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Strader C, Groth SS. Perforated Esophageal Cancer. Thorac Surg Clin 2024; 34:377-383. [PMID: 39332862 DOI: 10.1016/j.thorsurg.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2024]
Abstract
Esophageal perforation in the setting of malignancy is a surgical emergency for which there is little direct evidence in the literature to guide treatment. Instead, treatment is based on a combination of our understanding of managing benign esophageal perforations and a contemporary understanding of the treatment and prognosis of esophageal cancer. Due to the numerous challenges of managing perforated esophageal cancer, incorporating clinicians with expertise in esophageal cancer, advanced endoscopy, and esophageal surgery into shared decision-making discussions with patients and their families is essential.
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Affiliation(s)
- Christopher Strader
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Shawn S Groth
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
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2
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Chen M, Huang Y, Zhang S, Zheng Y, Zeng T, Chen C, Zheng B. Camrelizumab in combination with chemotherapy versus concurrent chemoradiotherapy for the conversion of locally advanced unresectable oesophageal squamous carcinoma: protocol for a two-arm, open-label phase II trial. BMJ Open 2024; 14:e075421. [PMID: 38418234 PMCID: PMC10910487 DOI: 10.1136/bmjopen-2023-075421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 02/14/2024] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Oesophageal cancer (OC) has higher morbidity and mortality rate than most other malignancies. The standard treatment for unresectable locally advanced oesophageal squamous cell carcinoma (OSCC) is concurrent chemoradiotherapy, with tumour regression observed in a proportion of patients after treatment, but prognostic improvement remains limited. Immunotherapy in combination with chemotherapy (CT) has been shown to be efficacious as the first-line treatment of advanced OC and neoadjuvant therapy. Therefore, we conducted a prospective, two-arm, randomised, unblinded phase II study to explore the efficacy of camrelizumab in combination with CT versus chemoradiotherapy for the conversion of unresectable advanced OSCC. METHODS AND ANALYSIS All participants meeting the inclusion criteria will be enrolled after signing an informed consent form. Patients with clinically cT4b or spread to at least one group of lymph nodes with possible invasion of surrounding organs and unresectable locally advanced squamous carcinoma of the thoracic segment of the oesophagus will be included in the study. Patients with suspected distant metastases on the preoperative examination will be excluded from this study. Patients eligible for enrolment will be grouped by centre randomisation according to the study plan. Patients will undergo radical surgery after completion of two cycles of chemotherapy (CT) combined with camrelizumab induction therapy or concurrent chemoradiotherapy if assessed to be operable. Patients evaluated as inoperable will be scheduled for a multidisciplinary consultation to determine the next treatment option. The primary endpoint is the R0 resection rate in patients undergoing surgery after treatment. Secondary endpoints are the rate of major pathological remission, pathological complete response rate, overall survival, progression-free survival and adverse events for all patients. ETHICS AND DISSEMINATION Ethical approval was obtained from the ethics committees of Fujian Medical University Union Hospital (No. 2022YF039-02). The findings will be disseminated in peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT05821452.
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Affiliation(s)
- Maohui Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Yizhou Huang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Province University, Fuzhou, Fujian, China
| | - Shuliang Zhang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Province University, Fuzhou, Fujian, China
| | - Yixiong Zheng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Province University, Fuzhou, Fujian, China
| | - Taidui Zeng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Province University, Fuzhou, Fujian, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Province University, Fuzhou, Fujian, China
| | - Bin Zheng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- National Key Clinical Specialty of Thoracic Surgery, Fuzhou, China
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3
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Harino T, Yamasaki M, Murai S, Yamashita K, Tanaka K, Makino T, Saito T, Yamamoto K, Takahashi T, Kurokawa Y, Nakajima K, Tomiyama N, Eguchi H, Nakamura H, Doki Y. Impact of MRI on the post-therapeutic diagnosis of T4 esophageal cancer. Esophagus 2023; 20:740-748. [PMID: 37233847 DOI: 10.1007/s10388-023-01010-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/25/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Opportunities for T4b esophageal cancer patients to receive curative surgery are increasing with the development of multidisciplinary treatments. However, the best modality to accurately diagnose infiltration to the organs surrounding T4b esophageal cancer is still unknown. The aim of this study was to determine the performance of CT and MRI in diagnosing T stage in T4b esophageal cancer, with reference to the pathological diagnosis. METHODS A retrospective medical records review of patients with T4b esophageal cancer patients from January 2017 to December 2021 was conducted. Among 125 patients who were treated for cT4b esophageal cancer in Osaka University Hospital, 30 patients were diagnosed with cT4b esophageal cancer by CT, ycT staging with CT (contrast-enhanced images) and MRI (T2-FSE images), and curative R0 resection was performed. Preoperative MRI staging was independently performed by two experienced radiologists. The diagnostic performance of CT and MRI were examined using McNemar's test. RESULTS Nineteen and 12 patients were diagnosed with ycT4b by CT and MRI, respectively. Combined T4b organ resection was performed in 15 patients. A pathological diagnosis of ypT4b was made in 11 cases. In comparison to CT, MRI showed a higher diagnostic performance, specificity (47% vs. 89%, p = 0.013), and accuracy (60% vs. 90%, p = 0.015) for CT vs. MRI. CONCLUSIONS Our results-with reference to the pathological diagnosis-revealed that MRI had a superior diagnostic performance to CT for diagnosing T4b esophageal cancer invading the surrounding organs. An accurate diagnosis of T4b esophageal cancer may facilitate the implementation of appropriate treatment strategies.
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Affiliation(s)
- Takashi Harino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Makoto Yamasaki
- Department of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka, 573-1010, Japan.
| | - Sachiko Murai
- Department of Radiology, Saito Yukokai Hospital, Osaka, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takuro Saito
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kiyokazu Nakajima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | | | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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Teranishi R, Makino T, Tanaka K, Yamashita K, Saito T, Yamamoto K, Takahashi T, Kurokawa Y, Motoori M, Yamasaki M, Nakajima K, Eguchi H, Doki Y. Long-term survival and prognostic factors associated with curative conversion surgery for ct4b esophageal squamous cell carcinoma: Analysis of 200 consecutive cases. Surgery 2023; 174:558-566. [PMID: 37385868 DOI: 10.1016/j.surg.2023.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/27/2023] [Accepted: 05/24/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND The optimal treatment strategy for cT4b esophageal cancer has not been established yet. Although curative surgery is sometimes performed after induction treatments, the prognostic factor of cT4b esophageal cancer cases who underwent R0 resection remains unknown. METHODS A total of 200 patients with cT4b esophageal cancer who underwent R0 resection after induction treatments between 2001 and 2020 in our institute were included in the present study. The relationship between clinicopathological factors and patient survival is evaluated to identify useful prognostic factors. RESULTS The median and 2-year overall survival were 40.1 months and 62.8%, respectively. Disease recurrence occurred in 98 (49%) patients after surgery. Compared to induction chemotherapy alone, chemoradiation-based induction treatments were associated with decreased locoregional recurrence (34.0% vs 60.8%, P = .0077) but increased pulmonary metastases (27.7% vs 9.8%, P = .0210) and dissemination (19.1% vs 3.9%, P = .0139) after surgery. Multivariate analysis of overall survival identified the preoperative C-reactive protein/albumin ratio (hazard ratio 1.7957, P = .0031), response to induction treatments (hazard ratio 2.9663, P = .0009), postoperative pneumonia (hazard ratio 2.3784, P = .0010), and pN (2-3) (hazard ratio 1.5693, P = .0355) as independent prognostic factors. Preoperative C-reactive protein/albumin ratio (hazard ratio 1.6760, P = .0068) and postoperative pneumonia (hazard ratio 1.8365, P = .0200) were also independent prognostic factors for recurrence-free survival. CONCLUSION Curative surgery after induction therapy for cT4b esophageal cancer achieved favorable survival. Preoperative C-reactive protein/albumin ratio, postoperative pneumonia, response to induction treatments, and pN were useful prognostic factors.
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Affiliation(s)
- Ryugo Teranishi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Japan.
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Japan
| | - Takuro Saito
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Japan
| | | | - Makoto Yamasaki
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | - Kiyokazu Nakajima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Japan
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Yamasaki M, Miyata H, Yamashita K, Hamakawa T, Tanaka K, Sugimura K, Makino T, Takeno A, Shiraishi O, Motoori M, Kimura Y, Hirao M, Fujitani K, Yasuda T, Yano M, Eguchi H, Doki Y. Chemoradiotherapy versus triplet chemotherapy as initial therapy for T4b esophageal cancer: survival results from a multicenter randomized Phase 2 trial. Br J Cancer 2023; 129:54-60. [PMID: 37142731 PMCID: PMC10307786 DOI: 10.1038/s41416-023-02286-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND We report the long-term results as primary endpoint in a multicentre randomized prospective Phase 2 trial which compared chemoradiotherapy (CRT) and triplet chemotherapy (CT) as the initial therapy for conversion surgery (CS) in T4b esophageal cancer (EC). METHODS Patients with T4b EC were randomly assigned to the CRT group or CT group as initial treatment. CS was performed if resectable after initial or secondary treatment. The primary endpoint was 2-year overall survival, analysed by intention-to-treat. RESULTS The median follow-up period was 43.8 months. The 2-year survival rate was higher in the CRT group (55.1%; 95% CI: 41.1-68.3%) compared to the CT group (34.7%; 95% CI: 22.8-48.9%), although the difference was not significant (P = 0.11). Local and regional lymph node recurrence in patients undergoing R0 resection was significantly higher in the CT group compared to the CRT group (local: 30% versus 8%, respectively, P = 0.03; regional: 37% versus 8%, respectively, P = 0.002). CONCLUSIONS Upfront CT was not superior to upfront CRT as induction therapy for T4b EC in terms of 2-year survival and was significantly inferior to upfront CRT in terms of local and regional control. REGISTRATION The Japan Registry of Clinical Trials (s051180164).
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Affiliation(s)
- Makoto Yamasaki
- Department of Surgery, Kansai Medical University, Hirakata, Osaka, Japan.
