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Yu BB, Huang JQ, Liang HW, Liu Y, Chen L, Pei S, Huang W, Pan XB. Treatment patterns and survival in T4b esophageal cancer: a retrospective cohort study. Aging (Albany NY) 2024; 16:7131-7140. [PMID: 38643464 PMCID: PMC11087096 DOI: 10.18632/aging.205747] [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: 11/01/2023] [Accepted: 03/18/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE This study aims to evaluate the efficacy of various treatment approaches in stage T4b esophageal cancer patients. MATERIALS AND METHODS Data were extracted from the Surveillance, Epidemiology, and End Results databases, covering patients diagnosed with esophageal cancer between 2000 and 2020. Kaplan-Meier analysis was used to assess cancer-specific survival (CSS) and overall survival (OS) across different treatment patterns. RESULTS The study included 482 patients: 222 (46.1%) received chemoradiotherapy, 58 (12.0%) underwent radiotherapy alone, 37 (7.7%) received chemotherapy alone, 50 (10.4%) underwent surgery, and 115 (23.8%) received no treatment. Median CSS were 12, 4, 6, 18, and 1 month for chemoradiotherapy, radiotherapy alone, chemotherapy alone, surgery, and non-treatment groups. Median OS for these groups were 11, 3, 6, 17, and 1 month, respectively. Multivariable proportional hazard regression analysis revealed that patients who underwent surgery experienced significantly improved CSS (hazard ratio [HR] = 0.42, 95% confidence interval [CI]: 0.24-0.72; P = 0.002) and OS (HR = 0.45, 95% CI: 0.28-0.74; P = 0.002) compared to those receiving chemoradiotherapy after propensity score matching. CONCLUSIONS Esophagectomy, with or without radiotherapy and/or chemotherapy, results in better survival outcomes than chemoradiotherapy in patients with stage T4b esophageal cancer.
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Affiliation(s)
- Bin-Bin Yu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi, P.R. China
| | - Jiang-Qiong Huang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi, P.R. China
| | - Huan-Wei Liang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi, P.R. China
| | - Yang Liu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi, P.R. China
| | - Long Chen
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi, P.R. China
| | - Su Pei
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi, P.R. China
| | - Wei Huang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi, P.R. China
| | - Xin-Bin Pan
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi, P.R. China
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2
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Lin Y, Liang HW, Liu Y, Pan XB. Nivolumab adjuvant therapy for esophageal cancer: a review based on subgroup analysis of CheckMate 577 trial. Front Immunol 2023; 14:1264912. [PMID: 37860010 PMCID: PMC10582756 DOI: 10.3389/fimmu.2023.1264912] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Esophageal cancer is the sixth most common cancer worldwide. Approximately 50% of patients have locally advanced disease. The CROSS and NEOCRTEC5010 trials have demonstrated that neoadjuvant chemoradiotherapy followed by surgery is the standard treatment for patients with resectable disease. However, a pathological complete response is frequently not achieved, and most patients have a poor prognosis. The CheckMate 577 trial demonstrates that nivolumab adjuvant therapy improves disease-free survival in patents without a pathological complete response. However, there are still numerous clinical questions of concern that remain controversial based on the results of the subgroup analysis. In this review, we aim to offer constructive suggestions addressing the clinical concerns raised in the CheckMate 577 trial.
