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Isozaki T, Ishikawa H, Yasuda S, Isozaki Y, Yamada S, Akutsu Y, Nagata M, Nabeya Y, Minashi K, Murakami K, Kuwano H, Nemoto K, Tsuji H, Uno T, Matsubara H. A Phase I/II Trial of Definitive Carbon Ion Radiotherapy for Clinical T1bN0M0 Esophageal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2023; 117:416-421. [PMID: 37116590 DOI: 10.1016/j.ijrobp.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/26/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Tetsuro Isozaki
- National Institutes for Quantum Science and Technology, QST Hospital, Chiba, Japan; Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Hitoshi Ishikawa
- National Institutes for Quantum Science and Technology, QST Hospital, Chiba, Japan
| | - Shigeo Yasuda
- National Institutes for Quantum Science and Technology, QST Hospital, Chiba, Japan; Department of Radiology, Chiba Rosai Hospital, Chiba, Japan
| | - Yuka Isozaki
- National Institutes for Quantum Science and Technology, QST Hospital, Chiba, Japan
| | - Shigeru Yamada
- National Institutes for Quantum Science and Technology, QST Hospital, Chiba, Japan
| | - Yasunori Akutsu
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan; Miwa Central Clinic, Mito, Japan
| | - Matsuo Nagata
- Division of Esophago-Gastrointestinal Surgery, Chiba Cancer Center, Chiba, Japan; Department of Surgery, Tojo Hospital, Chiba, Japan
| | - Yoshihiro Nabeya
- Division of Esophago-Gastrointestinal Surgery, Chiba Cancer Center, Chiba, Japan
| | - Keiko Minashi
- Clinical Trial Promotion Department, Chiba Cancer Center, Chiba, Japan
| | - Kentaro Murakami
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Gunma, Japan
| | - Kenji Nemoto
- Department of Radiation Oncology, Yamagata University, Yamagata, Japan
| | - Hiroshi Tsuji
- National Institutes for Quantum Science and Technology, QST Hospital, Chiba, Japan
| | - Takashi Uno
- Department of Diagnostic Radiology & Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Umezawa R, Ota H, Takagi H, Kadoya N, Nakajima Y, Takahashi N, Yamamoto T, Takase K, Jingu K. Clinical impact of radiation-induced myocardial damage detected by cardiac magnetic resonance imaging and dose-volume histogram parameters of the left ventricle as prognostic factors of cardiac events after chemoradiotherapy for esophageal cancer. JOURNAL OF RADIATION RESEARCH 2023:7194110. [PMID: 37308130 DOI: 10.1093/jrr/rrad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/27/2023] [Indexed: 06/14/2023]
Abstract
This prospective study aimed to evaluate whether radiation (RT)-induced myocardial damage by cardiac magnetic resonance (CMR) imaging could be a predictor of cardiac events after chemoradiotherapy (CRT) for esophageal cancer and determine the dose-volume histogram (DVH) parameters of the left ventricle (LV) in predicting cardiac events. CMR imaging was performed before and 6 months after CRT in patients receiving definitive CRT. RT-induced myocardial damage was defined as abnormal CMR findings indicating myocardial fibrosis corresponding to an isodose line of ≥30 Gy. The cutoff values of the LV DVH parameters were calculated using the receiver operating characteristic curve based on the presence of RT-induced myocardial damage. The prognostic factors related to cardiac events of Grade 3 or higher were examined. Twenty-three patients were enrolled in the study. RT-induced myocardial damage by late gadolinium enhancement and/or an increase of 100 ms or higher in native T1 post-CRT was detected in 10 of the 23 patients. LV V45 was the best predictive factor for RT-induced myocardial damage with a cutoff value of 2.1% and an area under the curve of 0.75. The median follow-up period was 82.1 months. The 5- and 7-year cumulative incidences of cardiac events of Grade 3 or higher were 14.7 and 22.4%, respectively. RT-induced myocardial damage and LV V45 were significant risk factors (P = 0.015 and P = 0.013, respectively). RT-induced myocardial damage is a significant predictor of cardiac events. LV V45 is associated with RT-induced myocardial damage and subsequent cardiac events.
