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Chen KN. ASO Author Reflections: On the Sources of Dispute in the Treatment of Cervical Esophageal Cancer. Ann Surg Oncol 2024:10.1245/s10434-024-16051-9. [PMID: 39150620 DOI: 10.1245/s10434-024-16051-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 08/01/2024] [Indexed: 08/17/2024]
Affiliation(s)
- Ke-Neng Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), The First Department of Thoracic Surgery, Peking University Cancer Hospital and Institute, Peking University School of Oncology, Beijing, China.
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2
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Mehta A, Vadgaonkar RA, Lewis S, Mahantshetty U, Agarwal JP. Definitive chemo-radiotherapy in cervical oesophageal cancer: a comprehensive review of literature. Rep Pract Oncol Radiother 2024; 29:391-408. [PMID: 39144270 PMCID: PMC11321780 DOI: 10.5603/rpor.100777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/16/2024] [Indexed: 08/16/2024] Open
Abstract
Background and Objectives Despite decades of experience with definitive chemo-radiotherapy (CRT) in cervical oesophageal cancer (CEC), the loco-regional control and survival outcomes are dismal. This review evaluated the outcomes of various treatment strategies being commonly utilized. Materials and methods A literature review was conducted to identify relevant articles on CEC published from years 2000-2023 addressing the predefined key questions. These questions focussed on the comparative outcomes of various primary treatment approaches (surgery, CRT, or trimodality treatment) and the radiation dose schedules, volumes, and techniques. Results CRT is the standard approach for treatment for CEC so far. The potential role of surgery and trimodality approach in settings of evolving surgical approaches needs to be validated. The high dose schedules that are preferentially practiced in CEC have not shown any benefit in improving the disease outcomes over the standard dose schedule of 50.4 Gy. The target volume delineation practice of elective nodal irradiation (ENI) does not have a proven benefit over the involved field irradiation (IFI). The limited evidence on radiation techniques suggests that intensity-modulated radiotherapy/volumetric-modulated arc therapy (IMRT/VMAT) techniques can improve toxicity profile over three-dimensional conformal radiotherapy (3DCRT), but no advantage proven in disease outcomes so far. Conclusion This review will guide clinicians in decision-making for the management of this relatively rare entity and the directions for future research in these areas. Future large-scale multicentre prospective studies are needed for validating and standardizing our current practices and exploring potential options to improve the outcomes.
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Affiliation(s)
- Ankita Mehta
- Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - Shirley Lewis
- Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Umesh Mahantshetty
- Radiation Oncology, Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, India
| | - JP Agarwal
- Radiation Oncology, Tata Memorial Hospital, Mumbai, India
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3
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Tchelebi LT, Goodman KA. Esophagogastric Cancer: The Current Role of Radiation Therapy. Hematol Oncol Clin North Am 2024; 38:569-583. [PMID: 38485552 DOI: 10.1016/j.hoc.2024.02.001] [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: 05/06/2024]
Abstract
Radiation therapy is an effective treatment modality in the management of patients with esophageal cancer regardless of tumor location (proximal, middle, or distal esophagus) or histology (squamous cell vs adenocarcinoma). The addition of neoadjuvant CRT to surgery in patients who are surgical candidates has consistently shown a benefit in terms of locoregional recurrence, pathologic downstaging, and overall survival. For patients who are not surgical candidates, CRT has a role as definitive treatment.
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Affiliation(s)
- Leila T Tchelebi
- Northwell, Lake Success, NY, USA; Department of Radiation Medicine, Northern Westchester Hospital, 400 East Main Street, Mount Kisco, NY 10549, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Karyn A Goodman
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1128, New York, NY 10029-6574, USA. https://twitter.com/KarynAGoodman
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Lee Y, Yun J, Jeon YJ, Lee J, Park SY, Cho JH, Kim HK, Choi YS, Shim YM. Surgical Outcomes of Cervical Esophageal Cancer: A Single-Center Experience. J Chest Surg 2024; 57:62-69. [PMID: 38174892 DOI: 10.5090/jcs.23.085] [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: 07/04/2023] [Revised: 09/26/2023] [Accepted: 10/20/2023] [Indexed: 01/05/2024] Open
Abstract
Background Cervical esophageal cancer is a rare malignancy that requires specialized care. While definitive chemoradiation is the standard treatment approach, surgery remains a valuable option for certain patients. This study examined the surgical outcomes of patients with cervical esophageal cancer. Methods The study involved a retrospective review and analysis of 24 patients with cervical esophageal cancer. These patients underwent surgical resection between September 1994 and December 2018. Results The mean age of the patients was 61.0±10.2 years, and 22 (91.7%) of them were male. Furthermore, 21 patients (87.5%) had T3 or T4 tumors, and 11 (45.8%) exhibited lymph node metastasis. Gastric pull-up with esophagectomy was performed for 19 patients (79.2%), while 5 (20.8%) underwent free jejunal graft with cervical esophagectomy. The 30-day operative mortality rate was 8.3%. During the follow-up period, complications included leakage at the anastomotic site in 9 cases (37.5%) and graft necrosis of the gastric conduit in 1 case. Progression to oral feeding was achieved in 20 patients (83.3%). Fifteen patients (62.5%) displayed tumor recurrence. The median time from surgery to recurrence was 10.5 months, and the 1-year recurrence rate was 73.3%. The 1-year and 3-year survival rates were 75% and 33.3%, respectively, with a median survival period of 17 months. Conclusion Patients with cervical esophageal cancer who underwent surgical resection faced unfavorable outcomes and relatively poor survival. The selection of cases and decision to proceed with surgery should be made cautiously, considering the risk of severe complications.
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Affiliation(s)
- Yoonseo Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeonghee Yun
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeong Jeong Jeon
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Junghee Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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5
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Wu X, Zhu MC, Li GL, Xiong P, Sun W, Zhang N, Zhao B, Li LQ, Fu XN, Zhu M. Treatment and survival analysis for 40-year SEER data on upper esophageal cancer. Front Med (Lausanne) 2023; 10:1128766. [PMID: 37529246 PMCID: PMC10387539 DOI: 10.3389/fmed.2023.1128766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/21/2023] [Indexed: 08/03/2023] Open
Abstract
Background Upper esophageal cancer (UEC) is rare in both Eastern and Western countries. The epidemiological characteristics and long-term survival of UEC patients are less known. In addition, the choice of optimal treatment for UEC has been controversial. Methods Cases of UEC (C15.3 and C15.0) arising during the period from 1973 to 2013 were identified and selected using the SEER database. Student's t-test and Pearson's chi-square test were used to compare the differences in parameters among different groups. Esophageal cancer-specific survival (ECSS) and overall survival (OS) rates were calculated by using the Kaplan-Meier method. Cox proportional hazard regression was used to analyze predictive factors. Results In the past 40 years, the cases of UEC have gradually increased, and the proportion of adenocarcinoma (AD) has gradually increased (from 3.6% to 11.8%, p < 0.001). There has been a significant increase (1973-1982 vs. 2004-2013) in median OS (7 months vs. 10 months, p < 0.001) and median ECSS (7 months vs. 11 months, p < 0.001) among UEC patients from 1973 to 2013. For the impact of different treatments, the results showed that the ECSS and OS of surgery without radiation (SWR) and radiation plus surgery (R+S) were superior to those of radiation without surgery (RWS). Subgroup analysis showed that ECSS and OS were highest among patients treated with SWR compared with R+S and RWS for patients with localized disease. For regional disease, ECSS and OS were highest among patients with R+S compared with SWR or RWS. Among patients with regional-stage squamous cell carcinoma (SCC), OS was higher with neoadjuvant radiotherapy or adjuvant radiotherapy compared with SWR. Multivariate analysis showed that radiotherapy sequence was dependently associated with OS among patients with regional-stage SCC. Conclusion Although the long-term survival of UEC remains poor, it has gradually increased since 1973. This should be closely related to the improvement of medical care over the past 40 years. Different treatment methods have a great influence on the long-term survival of UEC. For localized diseases, surgery may be a better choice. For regional disease, surgery plus adjuvant or neoadjuvant radiotherapy may be more beneficial to improve the long-term prognosis of UEC patients.
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Affiliation(s)
- Xi Wu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming-Chuang Zhu
- Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Guo-Liang Li
- Department of Radiation Oncology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Peng Xiong
- Intensive Care Unit, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Sun
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ni Zhang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Zhao
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Le-Qun Li
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang-Ning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Zhu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Qi K, Lin G, Liu H, Zhang X, Chen Z, Li J. Comparison between radical surgery and chemoradiotherapy in patients with cervical esophageal cancer: a propensity score matched analysis. BMC Surg 2023; 23:119. [PMID: 37170089 PMCID: PMC10176790 DOI: 10.1186/s12893-023-02029-z] [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: 01/25/2023] [Accepted: 05/06/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND The prognostic value of radical surgery (RS) and chemoradiotherapy (CRT) for cervical esophageal cancer (CEC) was estimated using the Surveillance, Epidemiology and End Results (SEER) database after 1:1 propensity score matching (PSM). METHODS This retrospective study used SEER data of CEC patients between 2004 and 2015. The prognostic effects on cancer-specific survival (CSS) were evaluated using multivariate cox regression analysis following radical surgery or CRT before and after PSM. The subgroup analysis of CSS is carried out according to T stages. RESULTS A total of 440 patients met the eligibility criteria. Three hundred and fifty-six(80.9%)patients underwent chemoradiotherapy, and eighty-four (19.1%) patients underwent radical surgery. There were significant differences between patients of radical surgery and CRT groups with regard to the tumor grade, histology and N stage. After PSM, 80 matched pairs (A total of 160 patients) were selected. Multivariable cox regression analysis revealed no difference in the CSS of patients that underwent either radical surgery or CRT before [hazard ratio (HR): 0.955, 95% CI: 0.704-1.295, P = 0.766] and after PSM (HR: 0.767, 95% CI: 0.512-1.149, P = 0.198). Subgroup analysis revealed no significant difference in CSS between patients with radical surgery and CRT groups for all T stages (T 1-4, all P > 0.05). CONCLUSIONS This analysis revealed that the prognostic outcomes in patients with cervical esophageal cancer were comparable between radical surgery and CRT.
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Affiliation(s)
- Kang Qi
- Department of Thoracic surgery, Peking University First Hospital, Xishiku str.8, 100034 Xicheng District, Beijing, China.
| | - Gang Lin
- Department of Thoracic surgery, Peking University First Hospital, Xishiku str.8, 100034 Xicheng District, Beijing, China
| | - Haibo Liu
- Department of Thoracic surgery, Peking University First Hospital, Xishiku str.8, 100034 Xicheng District, Beijing, China
| | - Xining Zhang
- Department of Thoracic surgery, Peking University First Hospital, Xishiku str.8, 100034 Xicheng District, Beijing, China
| | - Zhimao Chen
- Department of Thoracic surgery, Peking University First Hospital, Xishiku str.8, 100034 Xicheng District, Beijing, China
| | - Jian Li
- Department of Thoracic surgery, Peking University First Hospital, Xishiku str.8, 100034 Xicheng District, Beijing, China
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Nakagawa M, Nakajima M, Inoue N, Takise S, Kikuchi M, Kubo T, Muroi H, Morita S, Nakamura T, Kojima K. Segmental cervical esophagectomy with free jejunal flap reconstruction for cervical esophageal cancer in patients with previous history of gastric surgery: a report of two cases. Clin J Gastroenterol 2023:10.1007/s12328-023-01804-y. [PMID: 37165274 DOI: 10.1007/s12328-023-01804-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/12/2023] [Indexed: 05/12/2023]
Abstract
Although free-flap jejunal reconstruction is frequently performed after cervical esophagectomy for cervical esophageal cancer, the procedure after gastric surgery has not been reported. We encountered two patients with esophageal cancer and previous gastric surgeries who eventually underwent segmental esophagectomy with free-flap jejunal reconstruction. Case one involved a 75-year-old man who underwent abdominal abscess and duodenal ulcer perforation surgeries (abdominal drainage and subsequent gastrojejunal bypass). A type 0-IIa tumor was located posterior to the cervical esophagus's right wall, 21 cm from the incisor, without lymph node swelling or distant metastasis. The left lobe of the thyroid gland was mobilized to ensure an oral resection margin. Severe abdominal adhesions required careful adhesiolysis to harvest the jejunum (20 cm long) 40 cm from the jejunojejunostomy. An end-to-side and side-to-end esophagojejunostomy were performed for the proximal and distal ends, respectively. Case two involved a 75-year-old male with a history of distal gastrectomy with Billroth I reconstruction for early gastric cancer. A submucosal tumor-like lesion was located on the cervical esophageal wall on the left side, 21 cm from the incisor. The distal esophagus required additional segmental resection because the anal resection line was close to the tumor. Jejunum (10 cm long) 30 cm from Ligament of Treitz was harvested. An end-to-side and end-to-end esophagojejunostomy for the proximal and distal ends, respectively, was performed. This surgery requires a thorough preoperative examination to ensure an adequate surgical margin and a careful free-flap harvest based on post-gastric surgery anatomy.