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
| | - Hiroshi Miyata
- Department of Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takuya Hamakawa
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | | | - Tomoki Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Atsushi Takeno
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Osamu Shiraishi
- Department of Surgery, Kindai University Faculty of Medicine, Osaka Sayama, Osaka, Japan
| | - Masaaki Motoori
- Department of Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yutaka Kimura
- Department of Surgery, Kindai University Faculty of Medicine, Osaka Sayama, Osaka, Japan
| | - Motohiro Hirao
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | | | - Takusi Yasuda
- Department of Surgery, Kindai University Faculty of Medicine, Osaka Sayama, Osaka, Japan
| | - Masahiko Yano
- Department of Surgery, Suita Municipal Hospital, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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6
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Petric J, Handshin S, Bright T, Watson DI. Planned oesophagectomy after chemoradiotherapy versus salvage oesophagectomy following definitive chemoradiotherapy: a systematic review and meta-analysis. ANZ J Surg 2022; 93:829-839. [PMID: 36582046 DOI: 10.1111/ans.18225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/05/2022] [Accepted: 12/11/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Oesophageal cancer is the eighth most common cancer and sixth leading cause of cancer-related mortality worldwide. Salvage oesophagectomies are associated with an increased risk of mortality, although recent data suggests that long-term survival rates following salvage oesophagectomy are similar to planned oesophagectomy. The aim was therefore to meta-analyse outcomes for patients undergoing salvage versus planned oesophagectomies to assess the differences in short-term mortality and long-term survival. METHODS A systematic review of Medline, Scopus, Web of Science and PubMed was performed to identify relevant studies. Data were extracted and compared by meta-analysis, using odds ratio and mean differences with 95% confidence intervals. RESULTS Nineteen studies meeting inclusion criteria were included in the meta-analysis, which compared patients in the planned oesophagectomy group (n = 23 555) to patients in the salvage oesophagectomy group (n = 2227). There were significant differences between the groups in terms of rates of postoperative mortality (5.7% salvage oesophagectomy versus 3.1% planned oesophagectomy, P = 0.0004), anastomotic leak (20.6% salvage oesophagectomy versus 14.5% planned oesophagectomy, P < 0.00001), pulmonary complications (37.1% salvage oesophagectomy versus 24.2% planned oesophagectomy, P < 0.0001) and R0 margin (87.6% salvage oesophagectomy versus 91.3% planned oesophagectomy, P < 0.0001). There was no statistical difference between long-term survival rates at 5 years with 39.2% for salvage and 42.6% for planned oesophagectomy (P = 0.28). CONCLUSIONS Salvage oesophagectomies do offer a meaningful chance of long-term survival (at 5 years) for select patients with oesophageal cancer, but the elevated risk of post-operative complications and mortality following salvage oesophagectomy should be recognized.
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Affiliation(s)
- Josipa Petric
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Samuel Handshin
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Tim Bright
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - David I Watson
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Higuchi T, Shoji Y, Koyanagi K, Tajima K, Kanamori K, Ogimi M, Yatabe K, Ninomiya Y, Yamamoto M, Kazuno A, Nabeshima K, Nakamura K. Multimodal Treatment Strategies to Improve the Prognosis of Locally Advanced Thoracic Esophageal Squamous Cell Carcinoma: A Narrative Review. Cancers (Basel) 2022; 15:10. [PMID: 36612007 PMCID: PMC9817845 DOI: 10.3390/cancers15010010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/17/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Esophageal cancer is the seventh most common malignancy and sixth most common cause of cancer-related death globally. Esophageal squamous cell carcinoma (ESCC) with aortic or tracheal invasion is considered unresectable, and has an extremely poor prognosis; its standard treatment is definitive chemoradiotherapy (dCRT). In recent years, induction chemotherapy (ICT) has been reported to yield high response rates for locally advanced ESCC, and the efficacy and safety of ICT followed by conversion surgery (CS) have been investigated. Multimodal treatment, combining surgery with induction chemoradiotherapy (ICRT) or ICT, is necessary to improve ESCC prognosis. CS is generally performed for locally advanced ECC after ICRT or ICT when tumor downstaging is achieved, although its prognostic benefit remains controversial. The Japan Clinical Oncology Group (JCOG) has conducted a three-arm phase III randomized controlled trial (JCOG1510) to confirm the superiority of DCF (docetaxel, cisplatin, and 5-fluorouracil) ICT, over conventional dCRT, among patients with initially unresectable ESCC. In recent years, researchers have reported favorable outcomes of induction therapy followed by CS and salvage surgery, after dCRT or systemic immunochemotherapy. In this review, we will describe the latest developments in the multimodal treatment including chemotherapy, CRT, surgery, and immunotherapy, which may improve oncological and survival outcomes for patients with cT4 ESCC.
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Affiliation(s)
| | | | - Kazuo Koyanagi
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 259-1193, Japan
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Wang S, Zhang C, Wang Y, Luo K, Yang Y, Yang Y, Liu S, Li Q, Xi M. Risk factors and prognosis for esophageal fistula in patients with esophageal squamous cell carcinoma during radiotherapy. Esophagus 2022; 19:660-669. [PMID: 35419642 DOI: 10.1007/s10388-022-00919-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/23/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE To determine risk factors, treatment outcomes, and prognostic factors for esophageal fistula (EF) in patients with esophageal squamous cell carcinoma (ESCC) during radiotherapy. METHODS Between 2010 and 2018, 109 patients with EF during radiotherapy were retrospectively collected. A controlled cohort including 416 patients who received definitive chemoradiotherapy without EF was used to compare risk factors and survival outcomes. Univariate and multivariate logistic regression analyses were performed to identify predictors of EF. Propensity score matching (PSM) was applied to adjust for potential confounding factors. RESULTS Multivariate analysis demonstrated that sex, body mass index, alcohol history, esophageal ulceration, primary tumor length, T stage, and absolute lymphocyte count were independent risk factors for EF. After PSM, patients with EF showed remarkably worse prognosis than those without EF (median overall survival: 13.0 versus 20.5 months; P = 0.009). For patients with EF, serum albumin level (≥ 35 g/L), subsequent radiotherapy, and fistula closure were associated with significantly prolonged survival. In addition, esophageal-mediastinum fistula and subsequent radiotherapy were positive predictors for fistula closure. CONCLUSIONS We identified risk factors for radiotherapy-related EF and its unfavorable prognosis in patients with ESCC. Of them, patients with serum albumin level of ≥ 35 g/L, subsequent radiotherapy after EF, and fistula closure had a more favorable survival.
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Affiliation(s)
- Sifen Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Guangzhou, China
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, 510060, China
| | - Chao Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Guangzhou, China
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yuting Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Guangzhou, China
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, 510060, China
| | - Kongjia Luo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Guangzhou, China
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yuxian Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Guangzhou, China
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, 510060, China
| | - Yadi Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Guangzhou, China
- Department of Imaging Diagnosis and Interventional Center, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Shiliang Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Guangzhou, China
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, 510060, China
| | - Qiaoqiao Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Guangzhou, China.
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, 510060, China.
| | - Mian Xi
- State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Guangzhou, China.
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, 510060, China.
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9
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Lee CC, Soon YY, Vellayappan B, Ho F, Tey JCS. Survival rates and safety associated with chemoradiotherapy followed by surgery and chemoradiotherapy alone for patients with T4 esophageal cancer: a systematic review and meta-analysis. Acta Oncol 2022; 61:738-748. [PMID: 35450511 DOI: 10.1080/0284186x.2022.2062680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The optimal treatment approach for T4 esophageal cancer is not well established. We aimed to perform a systematic review and meta-analysis to determine the survival rates and safety of chemoradiotherapy followed by surgery (CRT-S) and chemoradiotherapy alone (CRT) in patients with T4 Nany M0 esophageal cancer. MATERIALS AND METHODS We searched databases for eligible prospective or retrospective studies. The outcomes of interest were overall survival (OS) at 1, 3 and 5 years, treatment-related fistula formation and mortality rates. Meta-analyses were performed using the random effects models separately for studies evaluating CRT-S and CRT. Subgroup analyses were performed based on histology, radiation dose, chemotherapy regimen and duration of the interval between CRT and surgery. RESULTS We identified 23 studies including 1,119 patients with predominantly squamous cell carcinoma (93%) and adenocarcinoma (3%) histology. The OS rates of patients receiving CRT-S were 65%, 36% and 20% at 1, 3 and 5 years, respectively. The OS rates of patients receiving CRT were 30%, 11% and 10% at 1, 3 and 5 years, respectively. Treatment-related fistula formation rates were 4% for CRT-S and 9% for CRT. Treatment-related mortality rates were 3% for both groups. Subgroup analyses showed that the interval of >2 months between CRT and surgery was associated with significantly improved OS rates at 1, 3 and 5 years. CONCLUSION Chemoradiotherapy is an efficacious treatment approach for T4 esophageal cancer, with clinically acceptable rates of treatment-related fistula formation and mortality. Tri-modality approach with surgery can be considered in carefully selected patients. Our study findings should be interpreted with caution due to the lack of high-quality evidence. Randomized controlled trials are warranted to confirm these findings.
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Affiliation(s)
- Chia Ching Lee
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore; National University Hospital, Singapore, Singapore; National University Health System, Singapore, Singapore; National University of Singapore, Singapore, Singapore
| | - Yu Yang Soon
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore; National University Hospital, Singapore, Singapore; National University Health System, Singapore, Singapore; National University of Singapore, Singapore, Singapore
| | - Balamurugan Vellayappan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore; National University Hospital, Singapore, Singapore; National University Health System, Singapore, Singapore; National University of Singapore, Singapore, Singapore
| | - Francis Ho
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore; National University Hospital, Singapore, Singapore; National University Health System, Singapore, Singapore; National University of Singapore, Singapore, Singapore
| | - Jeremy C. S. Tey
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore; National University Hospital, Singapore, Singapore; National University Health System, Singapore, Singapore; National University of Singapore, Singapore, Singapore
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10
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Yamada K, Nohara K, Enomoto N, Wake H, Yagi S, Terayama M, Kato D, Yokoi C, Kojima Y, Nakayama H, Kokudo N. Surgical strategies for treatment of clinical T4 esophageal cancer in Japan. Glob Health Med 2021; 3:371-377. [PMID: 35036618 PMCID: PMC8692096 DOI: 10.35772/ghm.2020.01090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/29/2021] [Accepted: 05/10/2021] [Indexed: 05/14/2023]
Abstract
Definitive chemoradiation (dCRT) is the mainstay treatment for cStage IVa esophageal squamous cell carcinoma (ESCC) with good performance status (PS), according to standard practice guidelines. Salvage surgery may incur operation complications and risk of mortality. According to the esophageal cancer practice guidelines outlined by the Japan Esophageal Society, when a tumor is residual and recurrent, chemotherapy and palliative symptomatic treatment is continued. However, salvage operation has been selected as a therapeutic option for recurrent or residual tumors after dCRT. There is weak evidence for not recommending surgery for cStage IVa ESCC exhibiting residual disease following dCRT. It has been reported that during salvage surgery the only prognostic factor that is thought to be performed is complete resection (R0), but at the same time, salvage esophagectomy increases the incidence of postoperative complications and mortality. The phase II chemoselection study by Yokota T et al. in Japan showed that multidisciplinary treatment initiated by induction therapy, in which docetaxel is added to cisplatin and 5-fluorouracil, resulted in a good prognosis in the short term. In this review, we discuss the surgical strategy and future of unresectable clinical T4 (cT4) ESCC.
