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Ryu DG, Yu F, Liu H, Lee SS, Lee SL. Clinical Outcomes and Prognosis of Esophageal Squamous Cell Carcinoma Presenting with Obstruction. J Gastrointest Cancer 2024; 56:35. [PMID: 39702624 DOI: 10.1007/s12029-024-01159-8] [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] [Accepted: 12/10/2024] [Indexed: 12/21/2024]
Abstract
BACKGROUND The prognosis of esophageal squamous cell carcinoma (ESCC) with obstruction is unclear. This study aimed to analyze clinical outcomes and prognosis of patients with ESCC and obstruction. METHODS Patients with advanced ESCC were included and divided into obstructive and non-obstructive groups. Clinical outcomes and survival according to treatment were compared between these groups. RESULTS Among 353 patients with advanced ESCC, obstruction was present in 105 (29.7%). ESCC with obstruction was more common in the upper thoracic location (23.8% vs. 14.5%, p = 0.036) and had a higher stage (7.6% vs. 32.7%, p < 0.001 in stage 2; 41.0% vs. 24.2%, p = 0.002 in stage 4) than those without obstruction. The median survival time of patients with obstruction was significantly shorter than that of patients without obstruction (7.6 months vs. 20.2 months, p < 0.001). Patients with obstruction had a significantly lower survival rate regardless of treatment. When surgery was performed first on patients with obstruction, the R0 resection rate was significantly lower (33.3% vs. 88.5%, p < 0.001). For patients with obstruction in resectable stages, surgery after neoadjuvant chemoradiotherapy resulted in the best survival (HR: 0.48; 95% CI: 0.15 - 1.49; p = 0.201). When only chemoradiotherapy was performed in resectable stages, clinically complete response rate was significantly lower (35.3% vs. 64.9%, p = 0.035) in the obstructive group. CONCLUSION ESCC with obstruction was at a more advanced stage and had a poor prognosis regardless of treatment. Surgery first or chemoradiotherapy alone is not recommended for these patients. Neoadjuvant chemoradiotherapy prior to surgical resection is recommended for those with ESCC and obstruction at resectable stages.
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Affiliation(s)
- Dae Gon Ryu
- Liver Unit, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Fengxue Yu
- Liver Unit, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hongqun Liu
- Liver Unit, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Samuel S Lee
- Liver Unit, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Sangjune Laurence Lee
- Division of Radiation Oncology, University of Calgary, Tom Baker Cancer Centre, 1331 29 Street NW, Calgary, AB, T2N 4N2, Canada.
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Chiu PWY, Yue GGL, Cheung MK, Yip HC, Chu SK, Yung MY, Wu JCY, Chan SM, Teoh AYB, Ng EKW, Norimoto H, Lau CBS. The effect of Andrographis paniculata water extract on palliative management of metastatic esophageal squamous cell carcinoma-A phase II clinical trial. Phytother Res 2023; 37:3438-3452. [PMID: 37042309 DOI: 10.1002/ptr.7815] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 03/13/2023] [Accepted: 03/18/2023] [Indexed: 04/13/2023]
Abstract
Patients with metastatic esophageal squamous cell carcinoma (ESCC) have a grave prognosis with limited life expectancy. Here, a phase II clinical trial was conducted to investigate the effect of Andrographis paniculata (AP) on the palliative care of patients with metastatic ESCC. Patients with metastatic or locally advanced ESCC deemed unfit for surgery, and who have already completed palliative chemotherapy or chemoradiotherapy or are not fit for these treatments, were recruited. These patients were prescribed AP concentrated granules for 4 months. They also received clinical and quality of life assessments for clinical response, as well as positron emission tomography-computed tomography at 3 and 6 months after AP treatment for the assessment of tumor volume. Furthermore, the change in gut microbiota composition after AP treatment was studied. From the results, among the 30 recruited patients, 10 completed the entire course of AP treatment, while 20 received partial AP treatment. Patients who completed the AP treatment achieved significantly longer overall survival periods with the maintenance of the quality of life during the survival period when compared to those who could not complete AP treatment. The treatment effect of AP also contributed to the shift of the overall structure of gut microbiota for ESCC patients towards those of healthy individuals. The significance of this study is the establishment of AP as a safe and effective palliative treatment for patients with squamous cell carcinoma of the esophagus. To the best of our knowledge, this is the first clinical trial of AP water extract in esophageal cancer patients demonstrating its new medicinal use.