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Affiliation(s)
- Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Hidenobu Takagi
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Yujiro Nakajima
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
- Department of Radiological Sciences, Komazawa University, 1-23-1, Setagayaku, Tokyo, 154-8525, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
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Umezawa R, Kadoya N, Ota H, Nakajima Y, Saito M, Takagi H, Takanami K, Takahashi N, Ishikawa Y, Yamamoto T, Matsushita H, Takeda K, Takase K, Jingu K. Dose-Dependent Radiation-Induced Myocardial Damage in Esophageal Cancer Treated With Chemoradiotherapy: A Prospective Cardiac Magnetic Resonance Imaging Study. Adv Radiat Oncol 2020; 5:1170-1178. [PMID: 33305078 PMCID: PMC7718544 DOI: 10.1016/j.adro.2020.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The purpose of this prospective study was to evaluate radiation-induced myocardial damage after mediastinal radiation therapy (RT) using late gadolinium-enhancement (LGE) magnetic resonance imaging (MRI). METHODS AND MATERIALS We enrolled 19 patients with esophageal cancer who were expected to have long-term survival by definitive treatment. They underwent delayed contrast-enhanced MRI (19 patients before treatment, 19 patients 6 months after treatment, and 12 patients 1.5 years after treatment). Dose distribution of the left ventricle was made using computed tomography, and the dose volume histogram of the left ventricle was calculated. Myocardial signal intensities in individual MRIs were normalized by the mean values in regions receiving low doses (<5 Gy). Changes in the normalized signal intensities after mediastinal radiation therapy were compared among regions where irradiation doses were 0 to 10 Gy, 10 to 20 Gy, 20 to 30 Gy, 30 to 40 Gy, 40 to 50 Gy, and 50 to 60 Gy, and we investigated whether intensity change was detected in a dose-dependent manner. RESULTS The registered patients were treated with concurrent chemoradiotherapy with a median total dose of 60 Gy (50.4-66 Gy). Chemotherapy consisting of cisplatin and 5-fluorouracil was administered. In the population-based dose-response curve, dose-dependent intensity changes progressively increased in regions receiving more than 30 Gy. The averages of relative intensity change at 6 months and 1.5 years after treatment were 1.1% and -1.9% at 20 to 30 Gy and 37.5% and 17.5% at 40 to 50 Gy, respectively. LGE in regions receiving more than 30 Gy was detected in 68% (13/19) of the patients. CONCLUSIONS A dose-dependent relationship for myocardial signal intensity change was found by using LGE MRI. It may be necessary to reduce the volume of the myocardium receiving more than 30 Gy.
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Affiliation(s)
- Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yujiro Nakajima
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masahide Saito
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hidenobu Takagi
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kentaro Takanami
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yojiro Ishikawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ken Takeda
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Toh Y, Numasaki H, Tachimori Y, Uno T, Jingu K, Nemoto K, Matsubara H. Current status of radiotherapy for patients with thoracic esophageal cancer in Japan, based on the Comprehensive Registry of Esophageal Cancer in Japan from 2009 to 2011 by the Japan Esophageal Society. Esophagus 2020; 17:25-32. [PMID: 31473871 DOI: 10.1007/s10388-019-00690-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/28/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although esophagectomy is the standard treatment for resectable esophageal cancer, chemoradiotherapy or radiotherapy alone is also selected for some cases. However, there have been very few detailed studies conducted on a large scale on the efficacy of these treatments in Japan. METHODS Of the patients enrolled in the Comprehensive Registry of Esophageal Cancer in Japan by the Japan Esophageal Society for the 2015-2017 surveys (patients treated between 2009 and 2011), the data of 388 patients treated by definitive radiotherapy alone (RTx) and 1964 patients treated by definitive chemoradiotherapy (CRTx) were analyzed. RESULTS The median age of the patients was 78 years in the RTx group and 69 years in the CRTx group; thus, the proportion of elderly patients was significantly higher in the RTx group than in the CRTx group (p < 0.0001). With regard to the rates of treatment by the two modalities according to the depth of invasion, extent of lymph node metastasis, and disease stage, the treatment rate by CRTx increased more significantly than that by RTx as the disease progressed (p < 0.0001). With regard to the distribution of the total irradiation dose, 11.4% and 2.3% of patients in the RTx and CRTx groups, respectively, received a dose of 67 Gy or more; thus, the RTx group received significantly higher total irradiation doses (p < 0.0001). In the RTx group, the 5-year overall survival rate was 23.2%, and the rates in patients with cStage 0-I, II, III, and IV disease were 41.8%,18.5%, 9.3%, and 13.9%, respectively. In the patients of the RTx group showing complete response (CR), the 5-year overall survival rate was 46.6% and the rates in patients with cStage 0-I, II, III, and IV disease were 54.8%, 39.6%, 32.4%, and 38.9%, respectively. In the CRTx group, the 5-year overall survival rate was 30.6% and the rates in patients with cStage 0-I, II, III, and IV disease were 57.8%, 47.8%, 23.4%, and 13.0%, respectively. In the patients of the CRTx group showing CR, the 5-year overall survival rate was 59.2% and the rates in patients with cStage 0-I, II, III, and IV disease were 67.9%, 59.5%, 56.5%, and 39.6%, respectively. CONCLUSION This study revealed the current status of treatment of esophageal cancer in Japan, and we think that we have been able to establish the grounds for explaining to patients with esophageal cancer and their families the treatment decisions made for them in daily clinical practice.