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Affiliation(s)
- Yan Lin
- Department of Gastroenterology, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Huan-Wei Liang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Yang Liu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Xin-Bin Pan
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
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3
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Tsuburaya A, Mizusawa J, Tanaka Y, Fukushima N, Nashimoto A, Sasako M. Neoadjuvant chemotherapy with S-1 and cisplatin followed by D2 gastrectomy with para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis. Br J Surg 2014; 101:653-60. [PMID: 24668391 DOI: 10.1002/bjs.9484] [Citation(s) in RCA: 226] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Locally advanced gastric cancer with extensive regional and/or para-aortic lymph node (PAN) metastases is typically unresectable and associated with poor outcomes. This study investigated the safety and efficacy of S-1 plus cisplatin followed by extended surgery with PAN dissection for gastric cancer with extensive lymph node metastasis. METHODS Patients with gastric cancer with bulky lymph node metastasis along the coeliac artery and its branches and/or PAN metastasis received two or three 28-day cycles of S-1 plus cisplatin, followed by gastrectomy with D2 plus PAN dissection. The primary endpoint was the percentage of complete resections with clear margins in the primary tumour (R0 resection). A target sample size of 50 with one-sided α of 0.105 and β of approximately 0.2 corresponded to an expected R0 rate of 65 per cent and a threshold of 50 per cent. RESULTS Between February 2005 and June 2007, 53 patients were enrolled, of whom 51 were eligible. The R0 resection rate was 82 per cent. Clinical and pathological response rates were 65 and 51 per cent respectively. The 3- and 5-year overall survival rates were 59 and 53 per cent respectively. During chemotherapy, grade 3/4 neutropenia occurred in 19 per cent and grade 3/4 non-haematological adverse events in 15.4 per cent. The incidence of grade 3/4 adverse events related to surgery was 12 per cent. There were no reoperations or treatment-related deaths. CONCLUSION For locally advanced gastric cancer with extensive lymph node metastasis, 4-weekly S-1 plus cisplatin followed by surgery including PAN dissection was safe and effective for some patients. Further investigation of this treatment strategy is warranted.
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Affiliation(s)
- A Tsuburaya
- Shonan Kamakura General Hospital, Kamakura, Tokyo, Japan
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4
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Chong IY, Cunningham D, Barber LJ, Campbell J, Chen L, Kozarewa I, Fenwick K, Assiotis I, Guettler S, Garcia-Murillas I, Awan S, Lambros M, Starling N, Wotherspoon A, Stamp G, Gonzalez-de-Castro D, Benson M, Chau I, Hulkki S, Nohadani M, Eltahir Z, Lemnrau A, Orr N, Rao S, Lord CJ, Ashworth A. The genomic landscape of oesophagogastric junctional adenocarcinoma. J Pathol 2013; 231:301-10. [DOI: 10.1002/path.4247] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Irene Y Chong
- The Breakthrough Breast Cancer Research Centre; The Institute of Cancer Research; 237 Fulham Road, London SW3 6JB UK
- Cancer Research UK Gene Function Laboratory; The Institute of Cancer Research; 237 Fulham Road, London SW3 6JB UK
- Royal Marsden Hospital NHS Foundation Trust; Downs Road Sutton SM2 5PT UK
| | - David Cunningham
- Royal Marsden Hospital NHS Foundation Trust; Downs Road Sutton SM2 5PT UK
| | - Louise J Barber
- The Breakthrough Breast Cancer Research Centre; The Institute of Cancer Research; 237 Fulham Road, London SW3 6JB UK
- Cancer Research UK Gene Function Laboratory; The Institute of Cancer Research; 237 Fulham Road, London SW3 6JB UK
| | - James Campbell
- The Breakthrough Breast Cancer Research Centre; The Institute of Cancer Research; 237 Fulham Road, London SW3 6JB UK
- Cancer Research UK Gene Function Laboratory; The Institute of Cancer Research; 237 Fulham Road, London SW3 6JB UK
- Tumour Profiling Unit; The Institute of Cancer Research; 237 Fulham Road, London SW3 6JB UK
| | - Lina Chen
- Tumour Profiling Unit; The Institute of Cancer Research; 237 Fulham Road, London SW3 6JB UK
| | - Iwanka Kozarewa
- Tumour Profiling Unit; The Institute of Cancer Research; 237 Fulham Road, London SW3 6JB UK
| | - Kerry Fenwick
- Tumour Profiling Unit; The Institute of Cancer Research; 237 Fulham Road, London SW3 6JB UK
| | - Ioannis Assiotis
- Tumour Profiling Unit; The Institute of Cancer Research; 237 Fulham Road, London SW3 6JB UK
| | - Sebastian Guettler