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Affiliation(s)
- Kazuhiko Yamada
- Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
- Address correspondence to:Kazuhiko Yamada, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. E-mail:
| | - Kyoko Nohara
- Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Naoki Enomoto
- Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hitomi Wake
- Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Syusuke Yagi
- Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masayoshi Terayama
- Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Daiki Kato
- Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Chizu Yokoi
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasushi Kojima
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hidetsugu Nakayama
- Department of Radiation Therapy, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norihiro Kokudo
- Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
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11
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Multicenter Randomized Phase 2 Trial Comparing Chemoradiotherapy and Docetaxel Plus 5-Fluorouracil and Cisplatin Chemotherapy as Initial Induction Therapy for Subsequent Conversion Surgery in Patients With Clinical T4b Esophageal Cancer: Short-term Results. Ann Surg 2021; 274:e465-e472. [PMID: 33065643 DOI: 10.1097/sla.0000000000004564] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We conducted a multicenter randomized prospective phase 2 trial of chemoradiotherapy (CRT) versus chemotherapy (CT) as initial induction therapy for conversion surgery (CS) in clinical T4b esophageal cancer. We compared treatment effects and adverse events (AEs). SUMMARY BACKGROUND DATA Although induction followed by CS is potentially curative for T4b esophageal cancer, the optimal initial induction treatment is unclear. METHODS Ninety-nine patients with T4b esophageal cancer were randomly allocated to chemoradiotherapy (Group A, n = 49) or CT (Group B, n = 50) as initial induction treatment. CRT consisted of radiation (50.4 Gy) with cisplatin and 5-fluorouracil. CT consisted of 2 cycles of docetaxel plus cisplatin and 5-fluorouracil (DCF). CRT or CT was followed by CS if resectable. If unresectable, the patient received the other treatment as secondary treatment. CS was performed if resectable after secondary treatment. The primary end point was 2-year overall survival. RESULTS In Group A, CS was performed in 34 (69%) and 7 patients (14%) after initial and secondary treatment. In Group B, CS was performed in 25 (50%) and 17 patients (34%) after initial and secondary treatment. The R0 resection rate after initial and secondary treatment was similar (78% vs 76%, P = 1.000). AEs including leukopenia, neutropenia, febrile neutropenia, and diarrhea were significantly more frequent in Group B. Group A had better histological complete response of the primary tumor (40% vs 17%, P = 0.028) and histological nodal status (P = 0.038). CONCLUSION Upfront CRT was superior to upfront CT in terms of pathological effects and AEs. The Japan Registry of Clinical Trials (s051180164).
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12
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Li CC, Chen CY, Chou YH, Huang CJ, Ku HY, Chien CR. Chemotherapy alone versus definitive concurrent chemoradiotherapy for cT4b esophageal squamous cell carcinoma: a population-based study. BMC Gastroenterol 2021; 21:153. [PMID: 33827451 PMCID: PMC8028221 DOI: 10.1186/s12876-021-01742-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background The role of radiotherapy for cT4bNanyM0 esophageal squamous cell carcinoma (ESqCC) is relatively unclear, with both chemotherapy (C/T) alone and definitive concurrent chemoradiotherapy (dCCRT) being treatment options in the current guidelines. We aimed to compare the survival of dCCRT versus C/T for these patients via a population-based approach. Methods Eligible cT4b ESqCC patients diagnosed between 2011 and 2017 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance the observable potential confounders between groups. The hazard ratio (HR) of death and incidence of esophageal cancer mortality (IECM) were compared between dCCRT and C/T. We also evaluated OS in subgroups of either low or standard radiotherapy doses. Results Our primary analysis consisted of 247 patients in whom covariates were well balanced after PS weighing. The HR for death when dCCRT was compared with C/T was 0.36 (95% confidence interval 0.24–0.53, P < 0.001). Similar results were found for IECM. Statistical significance was only observed in the standard RT dose but not in the low dose in subgroup analyses. Conclusions In this population-based nonrandomized study of cT4bNanyM0 ESqCC patients from Asia (Taiwan), we found that the use of radiotherapy with chemotherapy was associated with better overall survival than chemotherapy alone. Further studies (especially RCTs) are needed to confirm our findings. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-01742-4.
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Affiliation(s)
- Chia-Chin Li
- Department of Radiation Oncology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Chih-Yi Chen
- Division of Thoracic Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ying-Hsiang Chou
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan.,Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chih-Jen Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsiu-Ying Ku
- National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan.,Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Chun-Ru Chien
- Department of Radiation Oncology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan. .,Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan. .,School of Medicine, College of Medicine, China Medical University, No. 91 Hsueh-Shih Road, North District, Taichung, 40402, Taiwan.
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13
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High incidence of esophageal fistula on patients with clinical T4b esophageal squamous cell carcinoma who received chemoradiotherapy: A retrospective analysis. Radiother Oncol 2021; 158:191-199. [PMID: 33667583 DOI: 10.1016/j.radonc.2021.02.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/09/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Despite definitive chemoradiotherapy (CRT) being a recommended therapeutic method for patients with T4b esophageal squamous cell carcinoma (ESCC), treatment response and complications remain unclear. Esophageal fistula is a severe CRT-related complication when treating locally advanced ESCC, but data on risk factors that lead to esophageal fistula formation are limited. The aim of this analysis is to characterize the outcomes of T4b ESCC treated by CRT and investigate the risk factors of esophageal fistula. MATERIALS AND METHODS We retrospectively analyzed 136 patients with clinically unresectable T4b ESCC who were treated with CRT. Response, survival, and complication rates, particularly the rate of esophageal fistula and its associated risk factors were analyzed. RESULTS The median progression-free survival and overall survival (OS) of all patients were 7.9 (95% confidence interval [CI]: 6.1-9.7) and 12.2 months (95% [CI]: 8.9-15.4), respectively. The Kaplan-Meier curves showed that the 3- and 5-year OS rates were 29.9% and 20.2%, respectively. The incidence rate of esophageal fistulas was 30.1%. The median OS for patients with esophageal fistula was only 6.9 (95%[CI] = 6.0-7.8) months. The risk for developing esophageal fistulas was significantly high for ulcerative-type tumors (odds ratio [OR] = 3.202; 95%[CI] = 1.036-7.850, P = 0.011) and for those invading the bronchus/trachea (OR = 3.378; 95%[CI] = 1.223-9.332, P = 0.048). CONCLUSION We demonstrated that CRT for T4b ESCC patients has a curative potential, despite a high incidence of esophageal fistula, which was the main cause of treatment failure. The higher risk for fistula formation were tumors with ulceration or bronchus/trachea invasion.
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14
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Cho S. Fistulas between the Esophagus and Adjacent Vital Organs in Esophageal Cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:211-216. [PMID: 32793454 PMCID: PMC7409885 DOI: 10.5090/kjtcs.2020.53.4.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 11/16/2022]
Abstract
Esophageal fistulas may occur in an advanced stage or as a potentially life-threatening complication of treatment. They can be divided into esophageal-respiratory and esophageal-aorta fistulas. The diagnosis is confirmed with fluoroscopy using dilute barium oral contrast, followed by thin-section computed tomography, which defines the precise location and extent of the fistula. Flexible esophagoscopy and bronchoscopy are required for confirmation and anatomic assessment of the suspected fistula and provide additional information for treatment planning. Contamination is traditionally controlled by surgical exclusion, along with a jejunal feeding tube. Currently, fully covered self-expanding metal stents are the primary treatment option.
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Affiliation(s)
- Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
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15
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The Pattern of Residual Tumor After Neoadjuvant Chemotherapy for Locally Advanced Esophageal Cancer and Its Clinical Significance. Ann Surg 2020; 271:875-884. [PMID: 30829694 DOI: 10.1097/sla.0000000000003129] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To investigate the residual pattern of esophageal cancer in the esophageal wall after neoadjuvant chemotherapy (NAC) and its clinical significance. BACKGROUND NAC is a standard treatment for locally advanced esophageal cancer; however, residual tumor patterns in resected specimens after NAC and their clinico-pathological characteristics remain unknown. METHODS One hundred twenty consecutive patients with cT3 or deeper esophageal cancer underwent curative esophagectomy after NAC and achieved grade 2 histological responses between 2000 and 2016. Hematoxylin-eosin staining of residual tumor sections revealed 4 remnant categories: Type 1: shallow, Type 2: central, Type 3: deep, and Type 4: diffuse. We examined associations between these Types and clinico-pathological factors, including prognosis. RESULTS Forty-five (38%) specimens had no residual tumor cells in the mucosal layer. The adventitia layer displayed the lowest residual tumor cell frequency (18%) among all layers. Types 1, 2, 3, and 4 residual tumor patterns were found in 49 (41%), 33 (28%), 9 (8%), and 29 (24%) patients, respectively. Type 4 showed the maximum standard uptake value after NAC; Types 3 and 4 had higher ratios of venous invasion than Type 1 or 2. Patients with Type 3 or 4 more frequently developed pleural dissemination or distant metastasis than patients with Type 1 or 2. Survival was similar among the 4 Types. CONCLUSIONS After NAC for locally advanced esophageal cancer, the shallow residual tumor pattern was most common, but approximately 40% of specimens showed no tumor cells in the mucosal layer. Deep and diffuse remnant patterns were associated with high risks of pleural dissemination and distant metastasis.
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16
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Yamasaki M, Yamashita K, Saito T, Tanaka K, Makino T, Miyazaki Y, Takahashi T, Kurokawa Y, Nakajima K, Motoori M, Kimura Y, Mori M, Doki Y. Tracheal resection and anterior mediastinal tracheostomy in the multidisciplinary treatment of esophageal cancer with tracheal invasion. Dis Esophagus 2020; 33:5735623. [PMID: 32055845 DOI: 10.1093/dote/doz101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/04/2019] [Indexed: 12/11/2022]
Abstract
Combined tracheal resection and anterior mediastinal tracheostomy (AMT) for esophageal cancer with tracheal invasion is a challenging treatment because of its high morbidity and the lack of evidence regarding long-term outcomes. The aim of this study was to assess the short- and long-term outcomes of AMT as part of the multidisciplinary treatment for esophageal cancer with tracheal invasion. This retrospective study included 27 consecutive patients with esophageal cancer with tracheal invasion who underwent combined tracheal resection and AMT in their multidisciplinary treatment for esophageal cancer. We evaluated postoperative complications, body weight loss, and survival and examined the prognostic value of preoperative factors. All patients underwent chemotherapy and/or chemoradiotherapy as prior treatment. R0 resection was achieved in all cases. Clavien-Dindo grade I or greater complications occurred in 17 patients (63%), and grade III or greater complications occurred in 12 (44%). Overall in-hospital mortality was 4%, with one patient dying on postoperative day 48 when the brachiocephalic artery ruptured from tracheal compression. The 30- and 90-day mortality rates were 0% and 4%, respectively. Median weight change in patients without recurrence in the year after surgery was -1.7% (-9.6-21%). All of these patients received nutrition by oral intake and were living independently at home without public assistance. The 3- and 5-year disease-free survival rates were 25.9% and 18.5%, respectively; 3- and 5-year overall survival rates were 38.6% and 25.7%, respectively. Multivariate analysis identified response to prior treatment as an independent prognostic factor in these patients. Combined tracheal resection and AMT may be adapted as part of the multidisciplinary treatment of esophageal cancer with tracheal invasion. Improving AMT safety and optimizing patient selection may improve prognosis among patients with this cancer.