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Affiliation(s)
- Masatoshi Nakagawa
- Department of Upper Gastrointestinal Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotsuga-Gun, Tochigi, 321-0293, Japan.
| | - Masanobu Nakajima
- Department of Upper Gastrointestinal Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotsuga-Gun, Tochigi, 321-0293, Japan
| | - Noboru Inoue
- Department of Upper Gastrointestinal Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotsuga-Gun, Tochigi, 321-0293, Japan
| | - Shuhei Takise
- Department of Upper Gastrointestinal Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotsuga-Gun, Tochigi, 321-0293, Japan
| | - Maiko Kikuchi
- Department of Upper Gastrointestinal Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotsuga-Gun, Tochigi, 321-0293, Japan
| | - Tsukasa Kubo
- Department of Upper Gastrointestinal Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotsuga-Gun, Tochigi, 321-0293, Japan
| | - Hiroto Muroi
- Department of Upper Gastrointestinal Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotsuga-Gun, Tochigi, 321-0293, Japan
| | - Shinji Morita
- Department of Upper Gastrointestinal Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotsuga-Gun, Tochigi, 321-0293, Japan
| | - Takatoshi Nakamura
- Department of Surgical Oncology, Dokkyo Medical University Graduate School of Medicine, Tochigi, Japan
| | - Kazuyuki Kojima
- Department of Upper Gastrointestinal Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotsuga-Gun, Tochigi, 321-0293, Japan
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De Virgilio A, Costantino A, Festa BM, Mercante G, Franceschini D, Franzese C, Scorsetti M, Marrari A, Cavina R, Marano S, Castoro C, Spriano G. Reply to Letter to the Editor regarding "Oncological outcomes of squamous cell carcinoma of the cervical esophagus treated with definitive (chemo-)radiotherapy: a systematic review and meta-analysis". J Cancer Res Clin Oncol 2023; 149:1369-1371. [PMID: 36309603 DOI: 10.1007/s00432-022-04441-z] [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: 10/15/2022] [Accepted: 10/18/2022] [Indexed: 11/29/2022]
Abstract
In a previous study, we performed a meta-analysis of the oncological outcomes of patients suffering from cervical esophageal squamous cell carcinoma treated with definitive chemoradiotherapy. Further analysis was performed, and a random effect modeling showed a pooled local-regional failure rate of 41.4% (95% CI 32.2-50.8), and a pooled distant failure rate of 21.6% (95% CI 17.0-26.5). The included studies used a median radiotherapy (RT) dose of 61.2 Gy (95% CI 60.0-62.0, range 56.0-66.0), but we measured a non-significant impact of the RT dose on the pooled overall survival (OS), suggesting that an increased RT dose might not be related to an improved OS (p = 0.23). Further research should be conducted to define predictors and prognostic categories that may select the best treatment option for each patient.
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Affiliation(s)
- Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Davide Franceschini
- Radiotherapy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Ciro Franzese
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Radiotherapy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Radiotherapy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Andrea Marrari
- Oncology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Raffaele Cavina
- Oncology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Salvatore Marano
- Division of Upper Gastrointestinal SurgeryDepartment of Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Carlo Castoro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Division of Upper Gastrointestinal SurgeryDepartment of Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
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Oncological outcomes of squamous cell carcinoma of the cervical esophagus treated with definitive (chemo-)radiotherapy: a systematic review and meta-analysis. J Cancer Res Clin Oncol 2023; 149:1029-1041. [PMID: 35235020 DOI: 10.1007/s00432-022-03965-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/21/2022] [Indexed: 12/11/2022]
Abstract
PURPOSE To determine the oncological outcomes of cervical esophageal squamous cell carcinoma (CESCC) treated with definitive chemoradiotherapy (CRT). METHODS A systematic review and meta-analysis was performed according to the PRISMA guidelines. RESULTS A total of 1222 patients (median age: 63.0 years, 95% CI 61.0-65.0) were included from 22 studies. The median follow-up time was 34.0 months (n = 1181, 95% CI 26.4-36.0). Estimated pooled OS rates (95% CI) at 1, 3, and 5 years were 77.9% (73.9-82.2), 48.4% (43.2-54.3), and 35.3% (29.7-41.9), respectively. The median OS (95% CI) was 33.4 months (25.8-42.2). Estimated pooled PFS rates (n = 595; 95% CI) at 1, 3, and 5 years were 64.1% (57.9-71.0), 38.0% (33.3-45.5), and 29.8% (23.9-37.1), respectively. The median PFS (95% CI) was 19.8 months (14.9-26.6). CONCLUSIONS Definitive CRT is a valuable first-line treatment for the management of CESCC. Further studies should focus on survival predictors able to define stage-based clinical guidelines.
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Chakrabarty N, Mahajan A, Prabhash K, Patil P, Chowhan M, Munmmudi N, Niyogi D, Dabkara D, Singh S, Singh A, Devarmani S, Dhull VS. Imaging Recommendations for Diagnosis, Staging, and Management of Esophageal Cancer. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1760324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
AbstractEarly staging and treatment initiation affect prognosis of patients with esophageal and esophagogastric junction cancer; hence, it is imperative to have knowledge of proper choice of imaging modality for staging of these patients, to effectively convey relevant imaging findings to the treating physician/surgeon. It is also essential to be aware of pertinent imaging findings that need to be conveyed to the treating physician/surgeon at staging, and after treatment, including post-therapy complications (if any), so as to provide timely management to such patients. In this article, we have provided imaging guidelines for diagnosis, staging, post-therapy response evaluation, follow-up, and assessment of post-therapy complications of esophageal and esophagogastric junction cancer in a systematic manner. Besides, risk factors and clinical workup have also been elucidated. We have also attached comprehensive staging and post-therapy contrast-enhanced computed tomography and fluorodeoxyglucose-positron emission tomography/computed tomography-based synoptic reporting formats “ECI-RADS” and “pECI-RADS,” respectively, for esophageal and esophagogastric junction cancer in the supplement, for effective communication of imaging findings between a radiologist and the treating physician/surgeon.
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Affiliation(s)
- Nivedita Chakrabarty
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Abhishek Mahajan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Prachi Patil
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Manoranjan Chowhan
- Department of Nuclear Medicine and PET/CT, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
| | - Naveen Munmmudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Devayani Niyogi
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Deepak Dabkara
- Department of Oncology, CHL Hospitals, Indore, Madhya Pradesh, India
| | - Suryaveer Singh
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ajaykumar Singh
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sanjana Devarmani
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Varun Singh Dhull
- Department of Nuclear Medicine and PET/CT, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
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11
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Patel DC, Yang CFJ, Liou DZ, Berry MF. Treatment and Outcomes of Proximal Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 2023; 30:818-827. [PMID: 36305985 DOI: 10.1245/s10434-022-12683-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/22/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION This study evaluated the treatment of proximal (cervical or upper thoracic) esophageal squamous cell carcinoma (SCC), for which chemoradiation is the recommended therapy. METHODS Treatment and outcomes of patients with cT1-3N0-1M0 proximal esophageal SCC in the National Cancer Database between 2004 and 2016 was evaluated using logistic regression, Kaplan-Meier analysis, and propensity-score matching. RESULTS Therapy of 2159 patients was chemoradiation (n = 1500, 69.5%), no treatment (n = 205, 9.5%), surgery (n = 203, 9.4%), radiation alone (n = 190, 8.8%), and chemotherapy alone (n = 61, 2.8%). Factors associated with definitive therapy with either chemoradiation or surgery were younger age, non-Black race, being insured, cervical tumor location, clinical T2 and T3 stage, clinical nodal involvement, and treatment at a research/academic program. Five-year survival was significantly better in patients treated with definitive therapy than patients not treated definitively (34.0% vs. 13.3%, p < 0.001). In multivariable survival analysis, receiving definitive therapy (hazard ratio [HR] 0.39, p = 0.017) was associated with improved survival, while increasing age, male sex, clinical T3 stage, positive clinical nodal involvement, and increasing Charlson Comorbidity Index were associated with worse survival. Esophagectomy was not associated with improved survival in multivariable analysis of the definitive therapy cohort (HR 0.84, p = 0.08) or propensity matched analysis. However, the pathologic complete response was only 33.3% (40/120) for patients who did have an esophagectomy after chemoradiation. CONCLUSIONS This national analysis supports definitive chemoradiation for not only cervical but also proximal thoracic esophageal SCC. Routine surgery does not appear to be necessary but may have a role in patients with residual disease after chemoradiation.
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Affiliation(s)
- Deven C Patel
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Douglas Z Liou
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Mark F Berry
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA, USA. .,VA Palo Alto Health Care System, Palo Alto, CA, USA.
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Oncological outcomes of cervical esophageal cancer treated primarily with surgery: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2023; 280:373-390. [PMID: 35969248 DOI: 10.1007/s00405-022-07589-z] [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: 05/29/2022] [Accepted: 08/03/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To determine the oncological outcomes of cervical esophageal cancer (CEC) treated primarily with surgery. METHODS A systematic review and meta-analysis was performed according to the PRISMA guidelines. RESULTS A total of 868 patients were included from 18 studies. Estimated pooled Overall Survival (OS) rates (95% Confidence Interval, CI) at 1 and 5 years were 74.4% (66.5-83.3), and 26.6% (20.3-34.7), respectively. Larynx non-preserving surgery (n = 229) showed an estimated pooled OS rates (95% CI) at 1 and 5 years of 59.3% (51.5-68.2) and 14.6% (8.8-24.3), respectively. On the other hand, larynx preserving surgery (n = 213) showed an estimated pooled OS rates (95% CI) at 1 and 5 years of 83.6% (78.2-89.4) and 35.1% (24.9-49.6), respectively. CONCLUSIONS Primary larynx-preserving surgery remains a valuable option for the management of CEC, with similar survival outcomes compared to primary chemoradiotherapy (CRT). On the other hand, larynx non-preserving surgery showed a significantly reduced survival, that may reflect the more advanced T classification of these tumors. Further studies are mandatory to directly compare primary surgery and primary CRT, distinguishing larynx preserving and non-preserving surgery.
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13
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Gui Z, Hu W, Kong Q, Liu C, Xu Y, Wang F. Esophageal stenosis as an independent factor of poor prognosis in patients with ESCC treated with definitive chemoradiotherapy. Future Oncol 2022; 18:4193-4207. [PMID: 36651337 DOI: 10.2217/fon-2022-0125] [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: 01/19/2023] Open
Abstract
Aim: To evaluate the clinical outcome and elucidate the prognostic factors in patients with esophageal squamous cell carcinoma (ESCC) treated with definitive chemoradiotherapy (CRT). Patients: Data for patients newly diagnosed with ESCC receiving definitive CRT at our institution between 2012 and 2018 were retrospectively reviewed. Results: A total of 201 patients were included. Severe stenosis after radiotherapy was an independent factor relevant to prognosis. Maximal esophageal wall thickness, short-term responses, severe stenosis at diagnosis and a high neutrophil-to-lymphocyte ratio were independent risk factors for the occurrence of severe stenosis after radiotherapy. Conclusion: Severe stenosis after radiotherapy is a useful predictive indicator in patients with ESCC receiving definitive CRT. Further studies are needed to verify these findings.
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Affiliation(s)
- Zhongxuan Gui
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People's Republic of China
| | - Wenjun Hu
- Department of Radiation Oncology, Anhui Chest Hospital, Hefei, Anhui, 230022, People's Republic of China
| | - Qi Kong
- Department of Radiation Oncology, Anhui Second People's Hospital, Hefei, Anhui, 230012, People's Republic of China
| | - Can Liu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People's Republic of China
| | - Yuechen Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People's Republic of China
| | - Fan Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People's Republic of China
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Pharyngeal-Esophageal Malignancies with Dermatologic Paraneoplastic Syndrome. Life (Basel) 2022; 12:life12111705. [PMID: 36362860 PMCID: PMC9693568 DOI: 10.3390/life12111705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 12/24/2022] Open
Abstract
Systemic changes often send signals to the skin, and certain neoplastic diseases of the internal organs can also trigger skin manifestations. In this article, the authors make clinical photography presentations of the patients seen at our clinic with dermatologic paraneoplastic syndromes within pharyngeal–esophageal malignancies, describe several paraneoplastic dermatoses, and also review high-quality scientific literature in order to be able to highlight the dermatological signs of pharyngoesophageal malignant tumors. The majority of our patients with paraneoplastic dermatoses, filtering for pharyngoesophageal malignancies, had esophageal neoplasms, out of whom seven were female and two were male, making esophageal cancer more common within the paraneoplastic dermatoses within pharyngoesophageal malignancies. An early recognition of paraneoplastic dermatoses can diagnose neoplasms and sequentially contribute to a better prognosis for the patient. This matter is also useful for front-line medical personnel in order to improve early diagnosis of the underlying malignancy, curative interventions with prompt therapy administration and good prognosis.