- Structural Biology of Cell Signalling Laboratory; The Institute of Cancer Research; 237 Fulham Road, London SW3 6JB UK
| | - Isaac Garcia-Murillas
- The Breakthrough Breast Cancer Research Centre; The Institute of Cancer Research; 237 Fulham Road, London SW3 6JB UK
| | - Saima Awan
- The Breakthrough Breast Cancer Research Centre; The Institute of Cancer Research; 237 Fulham Road, London SW3 6JB UK
| | - Maryou Lambros
- The Breakthrough Breast Cancer Research Centre; The Institute of Cancer Research; 237 Fulham Road, London SW3 6JB UK
- Cancer Research UK Gene Function Laboratory; The Institute of Cancer Research; 237 Fulham Road, London SW3 6JB UK
- Tumour Profiling Unit; The Institute of Cancer Research; 237 Fulham Road, London SW3 6JB UK
| | - Naureen Starling
- Royal Marsden Hospital NHS Foundation Trust; Downs Road Sutton SM2 5PT UK
| | - Andrew Wotherspoon
- Royal Marsden Hospital NHS Foundation Trust; Downs Road Sutton SM2 5PT UK
| | - Gordon Stamp
- Royal Marsden Hospital NHS Foundation Trust; Downs Road Sutton SM2 5PT UK
| | | | - Martin Benson
- Royal Marsden Hospital NHS Foundation Trust; Downs Road Sutton SM2 5PT UK
| | - Ian Chau
- Royal Marsden Hospital NHS Foundation Trust; Downs Road Sutton SM2 5PT UK
| | - Sanna Hulkki
- Royal Marsden Hospital NHS Foundation Trust; Downs Road Sutton SM2 5PT UK
| | - Mahrokh Nohadani
- Royal Marsden Hospital NHS Foundation Trust; Downs Road Sutton SM2 5PT UK
| | - Zakaria Eltahir
- Royal Marsden Hospital NHS Foundation Trust; Downs Road Sutton SM2 5PT UK
| | - Alina Lemnrau
- Complex Trait Genetics Laboratory; The Institute of Cancer Research; London SW3 6JB UK
| | - Nicholas Orr
- Complex Trait Genetics Laboratory; The Institute of Cancer Research; London SW3 6JB UK
| | - Sheela Rao
- Royal Marsden Hospital NHS Foundation Trust; Downs Road Sutton SM2 5PT UK
| | - Christopher J Lord
- The Breakthrough Breast Cancer Research Centre; The Institute of Cancer Research; 237 Fulham Road, London SW3 6JB UK
- Cancer Research UK Gene Function Laboratory; The Institute of Cancer Research; 237 Fulham Road, London SW3 6JB UK
| | - Alan Ashworth
- The Breakthrough Breast Cancer Research Centre; The Institute of Cancer Research; 237 Fulham Road, London SW3 6JB UK
- Cancer Research UK Gene Function Laboratory; The Institute of Cancer Research; 237 Fulham Road, London SW3 6JB UK
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5
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Atanackovic D, Reinhard H, Meyer S, Spöck S, Grob T, Luetkens T, Yousef S, Cao Y, Hildebrandt Y, Templin J, Bartels K, Lajmi N, Stoiber H, Kröger N, Atz J, Seimetz D, Izbicki JR, Bokemeyer C. The trifunctional antibody catumaxomab amplifies and shapes tumor-specific immunity when applied to gastric cancer patients in the adjuvant setting. Hum Vaccin Immunother 2013; 9:2533-42. [PMID: 23955093 DOI: 10.4161/hv.26065] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Patients with gastric cancer benefit from perioperative chemotherapy, however, treatment is toxic and many patients will relapse. The trifunctional antibody catumaxomab targets EpCAM on tumor cells, CD3 on T cells, and the Fcγ-receptor of antigen-presenting cells. While in Europe catumaxomab is approved for treating malignant ascites, it has not been investigated in the perioperative setting and its exact immunological mode of action is unclear. METHODS In our study, gastric cancer patients received neoadjuvant platinum-based chemotherapy, one intraoperative application of catumaxomab, and 4 postoperative doses of intraperitoneal catumaxomab. Immunomonitoring was performed in 6 patients before surgery, after completion of catumaxomab treatment, and one month later. RESULTS Intraperitoneal application of catumaxomab caused an increased expression of activation markers on the patients' T cells. This was accompanied by a transient decrease in numbers of CXCR3(+) effector T cells with a T-helper (Th)-1 phenotype in the peripheral blood. All patients evidenced pre-existing EpCAM-specific CD4(+) and/or CD8(+) T cells. While these cells transiently disappeared from the blood stream after intraperitoneal application of catumaxomab, we detected increased numbers of peripheral EpCAM-specific cells and a modified EpCAM-specific T-cell repertoire 4 weeks after completion of treatment. Finally, catumaxomab also amplified humoral immunity to tumor antigens other than EpCAM. CONCLUSIONS Our findings suggest that catumaxomab exerts its clinical effects by (1) activating peripheral T cells, (2) redistributing effector T cells from the blood into peripheral tissues, (3) expanding and shaping of the pre-existing EpCAM-specific T-cell repertoire, and (4) spreading of anti-tumor immunity to different tumor antigens.