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Affiliation(s)
- Makoto Yamasaki
- Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kotaro Yamashita
- Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takuro Saito
- Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Koji Tanaka
- Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomoki Makino
- Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yasuhiro Miyazaki
- Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tsuyoshi Takahashi
- Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yukinori Kurokawa
- Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kiyokazu Nakajima
- Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masaaki Motoori
- Department of Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yutaka Kimura
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masaki Mori
- Department of Surgery and Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yuichiro Doki
- Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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17
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Hu B, Jia F, Zhou H, Zhou T, Zhao Q, Chen Y, Li B, Huang W. Risk Factors Associated with Esophageal Fistula after Radiotherapy for Esophageal Squamous Cell Carcinoma. J Cancer 2020; 11:3693-3700. [PMID: 32284766 PMCID: PMC7150448 DOI: 10.7150/jca.39033] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 02/25/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose: The aim of this study was to investigate risk factors for esophageal squamous cell carcinoma (ESCC) treated with radiotherapy (RT) with or without chemotherapy to guide how to reduce the occurrence of esophageal fistula (EF). Methods: 414 patients with ESCC who underwent RT with or without chemotherapy were collected in Shandong Cancer Hospital from February 2012 to June 2018 retrospectively. The clinical characters and dosimetric parameters were recorded. Univariate and multivariate logistic regression analyses were provided to determine the risk factors associated with EF. Results: The cumulative incidences of EF were 11.1% (46/414 patients). The median follow-up period was 15.8 months (range: 0.2-82.6months). The median survival time (MST) of patients with EF was 5.3 months. In univariate analysis, age, T4 stage, N3 stage, chemotherapy regimens, re-RT, ulcerative esophageal cancer (EC), esophageal stenosis, the maximum thickness of the tumor and the length of tumor had a correlation with the prevalence of EF. In multivariable logistic regression analysis, T4 stage, N3 stage, re-RT, ulcerative EC, esophageal stenosis, the maximum thickness of the tumor was confirmed as risk factors for EF. Conclusion: This study revealed that T4 stage, N3 stage, re-RT, ulcerative EC, esophageal stenosis, the maximum thickness of the tumor were risk factors associated with EF. We ought to attach importance to the prevention of EF. Patients with risk factors for EF should be paid close attention.
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Affiliation(s)
- Bing Hu
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong province, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong province, China
| | - Feng Jia
- Department of Oncology, Jinxiang people's hospital, Shandong province, China
| | - Haiyan Zhou
- Department of Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong province, China
| | - Tao Zhou
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong province, China
| | - Qian Zhao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong province, China
| | - Yiru Chen
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong province, China
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong province, China
| | - Wei Huang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong province, China
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18
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Taniyama TK, Tsuda T, Miyakawa K, Arai H, Doi A, Hirakawa M, Horie Y, Mizukami T, Izawa N, Ogura T, Sunakawa Y, Nakajima TE. Analysis of fistula formation of T4 esophageal cancer patients treated by chemoradiotherapy. Esophagus 2020; 17:67-73. [PMID: 31506805 DOI: 10.1007/s10388-019-00691-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 09/05/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIM Fistula is one of the known complications of T4 esophageal cancer (T4-EC). The standard treatment for T4-EC is chemoradiotherapy, but detailed data about fistula resulting from chemoradiotherapy in this condition are limited. In particular, radiographic findings of T4-EC with fistula have not been reported. This study assessed the risk factors of fistula based on clinical information on patients with chemoradiotherapy for T4-EC. METHODS We retrospectively reviewed the clinical data of 59 T4-EC patients who had squamous cell carcinoma without any fistula before receiving definitive or palliative chemoradiotherapy. RESULTS A fistula was observed in 18 patients (31%) throughout their clinical course. The overall survival in the fistula group was significantly shorter than that in the non-fistula group (259 vs. 346 days; p = 0.0341). The axial tumor size on computed tomography (CT) was confirmed as an independent risk factor for esophageal fistula in multivariate analysis of stepwise methods [OR 1.226; 95% CI 1.109-1.411; p < 0.0001]. Twelve out of 14 patients with an axial tumor size of 50 mm or greater had developed a fistula. CONCLUSIONS A large tumor size on the axial plane on CT is a risk factor for fistula formation.
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Affiliation(s)
| | - Takashi Tsuda
- Department of Clinical Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Kunihisa Miyakawa
- Department of Radiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Hiroyuki Arai
- Department of Clinical Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Ayako Doi
- Department of Clinical Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Mami Hirakawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yoshiki Horie
- Department of Clinical Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Takuro Mizukami
- Department of Clinical Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Naoki Izawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Takashi Ogura
- Department of Clinical Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yu Sunakawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Takako Eguchi Nakajima
- Department of Clinical Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
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19
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Anderegg MCJ, Ruurda JP, Gisbertz SS, Blom RLGM, Sosef MN, Wijnhoven BPL, Hulshof MCCM, Bergman JJGHM, van Laarhoven HWM, van Berge Henegouwen MI. Feasibility of extended chemoradiotherapy plus surgery for patients with cT4b esophageal carcinoma. Eur J Surg Oncol 2019; 46:626-631. [PMID: 31706717 DOI: 10.1016/j.ejso.2019.10.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 09/02/2019] [Accepted: 10/17/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Treatment of cT4b esophageal carcinoma usually consists of definitive chemoradiotherapy (dCRT). However, outcome after dCRT in these patients is poor. Whether surgery should have a place in the treatment of cT4b esophageal cancer is still subject to debate. Goal of this study was to evaluate the feasibility of esophagectomy after extended chemoradiotherapy in patients with cT4b esophageal cancer. METHODS Patients with cT4b esophageal carcinoma, as determined by endoscopic ultrasound and (PET-)CT, were eligible for this phase-2 study. Patients were treated with weekly carboplatin + paclitaxel with 50.4 Gy radiotherapy in 28 fractions for 5.5 weeks followed by an explorative thoracotomy and esophagectomy if deemed feasible. RESULTS From July 2011 through March 2013, 16 patients were enrolled. Five patients did not undergo surgery because of detection of distant metastases during/after CRT (n = 3), unwillingness to undergo surgery (n = 1) or death before start of CRT (n = 1). Of the 13 patients who completed CRT, 3 patients experienced major hematologic toxicity (grade 3). A radical (R0) resection was achieved in 9 of 11 patients. Postoperative complications occurred in 9 patients. A reoperation was performed in 2 patients and 2 patients died in hospital after surgery. Three patients developed recurrent disease (1 locoregional and 2 systemic) after a mean interval of 17 months. Median overall survival of all included patients was 14.3 months. CONCLUSIONS In certain patients with cT4b esophageal carcinoma a radical resection can be accomplished after chemoradiotherapy. However, this treatment is associated with considerable complications and should therefore be reserved for physically fit patients. NETHERLANDS TRIAL REGISTER NUMBER NTR3060.
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Affiliation(s)
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center, Utrecht, the Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Rachel L G M Blom
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Meindert N Sosef
- Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
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20
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Takeuchi M, Kawakubo H, Mayanagi S, Yoshida K, Irino T, Fukuda K, Nakamura R, Wada N, Takeuchi H, Kitagawa Y. The Benefits of Docetaxel Plus Cisplatin and 5-Fluorouracil Induction Therapy in Conversion to Curative Treatment for Locally Advanced Esophageal Squamous Cell Carcinoma. World J Surg 2019; 43:2006-2015. [PMID: 30972432 DOI: 10.1007/s00268-019-05000-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Definitive chemoradiotherapy (CRT), used for treatment of patients with an initial diagnosis of unresectable locally advanced esophageal cancer, has led to unsatisfactory long-term prognosis. Moreover, CRT can lead to esophageal fistula, perforation, and strictures. Therefore, strong induction chemotherapeutic treatments are necessary to reduce the tumor volume for subsequent radical esophagectomy. This study aimed to determine the oncological utility of docetaxel plus cisplatin and 5-fluorouracil (DCF) and the technical feasibility of subsequent esophagectomy for locally advanced esophageal cancer. METHODS Eighty-seven patients with clinical borderline unresectable T3 and T4 esophageal squamous cell carcinoma without distant metastases were included in this study. There were 44 patients in primary DCF group and 43 patients in definitive CRT group, and perioperative and long-term oncological outcomes were compared between the two groups. RESULTS Twenty-two patients (50%) achieved R0 resection in the DCF group. Albeit not significant, the rate of curative treatment was higher in the DCF group than the definitive CRT group (p = 0.099). The overall survival (OS) and progression-free survival (PFS) were better with DCF than with definitive CRT (median OS, 29 vs. 17 months, p = 0.206; median PFS, 10 vs. 6 months, p = 0.020). Specifically, the OS of patients with a Charlson score of less than 3 among the DCF-treated patients tended to be better than those among the definitive CRT-treated patients. CONCLUSION DCF and subsequent esophagectomy achieved R0 resection in 50% of the patients and was associated with better long-term oncological outcomes in patients with initially unresectable esophageal cancer if their systemic status is acceptable.