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Liu Y, Huang N, Xu W, Liu J, An C, Zhu Y, Liu S, Zhang Z. A modified tracheal transection approach for cervical esophageal lesion treatment: A report of 13 cases. Front Surg 2022; 9:1001488. [PMID: 36338615 PMCID: PMC9634415 DOI: 10.3389/fsurg.2022.1001488] [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: 07/23/2022] [Accepted: 10/03/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Surgical interventions for tumors in the cervical esophageal region are complicated and laryngeal function is frequently sacrificed. Therefore, we attempted the tracheal transection approach to resect the tumor while preserving laryngeal function. METHODS Three patients with papillary thyroid cancer (PTC), six with cervical esophageal cancer (CEC), and four with CEC mixed with thoracic esophageal cancer (TEC) were enrolled. The esophagus was exposed after the trachea was transected between the second and third tracheal rings. CEC/TEC: Resection of the esophagus or/and a portion of the hypopharynx with acceptable safety margins and repair with free jejunum or tubular stomach. PTC: Suture the small esophageal incision immediately after removing the tumor. The tracheal dissection was repaired with interrupted sutures throughout the entire layer after the esophageal lesion was resected. The status of the recurrent laryngeal nerve (RLN) determined whether a tracheotomy was necessary. RESULTS All 13 patients had effective esophageal lesion excision, with six of them requiring intraoperative tracheotomy. Postoperative complications included a tracheoesophageal fistula (one case, 7.7%), postoperative RLN paralysis (two cases, 15.4%), and aspiration (three cases, 23.1%). Except for two patients with distant metastases, there was no recurrence in the remaining patients after 5-92 months of follow-up. CONCLUSION The tracheal transection approach, as a new surgical technique, can retain laryngeal function while ensuring appropriate exposure and satisfactory surgical resection. Before surgery, the feasibility of this approach must be carefully assessed. The RLN should be protected during the procedure. The operation is both safe and effective, with a wide range of applications.
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Affiliation(s)
- Yang Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nan Huang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Xu
- Department of Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jie Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changming An
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiming Zhu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shaoyan Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zongmin Zhang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,Correspondence: Zongmin Zhang
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16
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Jin L, Chen Q, Shi A, Wang X, Ren R, Zheng A, Song P, Zhang Y, Wang N, Wang C, Wang N, Cheng X, Wang S, Ge H. Deep Learning for Automated Contouring of Gross Tumor Volumes in Esophageal Cancer. Front Oncol 2022; 12:892171. [PMID: 35924169 PMCID: PMC9339638 DOI: 10.3389/fonc.2022.892171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/21/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose The aim of this study was to propose and evaluate a novel three-dimensional (3D) V-Net and two-dimensional (2D) U-Net mixed (VUMix-Net) architecture for a fully automatic and accurate gross tumor volume (GTV) in esophageal cancer (EC)–delineated contours. Methods We collected the computed tomography (CT) scans of 215 EC patients. 3D V-Net, 2D U-Net, and VUMix-Net were developed and further applied simultaneously to delineate GTVs. The Dice similarity coefficient (DSC) and 95th-percentile Hausdorff distance (95HD) were used as quantitative metrics to evaluate the performance of the three models in ECs from different segments. The CT data of 20 patients were randomly selected as the ground truth (GT) masks, and the corresponding delineation results were generated by artificial intelligence (AI). Score differences between the two groups (GT versus AI) and the evaluation consistency were compared. Results In all patients, there was a significant difference in the 2D DSCs from U-Net, V-Net, and VUMix-Net (p=0.01). In addition, VUMix-Net showed achieved better 3D-DSC and 95HD values. There was a significant difference among the 3D-DSC (mean ± STD) and 95HD values for upper-, middle-, and lower-segment EC (p<0.001), and the middle EC values were the best. In middle-segment EC, VUMix-Net achieved the highest 2D-DSC values (p<0.001) and lowest 95HD values (p=0.044). Conclusion The new model (VUMix-Net) showed certain advantages in delineating the GTVs of EC. Additionally, it can generate the GTVs of EC that meet clinical requirements and have the same quality as human-generated contours. The system demonstrated the best performance for the ECs of the middle segment.
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Affiliation(s)
- Linzhi Jin
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
- Department of Radiation Oncology, Anyang Tumor Hospital, The Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang, China
| | - Qi Chen
- Department of Research and Development, MedMind Technology Co, Ltd., Beijing, China
| | - Aiwei Shi
- Department of Research and Development, MedMind Technology Co, Ltd., Beijing, China
| | - Xiaomin Wang
- Department of Radiation Oncology, Anyang Tumor Hospital, The Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang, China
| | - Runchuan Ren
- Department of Radiation Oncology, Anyang Tumor Hospital, The Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang, China
| | - Anping Zheng
- Department of Radiation Oncology, Anyang Tumor Hospital, The Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang, China
| | - Ping Song
- Department of Radiation Oncology, Anyang Tumor Hospital, The Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang, China
| | - Yaowen Zhang
- Department of Radiation Oncology, Anyang Tumor Hospital, The Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang, China
| | - Nan Wang
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Chenyu Wang
- Department of Radiation Oncology, Anyang Tumor Hospital, The Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang, China
| | - Nengchao Wang
- Department of Radiation Oncology, Anyang Tumor Hospital, The Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang, China
| | - Xinyu Cheng
- Department of Radiation Oncology, Anyang Tumor Hospital, The Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang, China
| | - Shaobin Wang
- Department of Research and Development, MedMind Technology Co, Ltd., Beijing, China
| | - Hong Ge
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
- *Correspondence: Hong Ge,
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17
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Guler OC, Onal C. Oncological outcomes of squamous cell carcinoma of the cervical esophagus treated with definitive (chemo‑)radiotherapy: a systematic review and meta‑analysis. In regard to De Virgilio et al. J Cancer Res Clin Oncol 2022; 148:2567-2568. [PMID: 35697858 DOI: 10.1007/s00432-022-04118-7] [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: 03/09/2022] [Accepted: 04/06/2022] [Indexed: 11/27/2022]
Abstract
This is a significant study that shows that definitive chemo-radiotherapy is an effective treatment option for cervical esophageal squamous cell carcinoma. We are curious, though, whether local control has any effect on survival.
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Affiliation(s)
- Ozan Cem Guler
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, 01120, Adana, Turkey
| | - Cem Onal
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, 01120, Adana, Turkey.
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey.
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18
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SEOM-GEMCAD-TTD Clinical Guideline for the diagnosis and treatment of esophageal cancer (2021). Clin Transl Oncol 2022; 24:658-669. [PMID: 35347573 PMCID: PMC8986732 DOI: 10.1007/s12094-022-02801-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 12/12/2022]
Abstract
Esophageal cancer is an aggressive tumor, and is the sixth-leading cause of death from cancer. Incidence is rising in Spain, particularly among men. Two main pathological different subtypes have been described: squamous cell carcinoma and adenocarcinoma. Growing evidence of their epidemiology and molecular differences explains their different response to novel treatments, and they are therefore likely to be treated as two separate entities in the near future. The best results are obtained with a multidisciplinary therapeutic strategy, and the introduction of immunotherapy is a promising new approach that will improve prognosis. In these guidelines, we review the evidence for the different methods of diagnosis and therapeutic strategies that form the basis of our standard of care.
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A Ferroptosis-Related lncRNA Model to Enhance the Predicted Value of Cervical Cancer. JOURNAL OF ONCOLOGY 2022; 2022:6080049. [PMID: 35178090 PMCID: PMC8847040 DOI: 10.1155/2022/6080049] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 11/23/2022]
Abstract
Background Cervical cancer (CC) is a common gynecological malignant tumor. Ferroptosis is a new type of programmed cell death, which plays a crucial part in cancer. However, current knowledge regarding ferroptosis-related long noncoding RNAs (lncRNAs) in CC is still limited. Therefore, our aim is to identify ferroptosis-related lncRNAs, build a steady prediction model, and improve the prediction value of CC. Methods We obtained RNA expression and ferroptosis-related gene data of female CC patients from TCGA and FerrDb databases, respectively. Then, the ferroptosis-related lncRNAs were obtained by the limma R package and Cytoscape 3.7.1. We constructed the prediction model by Cox regression analysis. Finally, the prediction model was verified by the median risk score, Kaplan–Meier analysis, the time-dependent receiver operating characteristic (ROC) curve, clinical features, and immunoinfiltration analysis. Results We acquired 1393 ferroptosis-related lncRNAs. The ferroptosis-related lncRNA signature was obtained by multivariate Cox regression analysis, and the patients were divided into a high-risk group and a low-risk group. The prognosis of the high-risk group was worse than that of the low-risk group. We found that the risk score can be used as an independent prognostic index by multivariate Cox regression analysis. The area under the time-dependent ROC curve reached 0.847 at 1 year, 0.906 at 2 years, 0.807 at 3 years, and 0.724 at 5 years in the training cohort. Principal component analysis showed that the diffusion directions of the two groups were different. Gene set enrichment analysis indicated that lncRNAs of two groups may be involved in tumorigenesis. Further analysis showed that high-risk groups were related to immune-related pathways. Ferroptosis-related lncRNAs are related to the proportion of tumor-infiltrating immune cells in CC. Conclusion We have constructed a ferroptosis-related lncRNA prediction model. The prognostic model had important clinical significance, including improving the predictive value and guiding the individualized treatment of CC patients.
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Yao W, Wang J, Zhu L, Jia X, Xu L, Tian X, Hu S, Wu S, Wei L. Epigenetic Regulator KDM4D Restricts Tumorigenesis via Modulating SYVN1/HMGB1 Ubiquitination Axis in Esophageal Squamous Cell Carcinoma. Front Oncol 2021; 11:761346. [PMID: 34820329 PMCID: PMC8606580 DOI: 10.3389/fonc.2021.761346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/18/2021] [Indexed: 12/27/2022] Open
Abstract
Background Increasing researches have been reported that epigenetic alterations play critical roles in ESCC development. However, the role of the histone demethylase KDM4D in ESCC tumorigenesis is poorly investigated. This study aims to discover the underlying mechanisms between KDM4D and ESCC progression. Methods CCK-8 assays, clone formation assay and soft-agar assays were performed to assess cell proliferation. Transwell assay was utilized to assess cell migration efficiency, while sphere formation assay was used to evaluate the cell self-renewal ability. Bioinformatic analysis was conducted to identify prognostic factors and predict the potential E3 ubiquitin ligases. In vitro ubiquitination assay was conducted to confirm the regulations between SYVN1 and HMGB1. The mRNA levels or protein levels of genes were detected by real-time PCR and western blot analysis. In vivo tumor xenograft models were used to determine whether the HMGB1 inhibition affected the malignant features of ESCC cells. Result Epigenome screening and low-throughput validations highlighted that KDM4D is a tumor suppressor in ESCC. KDM4D expressed lowly in tumors that predicts poor prognosis. KDM4D deficiency significantly enhanced tumor growth, migration and stemness. Mechanistically, KDM4D transcriptionally activates SYVN1 expressions via H3K9me3 demethylation at the promoter region, thereby triggering the ubiquitin-dependent degradation of HMGB1. Low KDM4D depended on accumulated HMGB1 to drive ESCC progression and aggressiveness. Targeting HMGB1 (Glycyrrhizin) could remarkably suppress ESCC tumor growth in vitro and in vivo, especially in KDM4D-deficient cells. Conclusions We systematically identified KDM4D/SYVN1/HMGB1 axis in ESCC progression, proving novel biomarkers and potential therapeutic targets.