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Affiliation(s)
- Djordje Atanackovic
- Department of Internal Medicine II; Oncology/Hematology/Bone Marrow Transplantation with the section Pneumology; University Medical Center Hamburg-Eppendorf; Hamburg, Germany
| | - Henrike Reinhard
- Department of Internal Medicine II; Oncology/Hematology/Bone Marrow Transplantation with the section Pneumology; University Medical Center Hamburg-Eppendorf; Hamburg, Germany
| | - Sabrina Meyer
- Department of Internal Medicine II; Oncology/Hematology/Bone Marrow Transplantation with the section Pneumology; University Medical Center Hamburg-Eppendorf; Hamburg, Germany
| | - Stefanie Spöck
- Department of Internal Medicine II; Oncology/Hematology/Bone Marrow Transplantation with the section Pneumology; University Medical Center Hamburg-Eppendorf; Hamburg, Germany
| | - Tobias Grob
- Institute for Pathology; University Medical Center Hamburg-Eppendorf; Hamburg, Germany
| | - Tim Luetkens
- Department of Internal Medicine II; Oncology/Hematology/Bone Marrow Transplantation with the section Pneumology; University Medical Center Hamburg-Eppendorf; Hamburg, Germany
| | - Sara Yousef
- Department of Internal Medicine II; Oncology/Hematology/Bone Marrow Transplantation with the section Pneumology; University Medical Center Hamburg-Eppendorf; Hamburg, Germany
| | - Yanran Cao
- Department of Internal Medicine II; Oncology/Hematology/Bone Marrow Transplantation with the section Pneumology; University Medical Center Hamburg-Eppendorf; Hamburg, Germany
| | - York Hildebrandt
- Department of Stem Cell Transplantation; University Medical Center Hamburg-Eppendorf; Hamburg, Germany
| | - Julia Templin
- Department of Internal Medicine II; Oncology/Hematology/Bone Marrow Transplantation with the section Pneumology; University Medical Center Hamburg-Eppendorf; Hamburg, Germany
| | - Katrin Bartels
- Department of Internal Medicine II; Oncology/Hematology/Bone Marrow Transplantation with the section Pneumology; University Medical Center Hamburg-Eppendorf; Hamburg, Germany
| | - Nesrine Lajmi
- Department of Internal Medicine II; Oncology/Hematology/Bone Marrow Transplantation with the section Pneumology; University Medical Center Hamburg-Eppendorf; Hamburg, Germany
| | - Heribert Stoiber
- Division of Virology; Medical University IBK; Innsbruck, Austria
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation; University Medical Center Hamburg-Eppendorf; Hamburg, Germany
| | | | | | - Jakob R Izbicki
- Department of General, Visceral, and Thoracic Surgery; University Medical Center Hamburg-Eppendorf; Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Internal Medicine II; Oncology/Hematology/Bone Marrow Transplantation with the section Pneumology; University Medical Center Hamburg-Eppendorf; Hamburg, Germany
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6
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De Dosso S, Zanellato E, Nucifora M, Boldorini R, Sonzogni A, Biffi R, Fazio N, Bucci E, Beretta O, Crippa S, Saletti P, Frattini M. ERCC1 predicts outcome in patients with gastric cancer treated with adjuvant cisplatin-based chemotherapy. Cancer Chemother Pharmacol 2013; 72:159-65. [PMID: 23645290 DOI: 10.1007/s00280-013-2181-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 04/26/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Adjuvant chemotherapy is gaining an increasing role in resectable gastric cancer. Customizing chemotherapy on the basis of chemosensitivity may improve outcome, and putative predictive molecular markers have been mostly evaluated in