imaging examinations showed that the primary gastric tumor and metastatic lymph nodes had reduced in size. We performed distal gastrectomy with D2 lymphadenectomy. Final pathological examinations demonstrated that no viable tumor cells remained in the resected stomach and dissected lymph nodes (Grade 3). SOX may be useful as neoadjuvant chemotherapy to improve prognosis in patients with advanced gastric cancer. Herein, we report a case of advanced gastric cancer with pathological complete response after neoadjuvant chemotherapy with the SOX regimen.