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Affiliation(s)
- Wenjian Yao
- Department of Thoracic Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, Zhengzhou, China
| | - Jianjun Wang
- Department of Thoracic Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, Zhengzhou, China
| | - Li Zhu
- Department of Thoracic Surgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xiangbo Jia
- Department of Thoracic Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, Zhengzhou, China
| | - Lei Xu
- Department of Thoracic Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, Zhengzhou, China
| | - Xia Tian
- Department of Thoracic Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, Zhengzhou, China
| | - Shuai Hu
- Department of Thoracic Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, Zhengzhou, China
| | - Sen Wu
- Department of Thoracic Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, Zhengzhou, China
| | - Li Wei
- Department of Thoracic Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, Zhengzhou, China
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21
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Lu Y, Xu C, Wang H, Song T, Wu S, Liang X, Xu H. Long-Term Survival Outcomes and Comparison of Different Treatment Modalities for Stage I-III Cervical Esophageal Carcinoma. Front Med (Lausanne) 2021; 8:714619. [PMID: 34631736 PMCID: PMC8492900 DOI: 10.3389/fmed.2021.714619] [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] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/26/2021] [Indexed: 12/11/2022] Open
Abstract
Purpose: To investigate the survival outcomes, prognostic factors and treatment modalities of stage I-III cervical esophageal carcinoma (CEC) patients using data from the Surveillance, Epidemiology, and End Results (SEER) database from the period 2004–2016. Methods: Patients with a histopathologic diagnosis of CEC were included. The primary endpoint was overall survival (OS). Univariate and multivariate analyses of OS were performed using Cox proportional hazards models, and OS was compared using the Kaplan-Meier method and log-rank test. Results: A total of 347 patients in the SEER database were enrolled. The median OS was 14.0 months, with a 5-year OS rate of 20.9%. The parameters that were found to significantly correlate with OS in the multivariate analysis were age at diagnosis [P < 0.001, hazard ratio (HR) = 1.832], sex [P < 0.001, HR= 1.867], histology [P = 0.001, HR = 0.366], surgery at the primary site [P = 0.021, HR = 0.553], radiotherapy (RT, P = 0.017, HR = 0.637) and chemotherapy (CT, P < 0.001, HR = 0.444). Comparison among the three treatment modalities demonstrated that a triple therapy regimen consisting of surgery, RT and CT was associated with a longer survival time than the other two treatment modalities before and after propensity score matching (PSM). However, triple therapy showed no significant survival benefit over double therapy (P = 0.496 before PSM and P = 0.184 after PSM). Conclusions: The survival of patients with CEC remains poor. Surgery, RT and CT were all strongly correlated with OS. We recommend a triple therapy regimen for select CEC patients based on the findings of the current study, although this recommendation should be further confirmed by prospective studies with large sample sizes.
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Affiliation(s)
- Yanwei Lu
- Department of Radiation Oncology, Oncology Center of Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Chenwang Xu
- Department of Applied Physics, Hangzhou Medical College, Hangzhou, China
| | - Haitao Wang
- Department of Thoracic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Tao Song
- Department of Radiation Oncology, Oncology Center of Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Shixiu Wu
- Department of Radiation Oncology, The Second Affiliated & Yuying Children's Hospital Wenzhou Medical University, Wenzhou, China
| | - Xiaodong Liang
- Department of Radiation Oncology, Oncology Center of Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Hong'en Xu
- Department of Radiation Oncology, Oncology Center of Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
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Chen P, Zhao X, Zhou F, Song X, Hu S, Jin Y, Wang X, Han X, Fan Z, Wang R, Li B, Han W, Wang P, Li J, Wan L, Zhang L, Bao Q, Chang F, Qin Y, Chang Z, Ku J, Yang H, Yuan L, Ren J, Li X, Wang L. Characterization of 500 Chinese patients with cervical esophageal cancer by clinicopathological and treatment outcomes. Cancer Biol Med 2021; 17:219-226. [PMID: 32296589 PMCID: PMC7142830 DOI: 10.20892/j.issn.2095-3941.2019.0268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/19/2019] [Indexed: 01/12/2023] Open
Abstract
Objective: There are no comprehensive studies on survival outcomes and optimal treatment protocols for cervical esophageal cancer (CEC), due to its rare clinical prevalence. Our objective was to determine the relationship between pathological characteristics, treatment protocols, and survival outcomes in Chinese CEC patients. Methods: A total of 500 Chinese CEC patients were selected from our 500,000 esophageal and gastric cardia carcinoma database (1973–2018). There were two main groups: patients treated with surgery, and patients receiving non-surgical treatments (radiotherapy, radiochemotherapy, and chemotherapy). The Chi-square test and Kaplan–Meier method were used to compare the continuous variables and survival. Results: Among the 500 CEC patients, 278 (55.6%) were male, and the median age was 60.9 ± 9.4 years. A total of 496 patients (99.2%) were diagnosed with squamous cell carcinoma. In 171 (34.2%) patients who received surgery, 22 (12.9%) had undergone laryngectomy. In 322 (64.4%) patients who received non-surgical treatments, 245 (76.1%) received radiotherapy. Stratified survival analysis showed that only T stage was related with survival outcomes for CEC patients in the surgical group, and the outcomes between laryngectomy and non-laryngectomy patients were similar. It was noteworthy that the 5-year survival rate was similar in CEC patients among the different groups treated with surgery, radiotherapy, chemotherapy, or radiochemotherapy (P = 0.244). Conclusions: The CEC patients had similar survival outcomes after curative esophagectomy and radiotherapy, including those with or without total laryngectomy. These findings suggest that radiotherapy could be the initial choice for treatment of Chinese CEC patients.
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Affiliation(s)
- Peinan Chen
- State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Xueke Zhao
- State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Fuyou Zhou
- State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.,Department of Thoracic Surgery, Anyang Tumor Hospital, Anyang 455000, China
| | - Xin Song
- State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Shoujia Hu
- State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Yan Jin
- State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.,Department of Histology and Embryology, School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang 453000, China
| | - Xianzeng Wang
- Department of Thoracic Surgery, Linzhou People's Hospital, Linzhou 456550, China
| | - Xuena Han
- State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Zongmin Fan
- State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Ran Wang
- State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Bei Li
- State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Wenli Han
- State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.,Department of Pathology and Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450000, China
| | - Panpan Wang
- State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Jilin Li
- Department of Pathology, Linzhou Esophageal Cancer Hospital, Linzhou 456550, China
| | - Lixin Wan
- Department of Oncology, Nanyang Central Hospital, Nanyang 473000, China
| | - Liguo Zhang
- Department of Thoracic Surgery, Xinxiang Central Hospital, Xinxiang 453000, China
| | - Qide Bao
- Department of Oncology, Anyang District Hospital, Anyang 455000, China
| | - Fubao Chang
- Department of Thoracic Surgery, Linzhou Center Hospital, Linzhou 456550, China
| | - Yanru Qin
- State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.,Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Zhiwei Chang
- State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.,Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Jianwei Ku
- Department of Gastroenterology, The Second Affiliated Hospital of Nanyang Medical College, Nanyang 473000, China
| | - Haijun Yang
- Department of Pathology, Anyang Tumor Hospital, Anyang 455000, China
| | - Ling Yuan
- Department of Radiotherapy, The Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou 450000, China
| | - Jingli Ren
- Department of Pathology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Xuemin Li
- Department of Pathology, Hebei Provincial Cixian People's Hospital, Cixian 056500, China
| | - Lidong Wang
- State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
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23
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Xu L, Chen XK, Xie HN, Wang Z, Qin JJ, Li Y. Treatment and Prognosis of Resectable Cervical Esophageal Cancer: A Population-based Study. Ann Thorac Surg 2021; 113:1873-1881. [PMID: 34329601 DOI: 10.1016/j.athoracsur.2021.06.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The optimal treatment strategy for resectable cervical esophageal cancer (CEC) remains controversial. This study aimed to explore prognostic factors and optimal treatment strategies in the context of staging. METHODS In this population-based study, 1371 patients with resectable CEC were identified in the SEER database. Univariate analysis and multivariable Cox regression model were performed to evaluate factors related to overall survival (OS). Subgroup analysis based on staging was performed to assess the effect of treatments on survival and propensity score matching (PSM) was conducted to adjust confounding factors. RESULTS Univariate and multivariable analyses revealed that age, sex, year of diagnosis, histological type, tumor size, cN stage, surgery, radiotherapy and chemotherapy are independent prognostic factors. After PSM, patients with local disease (cT1-2N0M0) who received surgery alone had a higher 10-year OS rate than those received chemoradiotherapy (CRT) (20.7% vs. 11.4%, p = 0.023). Compared with CRT, surgery-based multimodal therapy did not increase the OS rate of patients (14.8% vs. 11.1%, p = 0.084). For regional disease (cT3-4aN0M0/cT1-4aN1-3M0), although surgery alone did not improve the OS rate of patients compared with CRT (7.3% vs. 8.2%, p = 0.18), we observed a significant difference in 10-year OS among patients who underwent surgery-based multimodal therapy versus those who underwent CRT (20.4% vs. 9.0%, p = 0.031). CONCLUSIONS Compared with CRT, surgery alone improves the long-term survival of patients with localized disease, and surgery-based multimodal therapy increases the survival rate of patients with regional disease. Further studies are required to confirm our findings.
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Affiliation(s)
- Lei Xu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xian-Kai Chen
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hou-Nai Xie
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhen Wang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Jun Qin
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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24
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Wang SX, Marshall MB. Chemoradiation Therapy as Definitive Treatment of Esophageal Cancer. Surg Clin North Am 2021; 101:443-451. [PMID: 34048764 DOI: 10.1016/j.suc.2021.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Definitive chemoradiation therapy avoids the perioperative and long-term morbidity of esophagectomy and is the standard of care for cervical esophageal cancer. There are significant differences in tumor response to chemoradiation and recurrence patterns between squamous cell cancer and adenocarcinoma of the esophagus. Multimodality therapy for esophageal cancer continues to progress, now with the widespread use of PET scanning and possible active surveillance in patients with complete clinical response to chemoradiation. As drug development and targeted therapy trials continue to expand, our understanding of tumor biology and precision medicine will continue to refine the treatment of esophageal cancer.
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Affiliation(s)
- Sue Xue Wang
- Division of Thoracic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - M Blair Marshall
- Division of Thoracic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Division of Thoracic Surgery, West Roxbury VA Medical Center, 1400 VFW Pkwy, West Roxbury, MA 02132, USA.
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25
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Abstract
Trimodality therapy, or the use of concurrent chemoradiation followed by surgery, is the cornerstone of contemporary management of esophageal cancer. This article discusses the landmark trials and most current data to understand the concepts, applications, and outcomes from trimodality therapy in locally advanced esophageal cancer.
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Affiliation(s)
- Ammara A Watkins
- Division of Thoracic Surgery and Interventional Pulmonology, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA 02215, USA
| | - Jessica A Zerillo
- Division of Medical Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Shapiro 9, Boston, MA 02215, USA
| | - Michael S Kent
- Division of Thoracic Surgery and Interventional Pulmonology, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA 02215, USA.
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26
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Abstract
Salvage esophagectomy is an option for patients with recurrent or persistent esophageal cancer after definitive chemoradiation therapy or those who undergo active surveillance after induction chemoradiation therapy. Salvage resection is associated with higher rates of morbidity compared with planned esophagectomy but offers patients with locally advanced disease a chance at improved long-term survival. Salvage resection should be preferentially performed in a multidisciplinary setting by high-volume and experienced surgeons. Technical considerations, such as prior radiation dosage, radiation field, and choice of conduit, should be taken into account.
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27
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Li CC, Chen CY, Chou YH, Huang CJ, Ku HY, Chien CR. Optimal radiotherapy dose in cervical esophageal squamous cell carcinoma patients treated with definitive concurrent chemoradiotherapy: A population based study. Thorac Cancer 2021; 12:2065-2071. [PMID: 34028200 PMCID: PMC8287021 DOI: 10.1111/1759-7714.14009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The optimal radiotherapy dose for locally advanced cervical esophageal squamous cell carcinoma (C-ESqCC) treated with definitive concurrent chemoradiotherapy (dCCRT) is unclear. Here, we aimed to compare the survival of those treated with high dose versus standard dose via a population based approach. METHODS Eligible C-ESqCC patients diagnosed between 2011 and 2017 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance observable potential confounders between groups. The hazard ratio (HR) of death and incidence of esophageal cancer mortality (IECM) were compared between high (60-70 Gy) and standard dose (50-50.4 Gy). We also evaluated the outcome in supplementary analyses via alternative approaches. RESULTS Our primary analysis consisted of 141 patients in whom covariates were well balanced after PS weighting. The HR of death when high dose was compared with standard dose was 0.65 (95% confidence interval [CI]: 0.4-1.03, p = 0.07). The HR of IECM was 0.74 (p = 0.45). The HR of OS remained similarly insignificant in supplementary analyses. CONCLUSIONS We observed a trend in favor of high radiotherapy dose versus standard dose for C-ESqCC treated with dCCRT in this population-based nonrandomized study. Further studies are needed to confirm the findings of the study.