Asian patients. We profiled key DNA and damage signaling factors and correlated them with outcome, in a European cohort. METHODS Formalin-fixed tumor samples obtained from surgical specimens of patients treated with adjuvant cisplatin-based chemotherapy for gastric cancer were analyzed. Immunohistochemistry (IHC) was performed to analyze excision repair cross-complementing gene 1 (ERCC1) and thymidylate synthase (TS) expression, and p53 mutations were detected with direct sequencing. RESULTS Among the 68 patient recruited, the median age was 69 (range 30-74), and UICC stage was III in 44 patients (65 %). With a median follow-up of 40.5 months, disease-free and overall survival were 18.0 (95 % CI 13.4-22.76) and 56 months (95 % CI 44.87-67.13), respectively. ERCC1 score was 0 in 14 out 67 (21 %) cases, 1 in 19 (28 %), 2 in 20 (30 %) and 3 in 14 cases (21 %). Longer overall survival (p = 0.04) was found in patients categorized as ERCC1 negative by IHC according to median score. TS score was 0 in 16 out 67 (24 %) cases, 1 in 27 (40 %), 2 in 16 (24 %) and 3 in 8 cases (12 %). Mutations of p53 were found in 21 out 66 (32 %) cases. Neither TS nor p53 were found to correlate with outcome. CONCLUSION Excision repair cross-complementing gene 1 by IHC might predict patients more likely to benefit from adjuvant cisplatin-based chemotherapy in curatively resected gastric cancer. In patients exhibiting ERCC1 positive tumors, alternative regimens should be evaluated.
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Affiliation(s)
- Sara De Dosso
- Oncology Institute of Southern Switzerland, 6500, Bellinzona, Switzerland.
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7
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Chen MF, Yang YH, Lai CH, Chen PC, Chen WC. Outcome of patients with esophageal cancer: a nationwide analysis. Ann Surg Oncol 2013; 20:3023-30. [PMID: 23525703 DOI: 10.1245/s10434-013-2935-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Esophageal cancer is 1 of the 10 most common cancers and is a particular devastating form of cancer worldwide. More than 90% patients with esophageal cancer in Taiwan have squamous cell carcinoma (SCC). In the present study, we assessed the factors affecting survival of patients with esophageal cancer using data from Taiwan, a high-incidence area for esophageal SCC. METHODS We performed a retrospective review of 12,482 patients who were newly diagnosed with esophageal cancer from 1998 to 2007. The data were obtained from the National Health Insurance Research Database in Taiwan. Study participants were followed-up until the end of 2008. RESULTS Of the 12,482 patients, 11,490 (92.1%) were male with a median age of 60 years, and 992 (7.9%) were female with a median age of 71 years at the time of diagnosis. The overall 1-, 2-, 5-, and 10-year survival rates after diagnosis were 40.3, 22.9, 12.8, and 7.6%, respectively. Among parametric models for esophageal cancer prognosis, male sex, no curative treatment (surgery and/or radiotherapy), old age, and low socioeconomic status were significantly associated with shorter survival. Furthermore, curative treatment with surgery improved the survival of esophageal cancer patients more significantly compared with patients who undergo definite radiotherapy. CONCLUSIONS Our data indicated that age, sex, and curative treatment were significant predictors of lifetime survival in patients with esophageal cancer. The overall survival rates of patients with esophageal cancer are relatively low, while survival of patients who undergo surgery is improved significantly.