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Affiliation(s)
- Yasushi Toh
- Japan Esophageal Society, Tokyo, Japan.
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan.
| | - Hodaka Numasaki
- Japan Esophageal Society, Tokyo, Japan
- Department of Radiology, Osaka University, Osaka, Japan
| | - Yuji Tachimori
- Japan Esophageal Society, Tokyo, Japan
- Center for Cancer Treatment, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Takashi Uno
- Japan Esophageal Society, Tokyo, Japan
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Keiichi Jingu
- Japan Esophageal Society, Tokyo, Japan
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenji Nemoto
- Japan Esophageal Society, Tokyo, Japan
- Department of Radiology, Yamagata University, Yamagata, Japan
| | - Hisahiro Matsubara
- Japan Esophageal Society, Tokyo, Japan
- Department of Frontier Surgery, Chiba University, Chiba, Japan
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Voeten DM, den Bakker CM, Heineman DJ, Ket JCF, Daams F, van der Peet DL. Definitive Chemoradiotherapy Versus Trimodality Therapy for Resectable Oesophageal Carcinoma: Meta-analyses and Systematic Review of Literature. World J Surg 2019; 43:1271-1285. [PMID: 30607604 DOI: 10.1007/s00268-018-04901-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Standard therapy for loco-regionally advanced, resectable oesophageal carcinoma is trimodality therapy (TMT) consisting of neoadjuvant chemoradiotherapy and oesophagectomy. Evidence of survival advantage of TMT over organ-preserving definitive chemoradiotherapy (dCRT) is inconclusive. The aim of this study is to compare survival between TMT and dCRT. METHODS A systematic review and meta-analyses were conducted. Randomised controlled trials and observational studies on resectable, curatively treated, oesophageal carcinoma patients above 18 years were included. Three online databases were searched for studies comparing TMT with dCRT. Primary outcomes were 1-, 2-, 3- and 5-year overall survival rates. Risk of bias was assessed using the Cochrane risk of bias tools for RCTs and cohort studies. Quality of evidence was evaluated according to Grading of Recommendation Assessment, Development and Evaluation. RESULTS Thirty-two studies described in 35 articles were included in this systematic review, and 33 were included in the meta-analyses. Two-, three- and five-year overall survival was significantly lower in dCRT compared to TMT, with relative risks (RRs) of 0.69 (95% CI 0.57-0.83), 0.76 (95% CI 0.63-0.92) and 0.57 (95% CI 0.47-0.71), respectively. When only analysing studies with equal patient groups at baseline, no significant differences for 2-, 3- and 5-year overall survival were found with RRs of 0.83 (95% CI 0.62-1.10), 0.81 (95% CI 0.57-1.14) and 0.63 (95% CI 0.36-1.12). CONCLUSION These meta-analyses do not show clear survival advantage for TMT over dCRT. Only a non-significant trend towards better survival was seen, assuming comparable patient groups at baseline. Non-operative management of oesophageal carcinoma patients might be part of a personalised and tailored treatment approach in future. However, to date hard evidence proving its non-inferiority compared to operative management is lacking.