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Affiliation(s)
- Chia-Chin Li
- Department of Radiation Oncology, China Medical University Hsinchu Hospital, Hsinchu, Republic of China
| | - Chih-Yi Chen
- Division of Thoracic Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung, Republic of China.,Institute of Medicine, Chung Shan Medical University, Taichung, Republic of China
| | - Ying-Hsiang Chou
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Republic of China.,Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Republic of China
| | - Chih-Jen Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Republic of China
| | - Hsiu-Ying Ku
- National Institute of Cancer Research, National Health Research Institutes, Miaoli, Republic of China.,Department of Healthcare Administration, Asia University, Taichung, Republic of China
| | - Chun-Ru Chien
- Department of Radiation Oncology, China Medical University Hsinchu Hospital, Hsinchu, Republic of China.,School of Medicine, College of Medicine, China Medical University, Taichung, Republic of China.,Department of Radiation Oncology, China Medical University Hospital, Taichung, Republic of China
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28
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Januszewicz W, Trzebinski K, Lenarcik M, Cencelewicz-Lesikow A, Kaminski MF, Regula J. Adenocarcinoma of the cervical esophagus arising within a long segment of Barrett's metaplasia. Endoscopy 2021; 53:E112-E113. [PMID: 32668473 DOI: 10.1055/a-1207-0455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Wladyslaw Januszewicz
- Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland.,Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Krzysztof Trzebinski
- Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - Malgorzata Lenarcik
- Department of Pathology and Diagnostic Laboratory, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Anna Cencelewicz-Lesikow
- Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - Michal F Kaminski
- Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland.,Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jaroslaw Regula
- Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland.,Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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29
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de Vos-Geelen J, Geurts SME, Nieuwenhuijzen GAP, Voncken FEM, Bogers JA, Braam PM, Muijs CT, de Jong MA, Kasperts N, Rozema T, Blom GJ, Bouwense SAW, Valkenburg-van Iersel LBJ, Jeene PM, Hoebers FJP, Tjan-Heijnen VCG. Patterns of recurrence following definitive chemoradiation for patients with proximal esophageal cancer. Eur J Surg Oncol 2021; 47:2016-2022. [PMID: 33583629 DOI: 10.1016/j.ejso.2021.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/20/2020] [Accepted: 02/01/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The aim of this retrospective study was to determine the patterns of recurrence and overall survival (OS) in patients achieving clinical complete response after treatment with definitive chemoradiation (CRT) for proximal esophageal cancer. MATERIALS AND METHODS Patients with proximal esophageal cancer treated with CRT between 2004 and 2014 in 11 centers in the Netherlands were included. OS and progression-free survival (PFS) were calculated using the Kaplan-Meier method. Cumulative incidence of first recurrence (locoregional or distant) and locoregional recurrence (LRR) were assessed using competing risk analyses. RESULTS In 197 of the 200 identified patients, response was evaluated, 133 (68%) showed a complete response. In complete responders, median OS, three-year OS, and PFS were 45.0 months (95% CI 34.8-61.5 months), 58% (95% CI 48-66), and 49% (95% CI 40-57), respectively. Three- and five-year risk of recurrence were respectively 40% (95% CI 31-48), and 45% (95% CI 36-54). Three- and five-year risk of LRR were 26% (95% CI 19-33), and 30% (95% CI 22-38). Eight of 32 patients with an isolated LRR underwent salvage surgery, with a median OS of 32.0 months (95% CI 6.8-not reached). CONCLUSION In patients with a complete response after definitive CRT for proximal esophageal cancer, most recurrences were locoregional and developed within the first three years after CRT. These findings suggest to shorten locoregional follow-up from five to three years.
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Affiliation(s)
- J de Vos-Geelen
- Dept. of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. box 5800, 6202, AZ, Maastricht, the Netherlands.
| | - S M E Geurts
- Dept. of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. box 5800, 6202, AZ, Maastricht, the Netherlands
| | - G A P Nieuwenhuijzen
- Dept. of Surgery, Catharina Hospital Eindhoven, P.O. box 1350, 5602, ZA, Eindhoven, the Netherlands
| | - F E M Voncken
- Dept. of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, P.O. box 90203, 1006, BE, Amsterdam, the Netherlands
| | - J A Bogers
- Radiotherapiegroep Arnhem, P.O. box 60160, 6800, JD, Arnhem, the Netherlands
| | - P M Braam
- Dept. of Radiotherapy, RadboudUMC, P.O. box 9101, 6500, HB, Nijmegen, the Netherlands
| | - C T Muijs
- Dept. of Radiation Oncology, University Medical Center Groningen, University of Groningen, P.O. box 11120, 9700, RB, Groningen, the Netherlands
| | - M A de Jong
- Dept. of Clinical Oncology, Leiden University Medical Centre, P.O. box 9699, 2300, RC, Leiden, the Netherlands
| | - N Kasperts
- Dept. of Radiotherapy, University Medical Center Utrecht, P.O. box 85500, 3508, GA, Utrecht, the Netherlands
| | - T Rozema
- Insituut Verbeeten, P.O. box 90120, 5000, LA, Tilburg, the Netherlands
| | - G J Blom
- Dept. of Radiation Oncology, Amsterdam University Medical Centers, VU University, P.O. box 7057, 1007, MB, Amsterdam, the Netherlands
| | - S A W Bouwense
- Dept. of Surgery, Maastricht University Medical Center, P.O. box 5800, 6202, AZ, Maastricht, the Netherlands
| | - L B J Valkenburg-van Iersel
- Dept. of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. box 5800, 6202, AZ, Maastricht, the Netherlands
| | - P M Jeene
- Dept. of Radiotherapy, Amsterdam University Medical Centers, University of Amsterdam, P.O. box 22660, 1100, DD, Amsterdam, the Netherlands; Radiotherapiegroep Deventer, P.O. box 123, 7400, AC, Deventer, the Netherlands
| | - F J P Hoebers
- Dept. of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. box 3035, 6202, NA, Maastricht, the Netherlands
| | - V C G Tjan-Heijnen
- Dept. of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. box 5800, 6202, AZ, Maastricht, the Netherlands
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30
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Wang C, Tong J, Tang M, Lu Y, Liang G, Zhang Z, Chen T. Pretreatment Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Prognostic Factors and Reference Markers of Treatment Options for Locally Advanced Squamous Cell Carcinoma Located in the Middle and Upper Esophagus. Cancer Manag Res 2021; 13:1075-1085. [PMID: 33574705 PMCID: PMC7872927 DOI: 10.2147/cmar.s294344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/11/2021] [Indexed: 01/04/2023] Open
Abstract
Background Various inflammatory biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), have been well authenticated to predict clinical outcomes in numerous types of cancer. The optimal treatment for patients with locally advanced esophageal squamous cell carcinoma (ESCC) located in the middle or upper region is still inconclusive. The aim of the study was to examine pretreatment NLR and PLR to select from radical surgery or definitive chemoradiotherapy (dCRT) for these patients. The linkage between pretreatment NLR/PLR and prognosis was also analyzed. Methods NLR and PLR were calculated in 113 locally advanced ESCC located in the middle or upper esophagus of patients who underwent radical surgery or dCRT between January 2014 and December 2019. A receiver operating characteristic curve was plotted to select the best cut-off value of NLR and PLR for predicting survival. A survival curve was plotted using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were applied to assess predictors for survival. Results NLR and PLR were associated with the extent of lymph node metastasis (NLR: P = 0.045; PLR: P = 0.002). Additionally, high PLR and recurrence with distant organ metastasis were closely related (P = 0.014), and NLR was related to the tumor stage (P = 0.043). The results of the multivariate analysis revealed that NLR (>2.07) and PLR (>183.06) were independently associated with poor prognosis. It is noteworthy that surgery was associated with a superior OS compared with dCRT in the low NLR population (P = 0.045). Conclusion Low pretreatment NLR patients are fit to undergo radical surgery with a substantial therapeutic benefit. Pretreatment NLR and PLR are independent predictors for patients with locally advanced ESCC located in the middle and upper esophagus who underwent radical surgery or dCRT.
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Affiliation(s)
- Chen Wang
- Department of Gastroenterology, Ningbo Medical Center, Lihuili Hospital, Ningbo, People's Republic of China
| | - Jiaqi Tong
- Department of Hematology, Ningbo Medical Center, Lihuili Hospital, Ningbo, People's Republic of China
| | - Mengqiu Tang
- Department of Radiation Oncology, Ningbo Medical Center, Lihuili Hospital, Ningbo, People's Republic of China
| | - Yunyun Lu
- Department of Radiation Oncology, Ningbo Medical Center, Lihuili Hospital, Ningbo, People's Republic of China
| | - Gaofeng Liang
- Department of Thoracic Surgery, Ningbo Medical Center, Lihuili Hospital, Ningbo, People's Republic of China
| | - Zhanchun Zhang
- Department of Radiation Oncology, Ningbo Medical Center, Lihuili Hospital, Ningbo, People's Republic of China
| | - Tian Chen
- Department of Radiation Oncology, Ningbo Medical Center, Lihuili Hospital, Ningbo, People's Republic of China
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31
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Zhao W, Huang Z, Liu H, Wang C. LncRNA GIHCG Promotes the Development of Esophageal Cancer by Modulating miR-29b-3p/ANO1 Axis. Onco Targets Ther 2020; 13:13387-13400. [PMID: 33408485 PMCID: PMC7781470 DOI: 10.2147/ott.s282348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/27/2020] [Indexed: 12/12/2022] Open
Abstract
Background Esophageal cancer is one of the most frequent cancers with a higher mortality worldwide. Although many long non-coding RNAs (LncRNAs) are reported to play important roles in the progression of esophageal cancer, the function of lncRNA GIHCG in esophageal cancer remains unclear. Methods The expression of GIHCG in esophageal cancer tissues and cancer cell lines was detected by qRT-PCR. Cell proliferation was evaluated by Cell Counting Kit-8 (CCK-8) assay, EdU staining assay and colony formation assay. Cell invasion and migration were measured by transwell assay. Cell apoptosis was detected by a flow cytometer. Luciferase reporter assay and RIP assay were used to determine the interaction between GIHCG and miR-29b-3p, and their subsequent regulation of anoctamin 1 (ANO1). The expression of ANO1 in esophageal cancer tissues and cell lines was detected by Western blot. The effect of GIHCG/miR-29b-3p in tumor formation was assessed by the xenograft nude mice model in vivo. Results GIHCG was significantly upregulated in esophageal cancer tissues and relevant cancer cell lines. Downregulation of GIHCG significantly inhibited the growth, colony formation, invasion, migration and induced apoptosis of esophageal cancer cells in vitro. Bioinformatic analysis and RIP assay determined that GIHCG was a sponge of miR-29b-3p, and ANO1 was a direct target of miR-29b-3p. Moreover, functional experiments showed that GIHCG upregulated ANO1 expression by directly sponging miR-29b-3p. Furthermore, in vivo experiment revealed that knockdown of GIHCG significantly inhibited tumor growth in nude mice. Conclusion Our study revealed that lncRNA GIHCG promoted the progression of esophageal cancer by targeting the miR-29b-3p/ANO1 axis, suggesting that GIHCG might be a novel therapeutic target for esophageal cancer.
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Affiliation(s)
- Weifeng Zhao
- Department of Oncology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou City, Henan Province 450003, People's Republic of China
| | - Zhoufeng Huang
- Department of Oncology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou City, Henan Province 450003, People's Republic of China.,Institute of Hematology, Henan Provincial People's Hospital, Zhengzhou City, Henan Province 450003, People's Republic of China
| | - Huimin Liu
- Department of Oncology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou City, Henan Province 450003, People's Republic of China
| | - Chaojie Wang
- Department of Oncology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou City, Henan Province 450003, People's Republic of China
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Watanabe A, Taniguchi M, Kimura Y, Kikkawa T, Hosokawa M. Larynx-preserving hybrid surgery with endoscopic laryngopharyngeal surgery and open surgery for cervical esophageal cancer invading pharynx. Dis Esophagus 2020; 33:5827017. [PMID: 32350502 DOI: 10.1093/dote/doaa020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/25/2020] [Accepted: 01/29/2020] [Indexed: 12/11/2022]
Abstract
Larynx preserving hybrid surgery with endoscopic laryngopharyngeal surgery and open surgery (HELPS) was created for resectable cervical esophageal cancer (CEC) invading the hypopharynx. This study aimed to verify the effectiveness and to evaluate the feasibility of the new HELPS treatment method. Between 2014 and 2018, 19 patients with CEC invading the hypopharynx were treated with HELPS. The postoperative complications and survival rates were reviewed. Postoperative recurrent laryngeal nerve paralysis occurred in four patients. All patients consumed food orally without a feeding tube at the time of the discharge. The median follow-up period was 27 months. The 2- and 3-year overall survival rates were 94.7 and 71.5%, respectively. HELPS, a new surgical treatment method that utilizes endoscopic surgery, is effective, feasible and beneficial for preserving the larynx in patients with CEC even if the tumor invaded the pharynx.