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Affiliation(s)
- Masashi Takeuchi
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Shuhei Mayanagi
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kayo Yoshida
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tomoyuki Irino
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazumasa Fukuda
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Rieko Nakamura
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Norihito Wada
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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21
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Efficacy and Toxicity of Weekly Carboplatin and Paclitaxel as Induction or Palliative Treatment in Advanced Esophageal Cancer Patients. Cancers (Basel) 2019; 11:cancers11060826. [PMID: 31200588 PMCID: PMC6627268 DOI: 10.3390/cancers11060826] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/06/2019] [Accepted: 06/11/2019] [Indexed: 12/13/2022] Open
Abstract
Many patients have advanced esophageal cancer at diagnosis. However, the most optimal treatment has not been identified. Therefore, we evaluated a weekly regimen of carboplatin (area under the curve (AUC)) of 4 and paclitaxel at 100 mg/m2 as an induction or palliative treatment. All patients with advanced (gastro)esophageal cancer treated with this regimen between 2002-2018 were included. Exclusion criteria were previous radiotherapy or treatment elsewhere. Data on toxicity, response, and survival were collected. Analyses were performed in two groups: induction (iCT) or palliative chemotherapy (pCT). Median progression free survival (PFS) and overall survival (OS) were estimated with the Kaplan-Meier method. A total of 291 patients was included (iCT: 122; pCT: 169). Most patients had T3 carcinoma (iCT: 54%; pCT: 66%) and stage IV disease (iCT: 42%; pCT: 91%). A toxicity grade ≥3 occurred mainly as hematological toxicity (iCT: 71%; pCT: 73%) and gastrointestinal toxicity (iCT: 3%; pCT: 5%). Response rates were 48% (iCT) and 44% (pCT). Esophagectomy or definitive chemoradiotherapy followed in 42% of iCT, resulting in a PFS of 22.1 months (interquartile range (IQR): 12.4-114.2) and OS of 26.8 months (IQR: 15.4-91.7). For pCT, PFS was 8.2 months (IQR: 5.1-14.5) and OS 10.9 months (IQR: 6.5-18.3). This retrospective cohort study demonstrated that weekly carboplatin (AUC4) and paclitaxel (100 mg/m2) is a well-tolerated and effective induction or palliative treatment regimen for patients with locally advanced or metastatic disease. Future research should directly compare this treatment regimen with other first-line treatment options to determine its true value for clinical practice.
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22
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Tian D, Zhang L, Wang Y, Chen L, Zhang KP, Zhou Y, Wen HY, Fu MY. Neoadjuvant chemotherapy with irinotecan and nedaplatin in a single cycle followed by esophagectomy on cT4 resectable esophageal squamous cell carcinoma: a prospective nonrandomized trial for short-term outcomes. Dis Esophagus 2019; 32:5084843. [PMID: 30247659 DOI: 10.1093/dote/doy080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Neoadjuvant chemotherapy (NAC) significantly extends survival in advanced esophageal squamous cell carcinoma (ESCC), but the short-term outcomes for cT4 ESCC remain controversial. Many NAC regimens have been previously reported, although no study has reported a regimen of irinotecan and nedaplatin for cT4 potential resectable ESCC. We evaluated the short-term outcomes of NAC with irinotecan and nedaplatin in a single cycle followed by esophagectomy on cT4 resectable ESCC. A total of 51 patients with cT4 potentially resectable ESCC were eligible for this study. Twenty of these patients underwent NAC, and the other 31 patients underwent surgery alone. The toxicities and response of NAC were evaluated. The clinicopathologic characteristics, responses, toxicities, surgical outcomes, postoperative complications, and survival time between the two groups were analyzed. No significant differences were found in clinicopathologic characteristics between the groups (P > 0.05). The response rate of NAC was 75% (15/20). The differences in the long-axis diameter of the tumor and cT stage between pre- and post-NAC were significant (P < 0.05). Twenty-four toxic events occurred in 11 patients of the NAC group, and 20/24 of these were mild. The R0 resection rates in the NAC group and the surgery alone group were 85% and 64.5%, with no statistically significant difference (P > 0.05). Differences in the pathological T stage and pathological tumor-node-metastasis (TNM) stage were significant (P < 0.05). The overall survival (OS) time and mortality in the NAC group versus the surgery alone group were 31.57 ± 3.06 months versus 15.24 ± 1.46 months and 25% versus 61.3%, respectively. The differences in OS and mortality were significant (P < 0.05). The NAC group and R0 resection were significant and independent predictors of positive prognosis. NAC with irinotecan and nedaplatin in a single cycle followed by esophagectomy on cT4 resectable ESCC as a new NAC is safe and effective.
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Affiliation(s)
- D Tian
- Department of Cardiothoracic Surgery, Affiliated Hospital of North Sichuan Medical College
| | - L Zhang
- Department of Cardiothoracic Surgery, Affiliated Hospital of North Sichuan Medical College
| | - Y Wang
- Translational Medicine Research Center, North Sichuan Medical College, Nanchong, China
| | - L Chen
- Department of Cardiothoracic Surgery, Affiliated Hospital of North Sichuan Medical College
| | - K-P Zhang
- Department of Cardiothoracic Surgery, Affiliated Hospital of North Sichuan Medical College
| | - Y Zhou
- Department of Cardiothoracic Surgery, Affiliated Hospital of North Sichuan Medical College
| | - H-Y Wen
- Department of Cardiothoracic Surgery, Affiliated Hospital of North Sichuan Medical College
| | - M-Y Fu
- Department of Cardiothoracic Surgery, Affiliated Hospital of North Sichuan Medical College
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23
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Makino T, Yamasaki M, Tanaka K, Miyazaki Y, Takahashi T, Kurokawa Y, Motoori M, Kimura Y, Nakajima K, Mori M, Doki Y. Treatment and clinical outcome of clinical T4 esophageal cancer: A systematic review. Ann Gastroenterol Surg 2019; 3:169-180. [PMID: 30923786 PMCID: PMC6422802 DOI: 10.1002/ags3.12222] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/29/2018] [Accepted: 11/12/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Survival of patients with cT4 esophageal cancer is dismal. Although the optimal treatment strategy remains to be established, two treatment options are available for cT4 esophageal cancers: definitive chemoradiation (dCRT) and induction treatment followed by conversion surgery (CS). However, little is known concerning the differences in clinical outcome between patients with T4 esophageal tumors treated with dCRT and those eventually treated with CS. METHODS A systematic search of the scientific literature on PubMed/MEDLINE was carried out using the keywords "T4 esophageal cancer," "invading (involving) adjacent organ," "definitive chemoradiation," "induction therapy," "salvage surgery," and "conversion surgery," obtaining 28 reports published up to July 2018. RESULTS/CONCLUSION We found that CS was superior to dCRT with respect to local disease control and short-term survival; however, CS was associated with relatively higher perioperative mortality and morbidity. Alternatively, although dCRT might often cause fistula formation, a clinical complete response to dCRT is likely to lead to a better prognosis. Recent advances in chemotherapeutic agents have led to triple induction chemotherapy, with docetaxel, cisplatin, and 5-fluorouracil (DCF), which has shown promise as an initial induction treatment for cT4 esophageal cancer. Indeed, this regimen could control both local and systemic disease, which enables curative resection without preoperative CRT. Moreover, some appropriate changes in perioperative management and intensive systemic chemotherapy might enhance patient outcome. Randomized controlled trials with a large sample size are needed to establish the standard treatment for cT4 esophageal cancer.
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Affiliation(s)
- Tomoki Makino
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversityOsakaJapan
| | - Makoto Yamasaki
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversityOsakaJapan
| | - Koji Tanaka
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversityOsakaJapan
| | - Yasuhiro Miyazaki
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversityOsakaJapan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversityOsakaJapan
| | - Yukinori Kurokawa
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversityOsakaJapan
| | | | - Yutaka Kimura
- Department of SurgeryFaculty of MedicineKindai UniversityOsakaJapan
| | - Kiyokazu Nakajima
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversityOsakaJapan
| | - Masaki Mori
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversityOsakaJapan
| | - Yuichiro Doki
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversityOsakaJapan
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24
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Toxopeus ELA, de Man FM, Krak N, Biermann K, Nieuweboer AJM, Friberg LE, Oomen-de Hoop E, van Lanschot JJB, Shapiro J, Wijnhoven BPL, Mathijssen RHJ. Association between Paclitaxel Clearance and Tumor Response in Patients with Esophageal Cancer. Cancers (Basel) 2019; 11:cancers11020173. [PMID: 30717316 PMCID: PMC6406317 DOI: 10.3390/cancers11020173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/16/2019] [Accepted: 01/29/2019] [Indexed: 01/03/2023] Open
Abstract
Inter-individual variability in paclitaxel pharmacokinetics may play a role in the response to chemotherapy. Therefore, we studied the association between paclitaxel clearance and treatment response in patients with esophageal cancer. All patients who received paclitaxel (plus carboplatin) treatment for esophageal cancer between 2007 and 2013 were included. The treatment was given as neoadjuvant chemoradiotherapy (nCRT), induction chemotherapy (iCT), or palliative chemotherapy (pCT). The treatment response was assessed by the tumor regression grade (TRG) or by the RECIST1.1 criteria, respectively. The unbound paclitaxel clearance (CL) was estimated with NONMEM. The log-transformed clearance was related to response with ANOVA and independent sample t-tests. A total of 166 patients were included, of whom 113 received nCRT, 23 iCT and 30 pCT. In patients receiving nCRT, paclitaxel clearance was not associated with tumor regression grade (p-value = 0.25), nor with pathologically complete response (geometric mean 561.6 L/h) and residual disease (geometric mean 566.1 L/h, p-value = 0.90). In patients who underwent iCT or pCT, also no association between paclitaxel clearance and RECIST outcome was identified (iCT: p-value = 0.08 and pCT: p-value = 0.81, respectively). In conclusion, systemic paclitaxel exposure was not associated with response to common paclitaxel-based treatment regimens for esophageal cancer. Future studies should focus on tumor exposure in relation to systemic exposure and treatment outcome.
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Affiliation(s)
- Eelke L A Toxopeus
- Department of Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
| | - Femke M de Man
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
| | - Nanda Krak
- Department of Radiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
| | - Katharina Biermann
- Department of Pathology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
| | - Annemieke J M Nieuweboer
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
| | - Lena E Friberg
- Department of Pharmaceutical Biosciences, Uppsala University, Box 256, 751 05 Uppsala, Sweden.
| | - Esther Oomen-de Hoop
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
| | - Jan J B van Lanschot
- Department of Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
| | - Joel Shapiro
- Department of Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
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25
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Dai Z, He Q, Pan B, Liu L, Zhou D. Postoperative Complication Assessments of Different Reconstruction Procedures after Total Pharyngolaryngoesophagectomy: Tubular Gastric Pull-Up versus Whole Gastric Pull-Up. Am Surg 2018. [DOI: 10.1177/000313481808401239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hypopharynx carcinoma tends to be diagnosed at advanced stage and usually has a poor prognosis because of the high incidence of submucosal spreading and lymphatic metastasis. Total pharyngolaryngoesophagectomy (PLE) is mostly used as a curative intervention for this deadly disease, and a commonly used reconstruction method after PLE is gastric pull-up, which could be further divided into tubular gastric pull-up and whole gastric pull-up procedures. Aiming to achieve a precise guidance on optimal reconstruction method after PLE, the present study evaluated the postoperative complications involving in different gastric pull-up procedures in patients with hypopharynx cancer. A total of 52 consecutive patients with hypopharyngeal cancer who underwent total PLE with gastric pull-up reconstruction in Tianjin Medical University Cancer Institute and Hospital between 1996 and 2014 were analyzed in this study. Of these patients, 28 underwent tubular gastric pull-up reconstruction procedure (Group A), whereas 24 underwent whole gastric pull-up reconstruction procedure (Group B). We compared the postoperative complications between these two groups retrospectively. Postoperative anastomotic fistulas occurred in three patients in Group A (3/28) versus eight patients in Group B (8/24), leading to an incidence rate of 10.71 and 33.33 per cent, respectively. The incidence of intrathoracic stomach syndrome was 21.43 per cent in Group A (6/28) versus 58.33 per cent in Group B (14/24), and the incidence of reflux was 35.71 per cent in Group A (10/28) versus 66.67 per cent in Group B (16/24). All of the above postoperative complications exhibited statistical differences between two groups ( P ≤ 0.05). This retrospective observation study suggests that compared with whole gastric pull-up, tubular gastric pull-up is a better reconstruction procedure of choice after PLE, evidenced by reduced incidences of postoperative anastomotic fistula, intrathoracic stomach syndrome, and reflux.