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Affiliation(s)
- Daan M Voeten
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, 7F020, 1081 HV, Amsterdam, The Netherlands.
| | - Chantal M den Bakker
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, 7F020, 1081 HV, Amsterdam, The Netherlands
| | - David J Heineman
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, 7F020, 1081 HV, Amsterdam, The Netherlands
| | | | - Freek Daams
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, 7F020, 1081 HV, Amsterdam, The Netherlands
| | - Donald L van der Peet
- Department of Gastrointestinal Surgery, VU University Medical Center, De Boelelaan 1117, 7F020, 1081 HV, Amsterdam, The Netherlands
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Takagi H, Ota H, Umezawa R, Kimura T, Kadoya N, Higuchi S, Sun W, Nakajima Y, Saito M, Komori Y, Jingu K, Takase K. Left Ventricular T1 Mapping during Chemotherapy–Radiation Therapy: Serial Assessment of Participants with Esophageal Cancer. Radiology 2018; 289:347-354. [DOI: 10.1148/radiol.2018172076] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hidenobu Takagi
- From the Departments of Diagnostic Radiology (H.T., H.O., T.K., S.H., W.S., K.T.) and Radiation Oncology (R.U., N.K., Y.N., M.S., K.J.), Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba, Sendai, Miyagi, Japan 9808574; and Department of Research and Collaboration, Siemens Healthcare K.K., Shinagawa, Tokyo, Japan (Y.K.)
| | - Hideki Ota
- From the Departments of Diagnostic Radiology (H.T., H.O., T.K., S.H., W.S., K.T.) and Radiation Oncology (R.U., N.K., Y.N., M.S., K.J.), Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba, Sendai, Miyagi, Japan 9808574; and Department of Research and Collaboration, Siemens Healthcare K.K., Shinagawa, Tokyo, Japan (Y.K.)
| | - Rei Umezawa
- From the Departments of Diagnostic Radiology (H.T., H.O., T.K., S.H., W.S., K.T.) and Radiation Oncology (R.U., N.K., Y.N., M.S., K.J.), Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba, Sendai, Miyagi, Japan 9808574; and Department of Research and Collaboration, Siemens Healthcare K.K., Shinagawa, Tokyo, Japan (Y.K.)
| | - Tomoyoshi Kimura
- From the Departments of Diagnostic Radiology (H.T., H.O., T.K., S.H., W.S., K.T.) and Radiation Oncology (R.U., N.K., Y.N., M.S., K.J.), Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba, Sendai, Miyagi, Japan 9808574; and Department of Research and Collaboration, Siemens Healthcare K.K., Shinagawa, Tokyo, Japan (Y.K.)
| | - Noriyuki Kadoya
- From the Departments of Diagnostic Radiology (H.T., H.O., T.K., S.H., W.S., K.T.) and Radiation Oncology (R.U., N.K., Y.N., M.S., K.J.), Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba, Sendai, Miyagi, Japan 9808574; and Department of Research and Collaboration, Siemens Healthcare K.K., Shinagawa, Tokyo, Japan (Y.K.)
| | - Satoshi Higuchi
- From the Departments of Diagnostic Radiology (H.T., H.O., T.K., S.H., W.S., K.T.) and Radiation Oncology (R.U., N.K., Y.N., M.S., K.J.), Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba, Sendai, Miyagi, Japan 9808574; and Department of Research and Collaboration, Siemens Healthcare K.K., Shinagawa, Tokyo, Japan (Y.K.)
| | - Wenyu Sun
- From the Departments of Diagnostic Radiology (H.T., H.O., T.K., S.H., W.S., K.T.) and Radiation Oncology (R.U., N.K., Y.N., M.S., K.J.), Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba, Sendai, Miyagi, Japan 9808574; and Department of Research and Collaboration, Siemens Healthcare K.K., Shinagawa, Tokyo, Japan (Y.K.)
| | - Yujiro Nakajima
- From the Departments of Diagnostic Radiology (H.T., H.O., T.K., S.H., W.S., K.T.) and Radiation Oncology (R.U., N.K., Y.N., M.S., K.J.), Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba, Sendai, Miyagi, Japan 9808574; and Department of Research and Collaboration, Siemens Healthcare K.K., Shinagawa, Tokyo, Japan (Y.K.)
| | - Masahide Saito
- From the Departments of Diagnostic Radiology (H.T., H.O., T.K., S.H., W.S., K.T.) and Radiation Oncology (R.U., N.K., Y.N., M.S., K.J.), Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba, Sendai, Miyagi, Japan 9808574; and Department of Research and Collaboration, Siemens Healthcare K.K., Shinagawa, Tokyo, Japan (Y.K.)