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Affiliation(s)
- Miao-Fen Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
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Risk factors of peritoneal recurrence in eso-gastric signet ring cell adenocarcinoma: results of a multicentre retrospective study. Eur J Surg Oncol 2013; 39:235-41. [PMID: 23313257 DOI: 10.1016/j.ejso.2012.12.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 12/12/2012] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The poor prognosis of signet ring cell (SRC) eso-gastric adenocarcinoma (EGA) might be explained by its great affinity for the peritoneum. The aim of this study was to identify predictors of peritoneal carcinomatosis recurrence (PCR) after curative surgery and hence identify high risk patients. METHODS A retrospective national survey was conducted over 19 French surgical centers between 1997 and 2010. Patients with non-metastatic disease who benefited from curative surgery without postoperative death were included. Event-free patients who did not reach the time point of 24 months were excluded. RESULTS In a cohort of 3010 patients, 1050 were SRC EGA and 424 patients met the selection criteria. The tumor location was mainly gastric (68.9%) and a total gastrectomy was performed in 218 patients (51.4%). Chemoradiotherapy or chemotherapy alone was given preoperatively to 71 (16.7%) and postoperatively to 150 (35.4%) patients. After a median follow-up of 54 months, recurrence was diagnosed in 214 patients (50.5%) within a mean delay of 17 ± 10.7 months. PCR was diagnosed in 81 patients (19.1%). In multivariable analysis, four factors were identified as predictors of PCR: linitis plastica (p < 0.001; OR = 4.83), tumor invasion of/or through the peritoneal serosa (p = 0.022; OR = 1.58), lymph node involvement (p = 0.005; OR = 1.7) and tumors of gastric origin (p = 0.026; OR = 2.36), with PCR rates of 55%, 26%, 23% and 22%, respectively. CONCLUSION Identification of strong predictors for PCR among this large series of SRC EGA patients helps to identify subgroups of patients that may benefit from specific therapeutic strategies such as prophylactic hyperthermic intraperitoneal chemotherapy.
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Sterzing F, Grenacher L, Debus J. Radiotherapy of gastroesophageal junction cancer. Recent Results Cancer Res 2012; 196:187-99. [PMID: 23129375 DOI: 10.1007/978-3-642-31629-6_13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Adenocarcinomas of the gastroesophageal junction (GEJ) require multimodal treatment approaches to accomplish good local control and overall survival. While early T1/2 N0 tumors are treated with surgery alone, they are only found in a small subset of patients due to the lack of symptoms at this stage. Most of the tumors are detected in locally advanced stage where surgery alone results in disappointing outcome. Chemotherapy and/or chemoirradiation in the neoadjuvant setting are used to improve conditions for oncological surgery. They aim to achieve a downsizing with a pathological complete remission in the optimal case, improve R0 rates, and upfront treat microscopic metastatic tumor cells. The optimal neoadjuvant treatment approach-chemotherapy, chemoirradiation, or a multiphase approach of both-is yet unclear. Chemoirradiation can improve local control after incomplete surgery and is an important option for patients unfit for surgery. In addition, it enables symptom relief in a palliative setting, namely dysphagia, pain, or bleeding. While target volumes are very much standardized, new technologies as image-guided intensity-modulated radiotherapy (IG-IMRT) and particle therapy have the potential to improve the therapeutic window by minimizing toxicity. Challenges of the present and the future will be the combination of radiotherapy with other cytostatic drugs and modern targeted therapies. This should ideally be integrated into a multimodal setting that is able to identify risk groups according to predictive markers and tumor response, altogether leading to a personalized oncological approach.
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Affiliation(s)
- Florian Sterzing
- Department of Radiation Oncology, INF 400, 69120, Heidelberg, Germany.