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Affiliation(s)
- Zhenbo Dai
- Departments of Endoscopy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Qinghua He
- Departments of Endoscopy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Boyu Pan
- Gastrointestinal Cancer Biology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Liren Liu
- Gastrointestinal Cancer Biology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Dejun Zhou
- Departments of Endoscopy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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26
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Kawakami T, Tsushima T, Omae K, Ogawa H, Shirasu H, Kito Y, Yoshida Y, Hamauchi S, Todaka A, Machida N, Yokota T, Yamazaki K, Fukutomi A, Onozawa Y, Yasui H. Risk factors for esophageal fistula in thoracic esophageal squamous cell carcinoma invading adjacent organs treated with definitive chemoradiotherapy: a monocentric case-control study. BMC Cancer 2018; 18:573. [PMID: 29776344 PMCID: PMC5960135 DOI: 10.1186/s12885-018-4486-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/08/2018] [Indexed: 12/01/2022] Open
Abstract
Background Standard treatment for unresectable esophageal squamous cell carcinoma (ESCC) without distant metastasis is definitive chemoradiotherapy (dCRT), in which the incidence of esophageal fistula (EF) is reported to be 10–12%. An ad hoc analysis of JCOG0303, a phase II/III trial of dCRT for patients with unresectable ESCC (including non-T4b), suggested that esophageal stenosis is a risk factor for EF. However, risk factors for EF in patients limited to T4b ESCC treated with dCRT have yet to be clarified. The aim of this study was to investigate risk factors for EF in T4b thoracic ESCC treated with dCRT. Methods We retrospectively analyzed the data of consecutive T4b thoracic ESCC patients who were treated with dCRT (cisplatin and fluorouracil) at Shizuoka Cancer Center between April 2004 and September 2015. Results Excluding 8 patients with esophageal fistula clearly attributable to other iatrogenic interventions, the data of 116 patients who met the inclusion criteria were analyzed. Esophageal fistula was observed in 28 patients (24%). Although the fistula was closed in 5 patients, overall survival was significantly shorter in patients who experienced esophageal fistula (8.0 vs. 26.8 months; p < 0.0001). Among four potential variables extracted in univariate analysis, namely, total circumferential lesion, elevated CRP level, elevated white blood cell count, and anemia, the first two were revealed as risk factors for esophageal fistula in multivariate analysis. Conclusions This study demonstrated that total circumferential lesion and CRP ≥1.00 mg/dL are risk factors for esophageal fistula in T4b thoracic ESCC treated with dCRT. Trial registration This study was retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12885-018-4486-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Takeshi Kawakami
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takahiro Tsushima
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan. .,Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagizumi-cho, Sunto-gun, Shizuoka, 411-0934, Japan.
| | - Katsuhiro Omae
- Clinical Research Promotion Unit, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hirofumi Ogawa
- Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiromichi Shirasu
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yosuke Kito
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yukio Yoshida
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Satoshi Hamauchi
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akiko Todaka
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Nozomu Machida
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tomoya Yokota
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kentaro Yamazaki
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akira Fukutomi
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yusuke Onozawa
- Division of Clinical Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hirofumi Yasui
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
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27
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Makino T, Yamasaki M, Miyazaki Y, Wada N, Takahashi T, Kurokawa Y, Nakajima K, Takiguchi S, Mori M, Doki Y. Utility of initial induction chemotherapy with 5-fluorouracil, cisplatin, and docetaxel (DCF) for T4 esophageal cancer: a propensity score-matched analysis. Dis Esophagus 2018; 31:4670862. [PMID: 29190316 DOI: 10.1093/dote/dox130] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 10/10/2017] [Indexed: 12/11/2022]
Abstract
Although no consensus is available on the treatment of esophageal squamous cell carcinoma (ESCC) invading adjacent organs (T4), establishing effective induction treatments is crucial to altering an unresectable status and achieving curative resection. Here, we evaluated the efficacy of chemotherapy using 5-fluorouracil, cisplatin, and docetaxel (DCF) as the initial induction treatment for T4 ESCC. Fifty patients without distant metastasis who underwent initial induction chemotherapy using DCF for T4 ESCC were propensity score-matched with 50 patients who underwent radiotherapy concurrent with cisplatin and 5-fluorouracil (CRT). In the DCF group, 24 (48.0%) patients underwent surgery, achieving a 64% clinical response rate compared to 72.0% for induction CRT. CRT was also performed in another 24 (48.0%) patients in the DCF group in whom surgical resection was not indicated. The DCF group had significantly higher overall resectability than the CRT group (78.0% vs. 48.0%, P = 0.0017). The esophageal perforation rate during induction treatments was significantly lower in the DCF group than the CRT group (4.0% vs. 18.0%, P = 0.0205). Prognosis was significantly better in the DCF group than the CRT group (5-year cancer-specific survival 42.1% vs. 22.2%, P = 0.0146). Thus, induction DCF chemotherapy in patients with T4 ESCC reduced esophageal perforation and increased overall resectability, leading to better survival than CRT alone. Therefore, DCF chemotherapy may be an effective and safe option for initial induction treatment of T4 ESCC.
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Affiliation(s)
- T Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - M Yamasaki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Y Miyazaki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - N Wada
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - T Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Y Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - K Nakajima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - S Takiguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - M Mori
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Y Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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28
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New classification for the thoracic paraaortic lymph nodes of patients with esophageal squamous cell carcinoma. Surg Today 2017; 48:217-222. [PMID: 28836053 DOI: 10.1007/s00595-017-1576-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/17/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE To create a new classification for the thoracic paraaortic lymph nodes (No. 112ao) of patients with esophageal squamous cell carcinoma (ESCC). Classification of these nodes in ESCC patients has been the focus of very few reports. METHODS The subjects of this study were 27 patients with positive No. 112ao nodes on computed tomography (CT) images before treatment. We divided the No. 112ao nodes into No. 112aoA, located on the esophageal side as anterior No. 112ao nodes, and No. 112aoP, located on the opposite side of the esophagus as posterior No. 112ao nodes. We examined the association between No. 112aoA and No. 112aoP and clinicopathological factors. Recurrence-free survival (RFS) was compared between the No. 112aoA- and No. 112aoP-positive groups. RESULTS There were 12 patients in the No. 112aoA-positive group and 15 patients in the No. 112aoP-positive group. The No. 112aoP-positive group had significantly worse RFS than the No. 112aoA-positive group (p = 0.004). Cox multivariate analysis of RFS revealed that No. 112aoP positivity was an independent prognostic factor (p = 0.043). CONCLUSIONS Our new classification of No. 112ao nodes into No. 112aoA and No. 112aoP is useful clinically. No. 112aoP could correspond to the clinical N4 category of patients with ESCC.
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29
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Makino T, Yamasaki M, Tanaka K, Tatsumi M, Takiguchi S, Hatazawa J, Mori M, Doki Y. Importance of positron emission tomography for assessing the response of primary and metastatic lesions to induction treatments in T4 esophageal cancer. Surgery 2017; 162:836-845. [PMID: 28711321 DOI: 10.1016/j.surg.2017.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/02/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is no consensus strategy for treatment of T4 esophageal cancer, and because of this, a better evaluation of treatment response is crucial to establish personalized therapies. This study aimed to establish a useful system for evaluating treatment response in T4 esophageal cancer. METHODS This study included 130 patients with cT4 esophageal cancer without distant metastasis who underwent 18F-fluorodeoxyglucose-positron emission tomography before and after a series of induction treatments comprising chemoradiation or chemotherapy. We evaluated the maximal standardized uptake value and treatment response. RESULTS The mean ± standard deviation of standardized uptake value in the primary tumor before and after induction treatments were 13.8 ± 4.4 and 5.4 ± 4.1, respectively, and the mean standardized uptake value decrease was 58.4%. The most significant difference in survival between positron emission tomography-primary tumor responders and nonresponders was at a decrease of 60% standardized uptake value, based on every 10% stepwise cutoff analysis (2-year cause-specific survival: 60.2 vs 23.5%; hazard ratio = 2.705; P < .0001). With this cutoff value, the resectability (P = .0307), pathologic response (P = .0004), and pT stage (P < .0001) were associated with positron emission tomography-primary tumor response. Univariate analysis of 2-year cause-specific survival indicated a correlation between cause-specific survival and clinical stages according to TNM classification, esophageal perforation, positron emission tomography-primary tumor response, lymph node status evaluated by positron emission tomography before and after induction treatments, and operative resection. Multivariate analysis further identified positron emission tomography-primary tumor response (hazard ratio = 2.354; P = .0107), lymph node status evaluated by positron emission tomography after induction treatments (hazard ratio = 1.966; P = .0089), and operative resection (hazard ratio = 2.012; P = .0245) as independent prognostic predictors. CONCLUSION Positron emission tomography evaluation of the response of primary and metastatic lesions to induction treatments is important to formulate treatment strategies for cT4 esophageal cancer.