| | - Yoshiaki Komori
- From the Departments of Diagnostic Radiology (H.T., H.O., T.K., S.H., W.S., K.T.) and Radiation Oncology (R.U., N.K., Y.N., M.S., K.J.), Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba, Sendai, Miyagi, Japan 9808574; and Department of Research and Collaboration, Siemens Healthcare K.K., Shinagawa, Tokyo, Japan (Y.K.)
| | - Keiichi Jingu
- From the Departments of Diagnostic Radiology (H.T., H.O., T.K., S.H., W.S., K.T.) and Radiation Oncology (R.U., N.K., Y.N., M.S., K.J.), Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba, Sendai, Miyagi, Japan 9808574; and Department of Research and Collaboration, Siemens Healthcare K.K., Shinagawa, Tokyo, Japan (Y.K.)
| | - Kei Takase
- From the Departments of Diagnostic Radiology (H.T., H.O., T.K., S.H., W.S., K.T.) and Radiation Oncology (R.U., N.K., Y.N., M.S., K.J.), Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba, Sendai, Miyagi, Japan 9808574; and Department of Research and Collaboration, Siemens Healthcare K.K., Shinagawa, Tokyo, Japan (Y.K.)
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Barret M, Prat F. Diagnosis and treatment of superficial esophageal cancer. Ann Gastroenterol 2018; 31:256-265. [PMID: 29720850 PMCID: PMC5924847 DOI: 10.20524/aog.2018.0252] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/29/2018] [Indexed: 02/07/2023] Open
Abstract
Endoscopy allows for the screening, early diagnosis, treatment and follow up of superficial esophageal cancer. Endoscopic submucosal dissection has become the gold standard for the resection of superficial squamous cell neoplasia. Combinations of endoscopic mucosal resection and radiofrequency ablation are the mainstay of the management of Barrett’s associated neoplasia. However, protruded, non-lifting or large lesions may be better managed by endoscopic submucosal dissection. Novel ablation tools, such as argon plasma coagulation with submucosal lifting and cryoablation balloons, are being developed for the treatment of residual Barrett’s esophagus, since iatrogenic strictures still hamper the development of extensive circumferential resections in the esophagus. Optimal surveillance modalities after endoscopic resection are still to be determined. The assessment of the risk of lymph-node metastases, as well as of the need for additional treatments based on qualitative and quantitative histological criteria, balanced to the patient’s condition, requires a dedicated multidisciplinary team decision process. The need for trained endoscopists, expert pathologists and surgeons, and specialized multidisciplinary meetings underlines the role of expert centers in the management of superficial esophageal cancer.
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Affiliation(s)
- Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Paris, France
| | - Frédéric Prat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Paris, France
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Umezawa R, Jingu K, Matsushita H, Sugawara T, Kubozono M, Yamamoto T, Ishikawa Y, Kozumi M, Takahashi N, Katagiri Y, Kadoya N, Takeda K, Ariga H, Nemoto K, Yamada S. Long-term results of chemoradiotherapy for stage II-III thoracic esophageal cancer in a single institution after 2000 -with a focus on comparison of three protocols. BMC Cancer 2015; 15:813. [PMID: 26506988 PMCID: PMC4624589 DOI: 10.1186/s12885-015-1836-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 10/19/2015] [Indexed: 11/29/2022] Open
Abstract
Background To evaluate the long-term results of chemoradiotherapy (CRT) for stage II-III thoracic esophageal cancer mainly by comparing results of three protocols retrospectively. Methods Between 2000 and 2012, 298 patients with stage II-III thoracic esophageal cancer underwent CRT. Patients in Group A received two cycles of cisplatin (CDDP) at 70 mg/m2 (day 1 and 29) and 5-fluorouracil (5-FU) at 700 mg/m2/24 h (day 1–4 and 29–32) with radiotherapy (RT) of 60 Gy without a break. Patients in Group B received two cycles of CDDP at 40 mg/m2 (day 1, 8, 36 and 43) and 5-FU at 400 mg/m2/24 h (day 1–5, 8–12, 36–40 and 43–47) with RT of 60 Gy with a 2-week break. Patients in Group C received two cycles of nedaplatin at 70 mg/m2 (day 1 and 29) and 5-FU at 500 mg/m2/24 h (day 1–4 and 29–32) with RT of 60–70 Gy without a break. Differences in prognostic factors between the groups were analyzed by univariate and multivariate analyses. Results The 5-year overall survival rates for patients in Group A, Group B and Group C were 52.4, 45.2 and 37.2 %, respectively. The 5-year overall survival rates for patients in Stage II, Stage III (non-T4) and Stage III (T4) were 64.0, 40.1 and 22.5 %, respectively. The 5-year overall survival rates for patients who received 1 cycle and 2 cycles of concomitant chemotherapy were 27.9 and 46.0 %, respectively. In univariate analysis, stage, performance status and number of concomitant chemotherapy cycles were significant prognostic factors (p < 0.001, p = 0.008 and p < 0.001, respectively). In multivariate analysis, stage, protocol and number of concomitant chemotherapy cycles were significant factors (p < 0.001, p = 0.043 and p < 0.001, respectively). Conclusions The protocol used in Group A may be an effective protocol of CRT for esophageal cancer. It may be important to complete the scheduled concomitant chemotherapy with the appropriate intensity of CRT.