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Affiliation(s)
- Akihito Watanabe
- Department of Otolaryngology, Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
| | - Masanobu Taniguchi
- Department of Otolaryngology, Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
| | - Yuki Kimura
- Department of Otolaryngology, Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
| | - Tomohiro Kikkawa
- Department of Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
| | - Masao Hosokawa
- Department of Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
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Dong D, Zhao D, Li S, Liu W, Du F, Xu X, Xiao S, Zheng B, Sun Y, Wang W. Nomogram to predict overall survival for patients with non-metastatic cervical esophageal cancer: a SEER-based population study. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1588. [PMID: 33437787 PMCID: PMC7791199 DOI: 10.21037/atm-20-2505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Cervical esophageal cancer (CEC) is an uncommon malignancy with poor prognosis, and there is no specific model that can be used to accurately predict the survival of patients with CEC. Methods The Surveillance, Epidemiology, and End Results (SEER) database was searched for patients with non-metastatic CEC from 2004 to 2015. Overall survival (OS) and disease-specific survival (DSS) rates were calculated using the Kaplan-Meier method. Predictive factors were analyzed by Cox's proportional hazards regression, and a nomogram was created to predict survival probability using R software. Results We identified 601 patients with CEC, 94.3% of whom had squamous cell carcinoma (SCC). The median follow-up time was 71 months. The median OS and DSS for the overall population were 15 and 18 months, respectively. There was a statistically significant decrease in surgical rates over time, from 16.7% in 2004 to 8% in 2015 (P=0.035). Comprehensive strategies consisting of two or three treatment modalities were correlated with significantly better OS and DSS (P<0.001 for both). We randomly assigned half of the patients to the training cohort (n=300) and the other half to the validation cohort (n=301). Multivariate Cox regression analysis was performed using the training cohort. Age, sex, tumor size, stages in the 7th edition of the American Joint Committee on Cancer (AJCC) staging system, and treatment with surgery, radiotherapy, or chemotherapy were identified as independent risk factors for OS. These factors were incorporated into the development of a nomogram for predicting 1-, 3-, and 5-year OS rates. The C-index of the nomogram was 0.743, which was statistically higher than that of the AJCC staging system. The internal validation, using bootstrap resampling and external validation, demonstrated the accuracy of the nomogram. Conclusions We developed and validated the first nomogram for CEC. This nomogram could be used to predict the OS of CEC patients with a relatively high accuracy.
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Affiliation(s)
- Dezuo Dong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Dan Zhao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Shuai Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Weixin Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Feng Du
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), The VIP-II Gastrointestinal Cancer Division of Medical Department, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiaolong Xu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Shaowen Xiao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Baomin Zheng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yan Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Weihu Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China
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Xiao L, Lyu J, Liu X, Li K, Wang Y, Zhang R, Chen T, Li T. Clinical Application Value of the Prognostic Nutritional Index for Predicting Survival in Patients with Esophageal Squamous Cell Carcinoma Undergoing Chemoradiotherapy or Radiotherapy. Nutr Cancer 2020; 73:1933-1940. [PMID: 33044092 DOI: 10.1080/01635581.2020.1817511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The prognostic nutrition index (PNI) has been shown to have prognostic value for several common cancers. The study aim was to explore the clinical application value of the PNI for prognosis of patients with esophageal squamous cell carcinoma (ESCC) treated with radical chemoradiotherapy (CRT) or radiotherapy (RT). METHODS Overall, 193 patients with ESCC who received radiotherapy with or without chemotherapy at Sichuan Cancer Hospital from March 20, 2012 to December 25, 2017 were retrospectively analyzed. Based on serum measurements before treatment, the PNI at ESCC recurrence was calculated as albumin (g/L) + 5 × total lymphocyte count. The Kaplan-Meier method and Cox proportional regression model were used to analyze the relationship between PNI and overall survival (OS). RESULTS The average PNI of 193 ESCC patients was 49.01 ± 4.68. The optimal cutoff value of PNI was 47.975, and the patients were divided into a low-PNI group (<47.975) and a high-PNI group (≥47.975). PNI was related to tumor length, T-stage and synchronous chemotherapy in ESCC patients (P < 0.05). The median OS for the entire group was 22.37 mo,. The median OS of patients in the high-PNI group and low-PNI group were 32.63 mo, and 15.4 mo, respectively, the 3-year survival rates were 47.5% and 32.2% and the 5-year survival rates were 37.7% and 16.8%, respectively, (all P = 0.001). Univariate analysis showed that PNI, tumor length, T-stage and synchronous chemotherapy were related to the prognosis of ESCC patients (P < 0.05). Multivariate analysis showed that tumor length (P = 0.019), synchronous chemotherapy (P = 0.009) and PNI (P = 0.003) were independent prognostic factors affecting the prognosis of patients in ESCC treated with RT or CRT. CONCLUSIONS The calculation of PNI value is simple, reliable and repeatable and can improve the accuracy of a patient's prognosis. Confirmation of these results by a large-sample prospective study is desirable.
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Affiliation(s)
- Ling Xiao
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.,Department of Radiotherapy Centre, Sichuan Cancer Hospital & Institute, Chengdu, China
| | - Jiahua Lyu
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.,Department of Radiotherapy Centre, Sichuan Cancer Hospital & Institute, Chengdu, China
| | - Xiao Liu
- School of Clinical Medical Sciences, Southwest Medical University, Luzhou, China
| | - Ke Li
- School of Clinical Medical Sciences, Southwest Medical University, Luzhou, China
| | - Yuan Wang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Rongke Zhang
- School of Clinical Medical Sciences, Southwest Medical University, Luzhou, China
| | - Taiyu Chen
- Clinical Medical College of Chengdu Medical College, Chengdu, China
| | - Tao Li
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.,Department of Radiotherapy Centre, Sichuan Cancer Hospital & Institute, Chengdu, China
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Zhang Y, Li X, Zhang J, Mao L. E6 hijacks KDM5C/lnc_000231/miR-497-5p/CCNE1 axis to promote cervical cancer progression. J Cell Mol Med 2020; 24:11422-11433. [PMID: 32818316 PMCID: PMC7576292 DOI: 10.1111/jcmm.15746] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 07/14/2020] [Accepted: 07/30/2020] [Indexed: 12/15/2022] Open
Abstract
Emerging evidence suggests that long non‐coding RNA (lncRNA) plays an important role in disease development, particularly in cancers. Recent studies with genome‐wide sequencing on cervical squamous cell carcinoma and matched adjacent non‐tumour tissues showed that a newly identified lncRNA‐lnc_000231 was highly expressed in cervical cancers. However, the underlying mechanism through which it is activated and its role in cervical cancer progression is still unclear. In this study, first, we confirmed that lnc_000231 is up‐regulated in cervical cancer cells and tumour tissues. Mechanically, we demonstrated that E6 up‐regulates lnc_000231 expression through promoting its promoter region H3K4me3 modification by destabilizing KDM5C. In vitro and in vivo results showed that lnc_000231 promotes cervical cancer cell proliferation and tumour formation by acting as miR‐497‐5p sponge and maintaining cyclin E1 (CCNE1) expression. Thus, our studies identified a new signalling pathway through which E6 promotes cervical cancer progression. E6 hijacked KDM5C/lnc_000231/miR‐497‐5p/CCNE1 signalling pathway is a promising target for cervical cancer treatment in the future.
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Affiliation(s)
- Yan Zhang
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xing Li
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jun Zhang
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lin Mao
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
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Katsurahara K, Shiozaki A, Fujiwara H, Konishi H, Kudou M, Shoda K, Arita T, Kosuga T, Morimura R, Murayama Y, Kuriu Y, Ikoma H, Kubota T, Nakanishi M, Okamoto K, Otsuji E. Clinical significance of the distance between the cricoid cartilage and upper edge of the tumor using PET-CT in cervical esophageal cancer. Oncol Lett 2020; 20:40. [PMID: 32788935 PMCID: PMC7416402 DOI: 10.3892/ol.2020.11901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/19/2020] [Indexed: 11/06/2022] Open
Abstract
Cervical esophageal squamous cell carcinoma (CESCC) is less common compared with thoracic esophageal cancer, and few studies have investigated the clinicopathological features of CESCC. The present study analyzed 69 patients with CESCC who underwent various therapies at the University Hospital of Kyoto Prefectural University of Medicine between January 2000 and December 2016. The distance between the inferior border of the cricoid cartilage and upper edge of the tumor was evaluated using positron emission tomography and computed tomography. Positive and negative values indicated oral and anal directions, respectively. Using receiver operating characteristic curves, the cut-off value for laryngeal preservation was calculated as -5 mm. According to this value, the patients were divided into two groups: The short group (distance from the cricoid cartilage ≥-5 mm) and long group (distance from the cricoid cartilage <-5 mm). There were no significant differences in clinicopathological factors between the two groups except for body mass index. In univariate analysis, the 3-year overall survival rate was significantly lower in short group (45.4 vs. 79.6%; P=0.009). In multivariate analysis, short group was an independent prognostic risk factor (hazard ratio=2.65; P=0.039). This may be due to lymphatic flow around the cervical esophagus.
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Affiliation(s)
- Keita Katsurahara
- Division of Digestive Surgery, Department of Surgery, University Hospital, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Atsushi Shiozaki
- Division of Digestive Surgery, Department of Surgery, University Hospital, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Hitoshi Fujiwara
- Division of Digestive Surgery, Department of Surgery, University Hospital, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Hirotaka Konishi
- Division of Digestive Surgery, Department of Surgery, University Hospital, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Michihiro Kudou
- Division of Digestive Surgery, Department of Surgery, University Hospital, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Katsutoshi Shoda
- Division of Digestive Surgery, Department of Surgery, University Hospital, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Tomohiro Arita
- Division of Digestive Surgery, Department of Surgery, University Hospital, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Toshiyuki Kosuga
- Division of Digestive Surgery, Department of Surgery, University Hospital, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Ryo Morimura
- Division of Digestive Surgery, Department of Surgery, University Hospital, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Yasutoshi Murayama
- Division of Digestive Surgery, Department of Surgery, University Hospital, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Yoshiaki Kuriu
- Division of Digestive Surgery, Department of Surgery, University Hospital, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Hisashi Ikoma
- Division of Digestive Surgery, Department of Surgery, University Hospital, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Takeshi Kubota
- Division of Digestive Surgery, Department of Surgery, University Hospital, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Masayoshi Nakanishi
- Division of Digestive Surgery, Department of Surgery, University Hospital, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Kazuma Okamoto
- Division of Digestive Surgery, Department of Surgery, University Hospital, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, University Hospital, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
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de Vos-Geelen J, Hoebers FJP, Geurts SME, Hoeben A, de Greef BTA, Voncken FEM, Bogers J(HA, Braam PM, Muijs C(KT, de Jong MA, Kasperts N, Rozema T, Jeene PM, Blom GJ, van Dieren JM, Hulshof MCCM, van Laarhoven HWM, Grabsch HI, Lemmens VEPP, Tjan-Heijnen VCG, Nieuwenhuijzen GAP. A national study to assess outcomes of definitive chemoradiation regimens in proximal esophageal cancer. Acta Oncol 2020; 59:895-903. [PMID: 32319845 DOI: 10.1080/0284186x.2020.1753889] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Proximal esophageal cancer (EC) is commonly treated with definitive chemoradiation (CRT). The radiation dose and type of chemotherapy backbone are still under debate. The objective of this study was to compare the treatment outcomes of contemporary CRT regimens.Material and Methods: In this retrospective observational cohort study, we included patients with locally advanced squamous cell cancer of the proximal esophagus, from 11 centers in the Netherlands, treated with definitive CRT between 2004 and 2014. Each center had a preferential CRT regimen, based on cisplatin (Cis) or carboplatin-paclitaxel (CP) combined with low (≤50.4 Gy) or high (>50.4 Gy) dose radiotherapy (RT). Differences in overall survival (OS) between CRT regimens were assessed using a fully adjusted Cox proportional hazards and propensity score (PS) weighted model. Safety profiles were compared using a multilevel logistic regression model.Results: Two hundred patients were included. Fifty-four, 39, 95, and 12 patients were treated with Cis-low-dose RT, Cis-high-dose RT, CP-low-dose RT, and CP-high-dose RT, respectively. Median follow-up was 62.6 months (95% CI: 47.9-77.2 months). Median OS (21.9 months; 95% CI: 16.9-27.0 months) was comparable between treatment groups (logrank p = .88), confirmed in the fully adjusted and PS weighted model (p > .05). Grades 3-5 acute adverse events were less frequent in patients treated with CP-low-dose RT versus Cis-high-dose RT (OR 3.78; 95% CI: 1.31-10.87; p = .01). The occurrence of grades 3-5 late toxicities was not different between treatment groups.Conclusion: Our study was unable to demonstrate a difference in OS between the CRT regimens, probably related to the relatively small sample size. Based on the superior safety profile, carboplatin and paclitaxel-based CRT regimens are preferred in patients with locally advanced proximal EC.