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Affiliation(s)
- Tomoki Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Mitsuaki Tatsumi
- Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Jun Hatazawa
- Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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Sugimura K, Miyata H, Yano M, Yanagimoto Y, Ho MJ, Kobayashi S, Takahashi H, Omori T, Ohue M, Sakon M. Is 18F-FDG-PET useful for predicting R0 resection after induction therapy for initially unresectable locally advanced esophageal carcinoma? Gen Thorac Cardiovasc Surg 2017; 65:455-462. [PMID: 28585161 DOI: 10.1007/s11748-017-0786-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/18/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Induction therapy followed by surgery is a promising strategy for esophageal cancer patients with invasion of the trachea/bronchus or aorta. However, no diagnostic criteria have been established to diagnose whether R0 resection can be performed. We investigated whether 18F-2-deoxy-D-glucose positron emission tomography (18F-FDG-PET) and other modalities are useful for predicting R0 resection. METHODS Fifty-seven patients with esophageal cancer invading the trachea/bronchus or aorta who underwent induction therapy followed by surgery were enrolled. We divided the participants into two groups, an R0 resection group (n = 43) and a non-R0 resection group (n = 14), and then compared the between-group results of three modalities, including computed tomography (CT), endoscopy and 18F-FDG-PET, before and after induction therapy. RESULTS The post-maximal standardized uptake value (SUVmax) after induction therapy in the R0 resection group was significantly lower than that in the non-R0 resection group (4.4 vs. 6.6, p = 0.005). The receiver operating characteristic curve analysis showed that the cut-off value for the post-SUVmax based on 18F-FDG-PET prediction of R0 resection was 4.7. Furthermore, a tumor reduction rate of ≥44% on CT, no residual stenosis, and no deep ulcer on endoscopy were associated with R0 resection after induction therapy (p = 0.002, p = 0.091, and p = 0.059, respectively). Multivariate logistic analyses revealed that the tumor reduction rate on CT and post-SUVmax <4.7 in 18F-FDG-PET were independent factors for R0 resection. CONCLUSIONS The post-SUVmax determined by 18F-FDG-PET and the volume reduction rate based on CT scans were useful for predicting R0 resection after induction therapy for initially unresectable locally advanced esophageal carcinoma.
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Affiliation(s)
- Keijiro Sugimura
- Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan.
| | - Hiroshi Miyata
- Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan
| | - Masahiko Yano
- Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan
| | - Yoshitomo Yanagimoto
- Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan
| | - Moon Jeong Ho
- Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan
| | - Shogo Kobayashi
- Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan
| | - Hidenori Takahashi
- Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan
| | - Takeshi Omori
- Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan
| | - Masayuki Ohue
- Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan
| | - Masato Sakon
- Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, 537-8511, Japan
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Miyata H, Sugimura K, Motoori M, Fujiwara Y, Omori T, Mun M, Ohue M, Yasui M, Miyoshi N, Fujii T, Tajima H, Kurita T, Yano M. Clinical Assessment of Reconstruction Involving Gastric Pull-Up Combined with Free Jejunal Graft After Total Pharyngolaryngoesophagectomy. World J Surg 2017; 41:2329-2336. [DOI: 10.1007/s00268-017-3948-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Hamamoto Y, Nojima M, Aoki Y, Suzuki T, Kawasaki K, Hirata K, Sukawa Y, Kasuga A, Kawakubo H, Takeuchi H, Murakami K, Takaishi H, Kanai T, Kitagawa Y. Inter-evaluator heterogeneity of clinical diagnosis for locally advanced esophageal squamous cell carcinoma. Esophagus 2017; 14:324-332. [PMID: 28983229 PMCID: PMC5603637 DOI: 10.1007/s10388-017-0580-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/18/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Identifying clinical resectability of locally advanced esophageal squamous cell carcinoma (ESCC) is important, although inter-evaluator heterogeneity (IEH) could exist, especially in borderline resectable (BLR) cases. To investigate the extent of heterogeneity, we conducted clinical diagnostic imaging questionnaires. MATERIALS AND METHODS Five cases with clinical T3 or T4 cases, which were treated with neo-adjuvant triplet chemotherapy followed by surgery, were selected as the model. These cases were divided into two groups: curative resected cases (#1-#3) and non-curative resected cases (#4 and #5). Only imaging slides were shown without any information about patient characteristics or clinical course. The evaluators consisted of surgeons (staff and non-staff), medical oncologists, and an imaging radiologist; a total of 25 medical staff answered the questionnaire. Two questions (1: clinical T stage before chemotherapy, 2: resectability after chemotherapy) were answered. Occupational differences were assessed by comparing the results to the imaging radiologist. RESULTS IEH was observed for clinical diagnosis before chemotherapy in one case (clinical T4: 52%, clinical T3: 48%). In the other cases, most evaluators diagnosed them as clinical T4, with 76-88% agreement. IEH for clinical resectability after chemotherapy was relatively small. Occupational IEH was observed in both before and after chemotherapy. CONCLUSION IEH in decisions about treating BLR cases in ESCC should be considered in clinical practice. Multi-disciplinary teams are essential to overcome this problem.
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Affiliation(s)
- Yasuo Hamamoto
- 0000 0004 1936 9959grid.26091.3cKeio Cancer Center, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, Japan
| | - Masanori Nojima
- 0000 0001 2151 536Xgrid.26999.3dCenter for Translational Research, The Institute of Medical Science Hospital, The University of Tokyo, Tokyo, Japan
| | - Yu Aoki
- 0000 0004 1936 9959grid.26091.3cDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Tokyo, Japan
| | - Takeshi Suzuki
- 0000 0004 1936 9959grid.26091.3cDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Tokyo, Japan
| | - Kenta Kawasaki
- 0000 0004 1936 9959grid.26091.3cDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Tokyo, Japan
| | - Kenro Hirata
- 0000 0004 1936 9959grid.26091.3cDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Tokyo, Japan
| | - Yasutaka Sukawa
- 0000 0004 1936 9959grid.26091.3cDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Tokyo, Japan
| | - Akira Kasuga
- 0000 0004 1936 9959grid.26091.3cDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Tokyo, Japan
| | - Hirofumi Kawakubo
- 0000 0004 1936 9959grid.26091.3cDivision of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, Japan
| | - Hiroya Takeuchi
- 0000 0004 1936 9959grid.26091.3cDivision of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, Japan
| | - Koji Murakami
- 0000 0004 1936 9959grid.26091.3cDepartment of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, Japan
| | - Hiromasa Takaishi
- 0000 0004 1936 9959grid.26091.3cDivision of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, Japan
| | - Takanori Kanai
- 0000 0004 1936 9959grid.26091.3cDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Tokyo, Japan
| | - Yuko Kitagawa
- 0000 0004 1936 9959grid.26091.3cDivision of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, Japan
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Akutsu Y, Matsubara H. Chemoradiotherapy and surgery for T4 esophageal cancer in Japan. Surg Today 2015; 45:1360-5. [PMID: 25583206 DOI: 10.1007/s00595-015-1116-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/23/2014] [Indexed: 01/06/2023]
Abstract
Esophageal cancer is thought to be the most malignant neoplasm due to its biological aggressiveness. The most effective treatment modality for esophageal cancer, particularly T4 esophageal cancer, is chemoradiotherapy (CRT). Some T4 patients show long-term survival after receiving CRT, suggesting that even T4 esophageal cancer can be cured with this modality. Although surgery is performed after CRT in some T4 cases, its prognostic benefit is controversial. In this paper, we review the status of CRT and conversion surgery as well as the development of new regimens and discuss the future prospects of CRT in the treatment of T4 esophageal cancer in Japan.
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Affiliation(s)
- Yasunori Akutsu
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuoku, Chiba, 260-8670, Japan.
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuoku, Chiba, 260-8670, Japan
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Toxopeus ELA, Talman S, van der Gaast A, Spaander VMCW, van Rij CM, Krak NC, Biermann K, Tilanus HW, Mathijssen RHJ, van Lanschot JJB, Wijnhoven BPL. Induction chemotherapy followed by surgery for advanced oesophageal cancer. Eur J Surg Oncol 2014; 41:323-32. [PMID: 25534280 DOI: 10.1016/j.ejso.2014.11.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 11/14/2014] [Accepted: 11/25/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Patients with locoregionally advanced oesophageal tumours or disputable distant metastases are referred for induction chemotherapy with the aim to downstage the tumour before an oesophagectomy is considered. STUDY DESIGN Patients who underwent induction chemotherapy between January 2005 and December 2012 were identified from an institutional database. Treatment plan was discussed in the multidisciplinary team. Response to chemotherapy was assessed by CT. Survival was calculated using the Kaplan Meier method. Uni- and multivariable analyses were performed to identify prognostic factors for survival. RESULTS In total 124 patients received induction chemotherapy mainly for locoregionally advanced disease (n = 80). Surgery was withheld in 35 patients because of progressive disease (n = 16) and persistent unresectability (n = 19). The median overall survival of this group was 13 months (IQR: 8-19). The remaining 89 patients underwent surgery of which 13 still had unresectable tumour or distant metastases. Of the 76 patients that underwent an oesophagectomy, 50 patients had tumour free resection margins (66%) with an estimated 5-year survival of 37%. A positive resection margin (HR 4.148, 95% CI 2.298-7.488, p < 0.0001) was associated with a worse survival in univariable analysis, but only pathological lymph node status with increasing hazard ratio's (6.283-10.283, p = 0.001) remained significant after multivariable analysis. CONCLUSION Induction chemotherapy downstages the tumour and facilitates a radical oesophagectomy in patients with advanced oesophageal cancer. Pathological lymph node status is an independent prognostic factor for overall survival.
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Affiliation(s)
- E L A Toxopeus
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| | - S Talman
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - A van der Gaast
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - V M C W Spaander
- Department of Gastroenterology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - C M van Rij
- Department of Radiation Oncology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - N C Krak
- Department of Radiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - K Biermann
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - H W Tilanus
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - R H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J J B van Lanschot
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - B P L Wijnhoven
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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High pathologic complete remission rate from induction docetaxel, platinum and fluorouracil (DCF) combination chemotherapy for locally advanced esophageal and junctional cancer. Med Oncol 2014; 31:188. [PMID: 25148898 DOI: 10.1007/s12032-014-0188-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 08/13/2014] [Indexed: 12/26/2022]
Abstract
Adding docetaxel to the cisplatin/5-fluorouracil induction regimen for locally advanced esophageal and GEJ cancer may increase the pathologic complete remission (pCR) rate, leading to an improved outcome. Institutional ethics committee approved the protocol of retrospective analysis of patients with locally advanced esophageal and GEJ carcinoma, who received 2-3 cycles of docetaxel, cisplatin and 5-fluorouracil (DCF) induction chemotherapy with primary growth factors and prophylactic antibiotics. Following chemotherapy, a restaging scan was performed. If disease was deemed resectable, surgery was performed. Between February 2010 and October 2013, 31 patients received induction DCF. Ninety-four percent patients had squamous histology. Response rate was 81 %: complete remission (CR)-23 % and partial remission-58 %. Eighty-seven percent patients underwent surgery; R0 resection rate was 67 %. pCR occurred in 26 %. Common grade 3/4 toxicities included anemia-23 %, neutropenia-42 %, febrile neutropenia-39 %, diarrhea-39 %, hyponatremia-55 % and hypokalemia-39 %. There were no toxic deaths. At a median follow-up of 34 months (95 % CI 31.3-36.6), estimated median progression-free survival (PFS) was 27 months (95 % CI 11-39) and the overall survival (OS) at 1 year, 2 years and 3 years was 80, 68 and 55 %, respectively. Patients who attained pCR had a significant longer PFS and OS; median PFS and OS were not reached in patients with pCR and were 15 months (95 %CI 8.4-21.5 months), P = 0.012 and 25 months (95 %CI 10.3-39.7), P = 0.023, respectively, in patients who did not attain a pCR. DCF induction chemotherapy leads to pCR of 26 %, which rivals that obtained from chemoradiotherapy. Toxicity is substantial but manageable with adequate supportive care.