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Affiliation(s)
- Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Toshiyuki Sugawara
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Masaki Kubozono
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Yojiro Ishikawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Maiko Kozumi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Yu Katagiri
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Ken Takeda
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Tohoku University, Sendai, Japan.
| | - Hisanori Ariga
- Department of Radiology, Iwate Medical University School of Medicine, Morioka, Japan.
| | - Kenji Nemoto
- Department of Radiation Oncology, Yamagata University School of Medicine, Yamagata, Japan.
| | - Shogo Yamada
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1, Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
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Umezawa R, Ota H, Takanami K, Ichinose A, Matsushita H, Saito H, Takase K, Jingu K. MRI findings of radiation-induced myocardial damage in patients with oesophageal cancer. Clin Radiol 2014; 69:1273-9. [PMID: 25246336 DOI: 10.1016/j.crad.2014.08.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 06/21/2014] [Accepted: 08/12/2014] [Indexed: 01/09/2023]
Abstract
AIM To evaluate radiation-induced myocardial damage after mediastinal radiotherapy using MRI. MATERIALS AND METHODS Between May 2010 and April 2011, delayed contrast-enhanced MRI was performed for patients who had maintained a complete response to curative radiotherapy for oesophageal cancer for more than 6 months. The patients received radiotherapy with a median total dose of 66 Gy (60-70 Gy) for the primary tumour and metastatic lymph nodes. Images of MRI were analysed by a 17-segment method recommended by the American Heart Association. A segment included mainly in the 40 Gy dose line was defined as Segment 40 Gy, a segment included mainly in the 60 Gy dose line as Segment 60 Gy, and a segment out of the radiation fields as Segment OUT. The percentage of late gadolinium enhancement (LGE) was examined in those categories. The layer in which LGE was predominantly distributed was evaluated for each patient. RESULTS Four hundred and eight segments in 24 patients were analysed. The median interval from completion of radiotherapy to MRI was 23.5 months (range 6-88 months). LGE was detected in 12 of the 24 patients. LGE was detected in 15.38% of Segment 40 Gy cases, 21.21% of Segment 60 Gy cases, and 0% of Segment OUT cases. LGE in mid-myocardial and subendocardial layers was detected in 11 patients and one patient, respectively. CONCLUSION LGE suggesting radiation induced myocardial fibrosis was observed by performing delayed contrast-enhanced MRI. Care should be taken when planning radiotherapy to avoid late cardiac damage.
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Affiliation(s)
- R Umezawa
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan.
| | - H Ota
- Department of Diagnostic Radiology, Tohoku University School of Medicine, Sendai, Japan
| | - K Takanami
- Department of Diagnostic Radiology, Tohoku University School of Medicine, Sendai, Japan
| | - A Ichinose
- Department of Diagnostic Radiology, Tohoku University School of Medicine, Sendai, Japan
| | - H Matsushita
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - H Saito
- Department of Diagnostic Image Analysis, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K Takase
- Department of Diagnostic Radiology, Tohoku University School of Medicine, Sendai, Japan
| | - K Jingu
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan
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