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10
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Llaguna OH, Kim HJ, Deal AM, Calvo BF, Stitzenberg KB, Meyers MO. Utilization and morbidity associated with placement of a feeding jejunostomy at the time of gastroesophageal resection. J Gastrointest Surg 2011; 15:1663-9. [PMID: 21796458 DOI: 10.1007/s11605-011-1629-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Accepted: 07/12/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND The purpose of the study was to evaluate the utilization and morbidity associated with feeding jejunostomy tubes (JT) placed at the time of gastroesophageal resection (GER). METHODS Under institutional review board approval, a prospective database of patients undergoing GER from January 2004 to September 2010 was reviewed. Data analyzed included patient demographics, postoperative complications, JT use, and JT specific complications. Fisher's exact tests explored associations with utilization of a JT following resection. RESULTS Seventy-three patients (51 men, 22 women, median age of 59) underwent placement of a JT at the time of GER (total gastrectomy = 28, Ivor-Lewis = 28, subtotal gastrectomy = 8, proximal gastrectomy = 6, and transhiatal esophagectomy = 3) of both malignant (97%) and benign (3%) disease processes. Twenty-one JT specific complications (11 minor and 10 major) were identified. Reoperation was required in the management of two complications (small bowel obstructions), while all other complications were easily managed by an interventional radiologist (n = 8), bedside procedure (n = 5), or did not require intervention (n = 6). Eighty-six percent of patients were discharged tolerating a postgastrectomy diet, 10% nothing per orem, and 4% a liquid diet. Inpatient enteral nutrition (EN) was initiated in 68%, but continued on discharge in only 54% secondary to failure to thrive (54%), dysphagia (21%), anastomic leak (15%), chyle leak (3%), esophagostomy (3%), and duodenal stump leak (3%). The mean time to discontinuance of EN and removal of the JT was 44 days (range, 4-203) and 71 days (range, 15-337) respectively. Although only 13% (n = 5) of patients requiring adjuvant therapy were utilizing their JT at the commencement of therapy, 75% (n = 21) required EN during its course. The median time to adjuvant therapy was found to be slightly longer in those who required outpatient EN versus those who did not (61 vs. 90 days, p = 0.08). However, the median time to adjuvant therapy did not differ between those who were and were not receiving EN at the time of adjuvant therapy commencement (80 vs. 92 days, p = 0.2). Age (p = 0.4), number of co-morbidities (p = 0.2), preoperative percent body weight loss (p = 0.9), and clinical stage (p = 0.8) were not significantly associated with outpatient JT use. Patients who suffered a postoperative complication were most likely to require EN (p = 0.002), an association that strengthened as the number of complications increased (p = 0.0008). Although not statistically significant, a trend towards increased outpatient EN was noted in patients who underwent transhiatal esophagectomy and total gastrectomy (p = 0.06). CONCLUSIONS JT placement carries a considerable morbidity in patients undergoing GER. However, because it is difficult to preoperatively ascertain who will need prolonged EN, the routine placement of a JT is recommended, particularly in those who will likely require adjuvant therapy or are at high risk for postoperative complications. Despite patient desires for early removal of an unused JT, caution should be taken if adjuvant therapy is being considered.
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Affiliation(s)
- Omar H Llaguna
- Division of Surgical Oncology & Endocrine Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
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11
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Zhang X, Li N, Wei W, Yao W, Xie K, Hu J, Shen L, Ji W, Lu Y, Wen F, Jiang Y, Xu F, Feng H, Bi F, Li Q. Clinical management of gastric cancer: results of a multicentre survey. BMC Cancer 2011; 11:369. [PMID: 21864355 PMCID: PMC3224384 DOI: 10.1186/1471-2407-11-369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2010] [Accepted: 08/24/2011] [Indexed: 02/05/2023] Open
Abstract
Background The National Comprehensive Cancer Network clinical practice guidelines in oncology-gastric cancer guidelines have been widely used to provide appropriate recommendations for the treatment of patients with gastric cancer. The aim of this study was to examine the adherence of surgical oncologists, medical oncologists, and radiation oncologists' to the recommended guidelines. Methods A questionnaire asking the treatment options for gastric cancer cases was sent to 394 Chinese oncology specialists, including surgical oncologists, medical oncologists, and radiation oncologists working in hospitals joined in The Western Cooperative Gastrointestinal Oncology Group of China. The questionnaire involved a series of clinical scenarios regarding the interpretation of surgery, neoadjuvant, adjuvant, and advanced treatment planning of gastric cancer. Results Analysis of 358 respondents (91%) showed variations between each specialization and from the recommended guidelines in the management approaches to specific clinical scenarios. The majority of specialists admitted that less than 50% of patients received multidisciplinary evaluation before treatment. The participants gave different responses to questions involving adjuvant, neoadjuvant, and advanced settings, compared to the recommended guidelines. Conclusions These results highlight the heterogeneity of the treatment of gastric cancer. Surgical oncologists, medical oncologists, and radiation oncologists are not adhering to the recommended guidelines.
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Affiliation(s)
- Xiaolong Zhang
- The Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University; No, 37, Guo Xue Xiang, Chengdu, Sichuan, 610041, China
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