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Affiliation(s)
- Judith de Vos-Geelen
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frank J. P. Hoebers
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sandra M. E. Geurts
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ann Hoeben
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bianca T. A. de Greef
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Francine E. M. Voncken
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | | | - C. (Kristel) T. Muijs
- Department of Radiotherapy, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin A. de Jong
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nicolien Kasperts
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tom Rozema
- Insituut Verbeeten, Tilburg, The Netherlands
| | - Paul M. Jeene
- Department of Radiotherapy, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Radiotherapiegroep, Deventer, The Netherlands
| | - Gerrit J. Blom
- Department of Radiation Oncology, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
| | - Jolanda M. van Dieren
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Maarten C. C. M. Hulshof
- Department of Radiotherapy, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanneke W. M. van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Heike I. Grabsch
- Department of Pathology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Pathology & Data Analytics, Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | - Valery E. P. P. Lemmens
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), The Netherlands
- Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vivianne C. G. Tjan-Heijnen
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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Shah MA, Kennedy EB, Catenacci DV, Deighton DC, Goodman KA, Malhotra NK, Willett C, Stiles B, Sharma P, Tang L, Wijnhoven BPL, Hofstetter WL. Treatment of Locally Advanced Esophageal Carcinoma: ASCO Guideline. J Clin Oncol 2020; 38:2677-2694. [PMID: 32568633 DOI: 10.1200/jco.20.00866] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To develop an evidence-based clinical practice guideline to assist in clinical decision making for patients with locally advanced esophageal cancer. METHODS ASCO convened an Expert Panel to conduct a systematic review of the more recently published literature (1999-2019) on therapy options for patients with locally advanced esophageal cancer and provide recommended care options for this patient population. RESULTS Seventeen randomized controlled trials met the inclusion criteria. Where possible, data were extracted separately for squamous cell carcinoma and adenocarcinoma. RECOMMENDATIONS Multimodality therapy for patients with locally advanced esophageal carcinoma is recommended. For the subgroup of patients with adenocarcinoma, preoperative chemoradiotherapy or perioperative chemotherapy should be offered. For the subgroup of patients with squamous cell carcinoma, preoperative chemoradiotherapy or chemoradiotherapy without surgery should be offered. Additional subgroup considerations are provided to assist with implementation of these recommendations. Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.
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Affiliation(s)
- Manish A Shah
- New York Hospital/Weill Cornell Medical Center, New York, NY
| | | | | | | | | | | | | | - Brendon Stiles
- New York Hospital/Weill Cornell Medical Center, New York, NY
| | - Prateek Sharma
- University of Kansas School of Medicine and VAMC, Kansas City, KS
| | - Laura Tang
- Memorial Sloan Kettering Cancer Center, New York, NY
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Survival of esophageal and gastric cancer patients with adjuvant and palliative chemotherapy-a retrospective analysis of a register-based patient cohort. Eur J Clin Pharmacol 2020; 76:1029-1041. [PMID: 32372150 PMCID: PMC7306049 DOI: 10.1007/s00228-020-02883-3] [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] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/24/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE The survival of esophageal and gastric cancer patients treated with chemotherapy is rarely assessed outside of clinical trials. Therefore, we compared the effectiveness of various curative or palliative chemotherapy regimens on the survival of esophageal and gastric cancer patients in a "real world" clinical setting. METHODS We identified a cohort of 966 incident esophageal and gastric cancer patients in Stockholm/Gotland County (a low-risk Western population) during 2008-2013. Patients who received chemotherapy with curative intention (n = 279) and palliative intention (n = 182) were analyzed separately. Using Cox proportional hazards regression models, we estimated hazard ratios (HRs) with 95% confidence intervals (CIs) and adjusted for the potential confounding factors: age, sex, TNM stage, radiotherapy, comorbidity, marital status, education, income, and country of birth. RESULTS In esophageal cancer patients with curative treatment intention, we observed a higher hazard for death among patients who received carboplatin-fluorouracil compared to patients who received cisplatin-fluorouracil, corresponding to a HR of 2.18 (95% CI 1.09-4.37). Conversely, in patients with cancer in the gastroesophageal junction who had a curative treatment intention at diagnosis, we observed a reduced hazard for death among those who received fluorouracil-oxaliplatin, compared to patients who received cisplatin-fluorouracil (HR 0.28; 95% CI 0.08-0.96). CONCLUSION Among patients with esophageal cancer who received treatment with curative intention, cisplatin-fluorouracil was associated with better survival compared to carboplatin-fluorouracil, while patients with gastroesophageal junction cancer who were treated with cisplatin-fluorouracil had worse survival compared to fluorouracil-oxaliplatin.
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Abstract
Cervical esophageal carcinoma (CEC) is rare, accounting for 2-10% of esophageal cancers and is mostly squamous cell carcinoma. Because of the anatomical proximity of CEC to larynx, surgical treatment would involve pharyngo-laryngo-esophagectomy (PLE) with inherent high mortality and morbidity. Laryngeal preservation is an important consideration, and definitive chemoradiotherapy is the recommended treatment. Treatment strategy of CEC can be more akin to treatment for head and neck cancers than to thoracic esophageal cancers. Since the exact location, extent of primary and nodal metastasis varies between patients, radiotherapy treatment needs to be individualized. The optimal radiation dose for CEC is uncertain, but retrospective data suggests that higher radiation dose of at least 60 Gy is associated with better local control and survival. Advanced radiotherapy technique, like intensity modulated radiotherapy, is usually required to achieve high dose to tumor while protecting normal tissues from excessive radiation.
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Fountoulakis A, Souglakos J, Vini L, Douridas GN, Koumarianou A, Kountourakis P, Agalianos C, Alexandrou A, Dervenis C, Gourtsoyianni S, Gouvas N, Kalogeridi MA, Levidou G, Liakakos T, Sgouros J, Sgouros SN, Triantopoulou C, Xynos E. Consensus statement of the Hellenic and Cypriot Oesophageal Cancer Study Group on the diagnosis, staging and management of oesophageal cancer. Updates Surg 2019; 71:599-624. [DOI: 10.1007/s13304-019-00696-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022]
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Javadinia SA, Shahidsales S, Fanipakdel A, Mostafapour A, Joudi-Mashhad M, Ferns GA, Avan A. The Esophageal Cancer and the PI3K/AKT/mTOR Signaling Regulatory microRNAs: a Novel Marker for Prognosis, and a Possible Target for Immunotherapy. Curr Pharm Des 2019; 24:4646-4651. [PMID: 30636576 DOI: 10.2174/1381612825666190110143258] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/24/2018] [Accepted: 12/31/2018] [Indexed: 01/25/2023]
Abstract
The Phosphatidylinositol 3-kinase/AKT/Mammalian Target of Rapamycin (PI3K/AKT/mTOR) pathway has a critical regulatory role in cell biology including translation, transcription, and autophagy. Dysregulation of this pathway is involved in the pathogenesis, development, and prognosis of esophageal cancer that has been assessed in the recent years and its potential as a target in therapy. This report summarizes the current knowledge about PI3K/AKT/mTOR pathway and its cross-talk with a focus on the value of targeting this pathway as a potential therapeutic target in the treatment of esophageal cancer.
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Affiliation(s)
- Seyed A Javadinia
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Azar Fanipakdel
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asma Mostafapour
- Metabolic syndrome Research center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mona Joudi-Mashhad
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Department of Medical Education, Brighton and Sussex Medical School Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex, United Kingdom
| | - Amir Avan
- Metabolic syndrome Research center, Mashhad University of Medical Sciences, Mashhad, Iran
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Lin WC, Chang CL, Hsu HL, Yuan KSP, Wu ATH, Wu SY. Three-Dimensional Conformal Radiotherapy-Based or Intensity-Modulated Radiotherapy-Based Concurrent Chemoradiotherapy in Patients with Thoracic Esophageal Squamous Cell Carcinoma. Cancers (Basel) 2019; 11:cancers11101529. [PMID: 31658709 PMCID: PMC6826542 DOI: 10.3390/cancers11101529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 01/05/2023] Open
Abstract
Background: To date, intensity-modulated radiation therapy (IMRT) with concurrent chemoradiotherapy (CCRT) and CCRT with standard fractionation three-dimensional conformal radiation therapy (3D-CRT) have not been compared. In this study, the outcomes of IMRT-based concurrent CCRT and those of 3D-CRT-based CCRT were compared in patients with thoracic esophageal squamous cell carcinoma (TESCC). Methods: We enrolled 2062 patients with TESCC who had received CCRT and categorized them into two groups on the basis of their treatment modality: Group 1 (3D-CRT-based CCRT) and Group 2 (IMRT-based CCRT). Results: Multivariate Cox regression analysis indicated that the American Joint Committee on Cancer advanced stages (≥IIIA) and 3D-CRT were significant independent predictors of poor outcomes in patients with TESCC who received definitive CCRT. Moreover, receiving IMRT-based CCRT (adjusted hazard ratio [aHR]: 0.88, 95% confidence interval [CI]: 0.78–0.98) was a significant independent prognostic factor for overall survival (p = 0.0223). In Group 2, aHRs (95% CIs) for overall mortality at early (IA–IIB) and advanced clinical stages were 0.91 (0.67–1.25, p = 0.5746) and 0.88 (0.77–0.99, p = 0.0368), respectively. Conclusion: IMRT-based CCRT resulted in higher survival rates in patients with advanced clinical stages of TESCC (i.e., IIIA–IIIC), namely, clinical T3, clinical T4, or lymph node involvement.
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Affiliation(s)
- Wei-Cheng Lin
- Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei 106, Taiwan.
| | - Chia-Lun Chang
- Department of Hemato-Oncology, Wan Fang Hospital, Taipei Medical University, Taipei 106, Taiwan.
- Department of Internal Medicine, School of Medicine, College of Medicine, 106 Taipei Medical University, Taipei 106, Taiwan.
| | - Han-Lin Hsu
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 106, Taiwan.
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei 106, Taiwan.
| | - Kevin Sheng-Po Yuan
- Department of Otorhinolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei 106, Taiwan.
| | - Alexander T H Wu
- Ph.D. Program for Translational Medicine, Taipei Medical University, Taipei 106, Taiwan.
| | - Szu-Yuan Wu
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan.
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan.
- Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei 106, Taiwan.
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 106, Taiwan.
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Karaca S, Kırlı M. Adaptive radiation therapy for cervical esophageal cancer: dosimetric and volumetric analysis. J Gastrointest Oncol 2019; 10:506-512. [PMID: 31183201 DOI: 10.21037/jgo.2019.02.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Cervical esophageal cancer (CEC) patients may suffer from significant anatomical changes due to tumor shrinkage or weight loss during radiotherapy. The aim of the study is to evaluate the volumetric and dosimetric changes in the target and critical volumes of CEC patients by using adaptive radiotherapy (ART) technique. Methods Seven CEC patients treated in helical tomotherapy (HT) unit was analyzed. All patients had a replanning CT simulation at 3rd (CT2) and 5th (CT3) weeks in addition to the initial CT (CT1). Volumetric and dosimetric changes of target and organs at risk (OAR) were evaluated. Results The average weight loss of the patients was 9.03%. The major changes of the planning target volume (PTV), PTV boost, right and left parotid volumes were 4.74%; 15.93%; 26.82% and 26.64%, respectively. Using ART software was evaluated with first planning values (CT1) and pre-CT2-CT3 verification values. The correlation was decrease of the D95 and increase of the Dmax was statistically significant. When evaluated the varying values of the new CTs, there was no significant change between the initial PTV and adapted PTV's. But a significant decrease was observed at the summation plan for left and right parotids (P<0.05). The mean dose reductions of left and right parotid were 2.48 and 2.49 Gy, respectively. Conclusions Our results showed that using ART technique was beneficial to ensure adequate doses to the target volumes and safe doses to the OARs for the patients who need replanning during RT in uncommon CEC patients.