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Shimoji H, Karimata H, Nagahama M, Nishimaki T. Induction chemotherapy or chemoradiotherapy followed by radical esophagectomy for T4 esophageal cancer: results of a prospective cohort study. World J Surg 2014; 37:2180-8. [PMID: 23649529 DOI: 10.1007/s00268-013-2074-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND We hypothesized that the survival rate of patients undergoing R0 esophagectomy after induction chemotherapy or chemoradiotherapy for unresectable T4 esophageal cancer (URT4) would be similar to that of patients undergoing esophagectomy for immediately resectable esophageal cancer with no unfavorable prognostic factors (RNU). METHODS Between April 2002 and June 2012, 87 of 283 patients with esophageal cancer who presented at the University Hospital of the Ryukyus were enrolled in this prospective cohort study. Tumors were classified as RNU and URT4 in 44 and 43 of the 87 patients, respectively. Outcomes of treatment for URT4 patients were compared with those of RNU patients. RESULTS The R0 resection rate (61 %) and in-hospital mortality rate (20 %) of URT4 patients were significantly poorer than those of RNU patients (98 and 2.3 %, respectively), although the morbidity rate was similar in the two groups (63 and 52 %, respectively). The 5-year survival rate (35 %) of URT4 patients was significantly poorer than that of RNU patients (67 %) in the intention-to-treat analysis. However, no significant difference was noted between the two survival curves for cases of R0 resection (5-year survival rate, 60 % vs. 69 %). Multivariate analysis revealed R status as the only significant independent prognostic factor for URT4 patients (P < 0.001; hazard ratio = 8.279). CONCLUSIONS Satisfactory survival rates can be achieved if R0 resection is performed after induction treatment in patients with T4 esophageal cancer, although secondary radical esophagectomy is associated with a higher risk of in-hospital mortality.
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Affiliation(s)
- Hideaki Shimoji
- Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan.
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Miyata H, Yamasaki M, Takahashi T, Murakami K, Tanaka K, Yukinori K, Nakajima K, Takiguchi S, Morii E, Hatazawa J, Mori M, Doki Y. Determinants of response to neoadjuvant chemotherapy for esophageal cancer using 18F-fluorodeoxiglucose positron emission tomography (18F-FDG-PET). Ann Surg Oncol 2013; 21:575-82. [PMID: 24201746 DOI: 10.1245/s10434-013-3343-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND (18)F-FDG-PET is potentially useful for evaluating response to neoadjuvant therapy for esophageal cancer. However, the optimal (18)F-FDG-PET parameter for evaluating the response to therapy and survival has not been established. This study aimed to select the best of the two parameters of fluorodeoxyglucose ((18)F-FDG)-positron emission tomography (PET): decreased ratio of maximal standardized uptake (SUVmax-DR) or absolute value of posttreatment SUVmax (post-SUVmax), in predicting response and survival of patients with esophageal cancer who underwent neoadjuvant chemotherapy. METHODS The study subjects were 211 consecutive patients with esophageal cancer who received neoadjuvant chemotherapy followed by surgery. (18)F-FDG-PET was performed before and 2-3 weeks after completion of neoadjuvant chemotherapy in assessment with pretreatment SUVmax (pre-SUVmax), post-SUVmax and SUVmax-DR. RESULTS The mean SUVmax decreased during neoadjuvant chemotherapy from 11.4 to 5.8, and the mean SUVmax-DR was 49.4%. Both post-SUVmax and SUVmax-DR correlated significantly with pathological response, although neither post-SUVmax nor SUVmax-DR could distinguish pathological complete response from pathological good response. The 5-year survival rate was significantly higher in patients with SUVmax-DR of >50% than those with <50% (56.5 vs. 39.6 %, p = 0.0137), and also significantly higher in patients with post-SUVmax of <3.5 than those with >3.5 (62.2 vs. 35.1%, p < 0.0001). Multivariate analysis identified post-SUVmax value, but not SUVmax-DR, as an independent prognostic factor in patients who underwent neoadjuvant chemotherapy. CONCLUSIONS Post-SUVmax is more useful for predicting survival of patients with esophageal cancer who undergo neoadjuvant therapy followed by surgery, although both SUVmax-DR and post-SUVmax equally correlate with pathological response.
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Affiliation(s)
- Hiroshi Miyata
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan,
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Miyata H, Yamasaki M, Takahashi T, Murakami K, Kurokawa Y, Nakajima K, Takiguchi S, Mori M, Doki Y. Relevance of [18F]fluorodeoxyglucose positron emission tomography-positive lymph nodes after neoadjuvant chemotherapy for squamous cell oesophageal cancer. Br J Surg 2013; 100:1490-7. [DOI: 10.1002/bjs.9253] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2013] [Indexed: 12/22/2022]
Abstract
Abstract
Background
Several studies have examined the clinical significance of metabolic response in primary tumours by [18F]fluorodeoxyglucose positron emission tomography (18F-FDG-PET) in patients with oesophageal cancer who undergo neoadjuvant therapy. The relevance of the metabolic response in lymph nodes is unclear.
Methods
Consecutive patients with oesophageal cancer who underwent neoadjuvant chemotherapy followed by surgery were studied. 18F-FDG-PET was performed before and 2–3 weeks after completion of neoadjuvant chemotherapy, assessing FDG uptake in primary tumours and lymph nodes considered to be metastatic.
Results
Before therapy, 156 (73·9 per cent) of 211 patients had PET-positive nodes, of whom 89 (57.1 per cent) had no evidence of metabolic activity in these lymph nodes following chemotherapy. There was a significant relationship between post-treatment lymph node status assessed by FDG-PET and numbers of pathologically confirmed metastatic lymph nodes. Patients with post-treatment PET-positive nodes had shorter survival than those without (5-year survival rate 25 versus 62·6 per cent; P < 0·001). There was no difference in survival between patients with PET-positive nodes before but not after therapy and patients who had PET-negative nodes throughout (5-year survival rate 59 versus 71 per cent respectively; P = 0·207). Multivariable analysis identified post-treatment nodal status assessed by FDG-PET and tumour depth as independent prognostic factors.
Conclusion
Identification of PET-positive lymph nodes after completion of chemotherapy is a predictor of poor prognosis of patients with oesophageal cancer scheduled for surgery. FDG-PET lymph node status after neoadjuvant chemotherapy is more important than that before chemotherapy.
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Affiliation(s)
- H Miyata
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - M Yamasaki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - T Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - K Murakami
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Y Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - K Nakajima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - S Takiguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - M Mori
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Y Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Ajani JA, Xiao L, Roth JA, Hofstetter WL, Walsh G, Komaki R, Liao Z, Rice DC, Vaporciyan AA, Maru DM, Lee JH, Bhutani MS, Eid A, Yao JC, Phan AP, Halpin A, Suzuki A, Taketa T, Thall PF, Swisher SG. A phase II randomized trial of induction chemotherapy versus no induction chemotherapy followed by preoperative chemoradiation in patients with esophageal cancer. Ann Oncol 2013; 24:2844-9. [PMID: 23975663 DOI: 10.1093/annonc/mdt339] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The contribution of induction chemotherapy (IC) before preoperative chemoradiation for esophageal cancer (EC) is not known. We hypothesized that IC would increase the rate of pathologic complete response (pathCR). METHODS Trimodality-eligibile patients were randomized to receive no IC (Arm A) or IC (oxaliplatin/FU; Arm B) before oxaliplatin/FU/radiation. Surgery was attempted ∼5-6 weeks after chemoradiation. The pathCR rate, post-surgery 30-day mortality, overall survival (OS), and toxic effects were assessed. Bayesian methods and Fisher's exact test were used. RESULTS One hundred twenty-six patients were randomized dynamically to balance the two arms for histology, baseline stage, gender, race, and age. Fifty-five patients in Arm A and 54 in Arm B underwent surgery. The median actuarial OS for all patients (54 deaths) was 45.62 months [95% confidence interval (CI), 27.63-NA], with median OS 45.62 months (95% CI 25.56-NA) in Arm A and 43.68 months (95% CI 27.63-NA) in Arm B (P = 0.69). The pathCR rate in Arm A was 13% (7 of 55) and 26% (14 of 54) in Arm B (two-sided Fisher's exact test, P = 0.094). Safety was similar in both arms. CONCLUSIONS These data suggest that IC produces non-significant increase in the pathCR rate and does not prolong OS. Further development of IC before chemoradiation may not be beneficial. Clinical trial no.: NCT 00525915 (www.clinicaltrials.gov).
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Affiliation(s)
- J A Ajani
- Departments of Gastrointestinal Medical Oncology
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Shimoji H, Kinjo T, Karimata H, Nagahama M, Nishimaki T. Clinical and oncological effects of triplet chemotherapy followed by radical esophagectomy for resectable esophageal cancer associated with unfavorable prognostic factors. Surg Today 2013; 44:1273-81. [PMID: 23963503 DOI: 10.1007/s00595-013-0700-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 07/04/2013] [Indexed: 12/16/2022]
Abstract
PURPOSES The purpose of this study was to evaluate the hypothesis that the survival of patients undergoing R0 resection after triplet chemotherapy for resectable esophageal cancer with unfavorable prognostic factors (Category 3) would be similar to that of patients undergoing esophagectomy for esophageal cancer without such factors (Category 1). METHODS Patients with Category 3 tumors were assigned to receive triplet chemotherapy consisting of 5-fluorouracil, doxorubicin and nedaplatin (FAN) followed by radical esophagectomy. The outcomes of the bimodality treatment for Category 3 patients (n = 25) were compared with those of Category 1 patients (n = 41) in a prospective cohort study. RESULTS Grade 3 or higher toxicity developed during chemotherapy in 32 % of the Category 3 patients, with no treatment-related deaths. No significant difference was detected in the surgery-related mortality and morbidity rates between the two groups. The recurrence-free survival was significantly worse in Category 3 than in Category 1 patients (p = 0.002), although the overall survival was not significantly different (p = 0.085) between the two groups in cases of R0 resection (5-year survival rates: 34.4 vs. 66.5 %). CONCLUSIONS Although FAN chemotherapy followed by radical esophagectomy can be safely performed, this treatment modality may not have sufficient power to cure Category 3 disease.
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Affiliation(s)
- Hideaki Shimoji
- Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan,
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Induction chemotherapy increases chance of cure. Nat Rev Clin Oncol 2012. [DOI: 10.1038/nrclinonc.2012.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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