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Affiliation(s)
- Sibel Karaca
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Meltem Kırlı
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
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Toya R, Matsuyama T, Saito T, Imuta M, Shiraishi S, Fukugawa Y, Iyama A, Watakabe T, Sakamoto F, Tsuda N, Shimohigashi Y, Kai Y, Murakami R, Yamashita Y, Oya N. Impact of hybrid FDG-PET/CT on gross tumor volume definition of cervical esophageal cancer: reducing interobserver variation. JOURNAL OF RADIATION RESEARCH 2019; 60:348-352. [PMID: 30864652 PMCID: PMC6530614 DOI: 10.1093/jrr/rrz004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/14/2019] [Indexed: 05/09/2023]
Abstract
Intensity-modulated radiation therapy is being increasingly used to treat cervical esophageal cancer (CEC); however, delineating the gross tumor volume (GTV) accurately is essential for its successful treatment. The use of computed tomography (CT) images to determine the GTV produces a large degree of interobserver variation. In this study, we evaluated whether the use of [18F]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET)/CT fused images reduced interobserver variation, compared with CT images alone, to determine the GTV in patients with CEC. FDG-PET/CT scans were obtained for 10 patients with CEC, imaged positioned on a flat tabletop with a pillow. Five radiation oncologists independently defined the GTV for the primary tumors using routine clinical data; they contoured the GTV based on CT images (GTVCT), followed by contouring based on FDG-PET/CT fused images (GTVPET/CT). To determine the geometric observer variation, we calculated the conformality index (CI) from the ratio of the intersection of the GTVs to their union. The interobserver CI was compared using Wilcoxon's signed rank test. The mean (±SD) interobserver CIs of GTVCT and GTVPET/CT were 0.39 ± 0.15 and 0.58 ± 0.10, respectively (P = 0.005). Our results suggested that FDG-PET/CT images reduced interobserver variation when determining the GTV in patients with CEC. FDG-PET/CT may increase the consistency of the radiographically determined GTV in patients with CEC.
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Affiliation(s)
- Ryo Toya
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
- Corresponding author. Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan. Tel/Fax: +81 96-373-5522;
| | - Tomohiko Matsuyama
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tetsuo Saito
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Masanori Imuta
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinya Shiraishi
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshiyuki Fukugawa
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Ayumi Iyama
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takahiro Watakabe
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Fumi Sakamoto
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Noriko Tsuda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | | | - Yudai Kai
- Department of Radiological Technology, Kumamoto University Hospital, Kumamoto, Japan
| | - Ryuji Murakami
- Department of Medical Imaging, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Dai Y, Fu X, Li T, Yao Q, Su L, Su H, Li J. Long-term impact of prognostic nutritional index in cervical esophageal squamous cell carcinoma patients undergoing definitive radiotherapy. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:175. [PMID: 31168456 DOI: 10.21037/atm.2019.03.60] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background The prognostic nutritional index (PNI) has been found to have prognostic value in several cancers, and we aimed to determine its predictive value for the long-term prognosis of cervical esophageal squamous cell carcinoma (CESCC) patients treated with chemoradiotherapy (CRT). Methods The data for 106 CESCC patients who received radiotherapy with or without chemotherapy at the Cancer Hospital of Fujian Medical University from June 1, 2000 to December 31, 2015 were retrospectively analyzed. According to serum measurements taken before therapy, the PNI was calculated as albumin (g/L) + 5 × total lymphocyte count. The association between PNI and overall survival (OS) was determined by the Kaplan-Meier method and Cox proportional regression model analysis. Results The median follow-up time was 19 months. The optimal cutoff value for PNI was calculated to be 48.15, and patients were divided into a low PNI group (<48.15) and high PNI group (≥48.15). Univariate analysis showed that a low survival rate was significantly associated with male gender (P=0.004), tumor length ≥5.0 cm (P=0.043), radiotherapy technique (P=0.016), synchronous chemotherapy (P=0.012), lymphocyte-monocyte ratio (LMR) (P=0.007), neutrophil-lymphocyte ratio (NLR) (P=0.007), lung cancer inflammation index (ALI) (P=0.008), cervical esophageal carcinoma inflammation index (CEI) (P=0.043), and PNI (P<0.001). The OS was higher in the high PNI group than in the low PNI group. On multivariate analysis, gender (P=0.004), radiotherapy technique (P=0.029), and PNI (P=0.007) were independent prognostic factors in CESCC treated with CRT. Conclusions The PNI value is a simple, reliable, and reproducible indicator for improving the accuracy of patient prognosis. And larger-scale studies are warranted to validate these findings.
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Affiliation(s)
- Yaqing Dai
- Departmen of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou 350014, China
| | - Xiaobin Fu
- Departmen of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou 350014, China
| | - Tingting Li
- Departmen of Radiation Oncology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China
| | - Qiwei Yao
- Departmen of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou 350014, China
| | - Liyu Su
- Departmen of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou 350014, China
| | - Huiyan Su
- Departmen of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou 350014, China
| | - Jiancheng Li
- Departmen of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou 350014, China
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Wang Y, Zhou S, Fan K, Jiang C. MicroRNA-21 and its impact on signaling pathways in cervical cancer. Oncol Lett 2019; 17:3066-3070. [PMID: 30867735 DOI: 10.3892/ol.2019.10002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 11/29/2018] [Indexed: 01/03/2023] Open
Abstract
Oncogenic microRNA-21 (miR-21/miRNA-21) is a stable inhibitor of gene expression that is often upregulated in cervical cancer, a disease that affects the health of women and tends to transform and spread. Previous studies investigating miR-21 in biopsies and cells from cervical cancer patients have identified that miR-21 binds target mRNAs in signaling pathways or long non-coding RNAs (lncRNA). Furthermore, studies have elucidated the molecular mechanisms of two tumor necrosis factor α (TNF-α) signaling pathways that promote cell proliferation and inhibit cell apoptosis. miR-21 inhibits the TNF receptor 1 (TNFR1) signaling pathway and activates the TNFR2 signaling pathway. Moreover, miR-21 enhances cervical cancer cell proliferation by influencing the protein kinase B/mammalian target of rapamycin and RAS p21 protein activator 1 signaling pathways. The present review discusses the evidence that miR-21 may impact cervical cancer through inhibiting apoptosis and enhancing proliferation, and may therefore be a target for clinical intervention.
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Affiliation(s)
- Yong Wang
- Department of Obstetrics, Jinan Maternity and Child Care Hospital, Jinan, Shandong 250002, P.R. China
| | - Shiying Zhou
- Department of Obstetrics, Jinan Maternity and Child Care Hospital, Jinan, Shandong 250002, P.R. China
| | - Kefeng Fan
- Department of Obstetrics, Jinan Maternity and Child Care Hospital, Jinan, Shandong 250002, P.R. China
| | - Chen Jiang
- Department of Gynecology, Jinan Maternity and Child Care Hospital, Jinan, Shandong 250002, P.R. China
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Valmasoni M, Pierobon ES, Zanchettin G, Briscolini D, Moletta L, Ruol A, Salvador R, Merigliano S. Cervical Esophageal Cancer Treatment Strategies: A Cohort Study Appraising the Debated Role of Surgery. Ann Surg Oncol 2018; 25:2747-2755. [PMID: 29987601 DOI: 10.1245/s10434-018-6648-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Few studies have examined optimal treatment specifically for cervical esophageal carcinoma. This study evaluated the outcome of three common treatment strategies with a focus on the debated role of surgery. METHODS All patients with cervical esophageal cancer treated at a single center were identified and their outcomes analyzed in terms of morbidity, mortality, and recurrence according to the treatment they received, i.e. surgery alone, definitive platinum-based chemoradiation (CRT), or CRT followed by surgery. RESULTS The study population included 148 patients with cervical esophageal cancer from a prospective database of 3445 patients. Primary surgery was the treatment of choice for 56 (37.83%) patients, definitive CRT was the treatment of choice for 52 (35.13%) patients, and CRT followed by surgery was the treatment of choice for 40 (27.02%) patients. CRT-treated patients obtained 36.96% complete clinical response, with overall morbidity and mortality rates of 36.95 and 2.17%, respectively. Surgical complete resection was achieved in 71.88% of surgically treated cases, with morbidity and mortality rates of 52.17 and 6.25%, respectively. No significant survival difference existed among the three treatments, but patients who underwent surgery alone had a significantly lower stage of disease (p = 0.031). Compared with patients with complete response after CRT, surgery did not confer any significant survival benefit, and overall 5-year survival was lower than definitive CRT alone. In contrast, surgery improved survival significantly in patients with non-complete response after definitive CRT (p = 0.023). CONCLUSIONS Definitive platinum-based CRT should be the treatment of choice for cervical esophageal cancer. Surgery has a role for patients with non-complete response as it adds significant survival benefit, with acceptable morbidity and mortality.
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Affiliation(s)
- Michele Valmasoni
- Department of Surgical, Oncological and Gastroenterological Sciences, Center for Esophageal Disease, University of Padova, Padua, Italy. .,University Hospital, Padua, Italy.
| | - Elisa Sefora Pierobon
- Department of Surgical, Oncological and Gastroenterological Sciences, Center for Esophageal Disease, University of Padova, Padua, Italy
| | - Gianpietro Zanchettin
- Department of Surgical, Oncological and Gastroenterological Sciences, Center for Esophageal Disease, University of Padova, Padua, Italy
| | - Dario Briscolini
- Department of Surgical, Oncological and Gastroenterological Sciences, Center for Esophageal Disease, University of Padova, Padua, Italy
| | - Lucia Moletta
- Department of Surgical, Oncological and Gastroenterological Sciences, Center for Esophageal Disease, University of Padova, Padua, Italy.,University Hospital, Padua, Italy
| | - Alberto Ruol
- Department of Surgical, Oncological and Gastroenterological Sciences, Center for Esophageal Disease, University of Padova, Padua, Italy
| | - Renato Salvador
- Department of Surgical, Oncological and Gastroenterological Sciences, Center for Esophageal Disease, University of Padova, Padua, Italy.,University Hospital, Padua, Italy
| | - Stefano Merigliano
- Department of Surgical, Oncological and Gastroenterological Sciences, Center for Esophageal Disease, University of Padova, Padua, Italy.,University Hospital, Padua, Italy
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Li CC, Chen CY, Chien CR. Comparison of intensity-modulated radiotherapy vs 3-dimensional conformal radiotherapy for patients with non-metastatic esophageal squamous cell carcinoma receiving definitive concurrent chemoradiotherapy: A population-based propensity-score-matched analysis. Medicine (Baltimore) 2018; 97:e10928. [PMID: 29851829 PMCID: PMC6392994 DOI: 10.1097/md.0000000000010928] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Whether the survival outcome of patients with non-metastatic esophageal squamous cell carcinoma (NM-ESCC) receiving definitive concurrent chemoradiotherapy (CCRT) is better with intensity-modulated radiotherapy (IMRT) or with 3-dimensional conformal radiotherapy (3DCRT) has been debated in the literature. We designed this population-based propensity-score (PS)-matched analysis to address this question. We identified eligible patients diagnosed between 2008 and 2015 from the Taiwan Cancer Registry and constructed a PS-matched cohort (1:1 for IMRT vs 3DCRT) to balance observable potential confounders. We compared the hazard ratio (HR) of death between IMRT and 3DCRT during the entire follow-up period. We also evaluated freedom from local regional recurrence (FFLRR) and esophageal cancer-specific survival (ECSS). Sensitivity analyses (SA) were performed to examine the robustness of our findings. Our study population constituted 558 patients who were well balanced with regard to the measured covariables. The HR of death with IMRT compared to 3DCRT was 0.43 (95% confidence interval 0.35-0.52, P < .001). The results remained significant for FFLRR and ECSS. In SA, our results remained significant when additional covariables were taken into consideration. The survival outcome of patients with NM-ESCC receiving CCRT might be better with IMRT vs 3DCRT. These study results should be interpreted with caution given some possible covariates lacking in the registry. Further studies are needed to clarify this issue.
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Affiliation(s)
- Chia-Chin Li
- Department of Radiation Oncology, China Medical University Hospital
| | - Chih-Yi Chen
- Division of Thoracic Surgery, Department of Surgery, Chung Shan Medical University, Chung Shan Medical University Hospital
| | - Chun-Ru Chien
- Department of Radiation Oncology, China Medical University Hospital
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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50
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Esmati E, Maddah Safaei A, Ghalehtaki R, Mousavi N, Saraee E, Shirouei S, Mohammadi N, Lashkari M. Outcomes of Definitive Chemoradiotherapy for Cervical and Upper Thoracic Esophageal Cancers: a Single-Institution Experience of a Rare Cancer. J Gastrointest Cancer 2018; 50:380-385. [DOI: 10.1007/s12029-018-0081-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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