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Affiliation(s)
- Philip Wai-Yan Chiu
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
- Institute of Digestive Disease and State Key Laboratory of Digestive Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Grace Gar-Lee Yue
- Institute of Chinese Medicine and State Key Laboratory of Research on Bioactivities and Clinical Applications of Medicinal Plants, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Man Kit Cheung
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hon-Chi Yip
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
- Institute of Digestive Disease and State Key Laboratory of Digestive Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Siu-Kai Chu
- Nong's, PuraPharm Corporation Limited, Tai Po, Hong Kong
| | - Man-Yee Yung
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
- Institute of Digestive Disease and State Key Laboratory of Digestive Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Justin Che-Yuen Wu
- Institute of Digestive Disease and State Key Laboratory of Digestive Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong
- Division of Gastroenterology and Hepatology, Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Shannon Melissa Chan
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
- Institute of Digestive Disease and State Key Laboratory of Digestive Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Anthony Yuen-Bun Teoh
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
- Institute of Digestive Disease and State Key Laboratory of Digestive Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Enders Kwok-Wai Ng
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
- Institute of Digestive Disease and State Key Laboratory of Digestive Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Clara Bik-San Lau
- Institute of Chinese Medicine and State Key Laboratory of Research on Bioactivities and Clinical Applications of Medicinal Plants, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
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Park MI. Chemoradiotherapy for Esophageal Cancer. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2019. [DOI: 10.7704/kjhugr.2019.19.3.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Tonoiso C, Ikushima H, Kubo A, Kawanaka T, Funatani S, Kudo T, Yoshida T, Miyamoto H, Harada M, Takayama T, Tangoku A. Clinical outcomes and prognostic factors of definitive radiotherapy for esophageal cancer. THE JOURNAL OF MEDICAL INVESTIGATION 2019; 66:99-105. [PMID: 31064964 DOI: 10.2152/jmi.66.99] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Purpose To assess the treatment results of definitive radiotherapy for esophageal cancer at Tokushima University Hospital and clarify the prognostic factors. Methods Seventy consecutive patients with esophageal cancer who underwent definitive radiotherapy between May 2004 and March 2012 were included in the present study. Local control rate, overall survival rate, and radiation morbidity were examined and univariate and multivariate analyses were performed to investigate prognostic factors. Results The 5-yearoverall survival rates of stages I, II, III, and IVA were 81%, 71%, 0%, and 9%, respectively. Performance status, clinical stage, and neoadjuvant chemotherapy were significant prognostic factors. A past history of interstitial pneumonia was associated with severe radiation-induced lung injury. Conclusions Patients who underwent definitive chemoradiotherapy for esophageal cancer in stage I/II showed good prognosis. However, treatment results of the patients in stage III/IV were not satisfactory, and those who could not undergo surgery after neoadjuvant chemotherapy had the worst prognosis.J.Med.Invest.66:99-105, February, 2019.
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Affiliation(s)
- Chisato Tonoiso
- Department of Radiology, Institute of Biomedical Sciences, Tokushima University,Tokushima, Japan
| | - Hitoshi Ikushima
- Department of Therapeutic Radiology, Institute of Biomedical Sciences, Tokushima University,Tokushima, Japan
| | - Akiko Kubo
- Department of Radiology, Institute of Biomedical Sciences, Tokushima University,Tokushima, Japan
| | - Takashi Kawanaka
- Department of Radiology, Institute of Biomedical Sciences, Tokushima University,Tokushima, Japan
| | - Shunsuke Funatani
- Department of Radiology, Institute of Biomedical Sciences, Tokushima University,Tokushima, Japan
| | - Takaharu Kudo
- Department of Oral and Maxillofacial Surgery, Institute of Biomedical Sciences, Tokushima University,Tokushima, Japan
| | - Takahiro Yoshida
- Department of Thoracic,Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University,Tokushima, Japan
| | - Hiroshi Miyamoto
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University,Tokushima, Japan
| | - Masafumi Harada
- Department of Radiology, Institute of Biomedical Sciences, Tokushima University,Tokushima, Japan
| | - Tetsuji Takayama
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University,Tokushima, Japan
| | - Akira Tangoku
- Department of Thoracic,Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University,Tokushima, Japan
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Forootan M, Tabatabaeifar M, Fatemi M, Darvishi M. Efficacy of Chemoradiotherapy on Health-Related Quality of Life in Esophageal Cancer Patients with Dysphagia. Mater Sociomed 2019; 31:246-252. [PMID: 32082087 PMCID: PMC7007622 DOI: 10.5455/msm.2019.31.246-252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: Esophageal cancer is diagnosed with more than 480,000 patients per year and this disease became the eighth most common cancer worldwide. Aim: In this study, we tried to investigate the role of chemoradiotherapy in decreasing the severity of dysphagia and increasing the quality of life (QOL) in patients with esophageal cancer. Methods: Patients were diagnosed with esophageal cancer, which were proven by pathological studies. Also, all of these patients had no primary surgeries for their esophageal cancer. For determining the cancer staging, the endoscopy, sonography, abdominal and pelvic computed tomography scans were assessed. Results: In this study, 81% of patients showed responsiveness to the chemoradiotherapy and their dysphagia significantly was getting improved after treatment in comparison to the initial date (P<0.01). Also, the pain score significantly decreased after chemoradiotherapy. However, the analysis failed to show any significant difference between before and after treatment in 19% of patients who had high degrees of dysphagia and they were the candidate for surgery and stent putting. On the other hand, we demonstrated that there is no correlation between sex, age, tumor type and location with the recovery rate of dysphagia. In addition, we showed that none of the patients showed the recurrence of dysphagia during the study (1.5 years). Conclusion: Chemoradiotherapy could be a novel treatment for patients with inoperable esophageal cancer to reduce the severity of dysphagia and increasing the QOL of these individuals.
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Affiliation(s)
- Mojgan Forootan
- Department of Gastroenterology, Gastrointestinal and Liver Diseases Research Center (RCGLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Tabatabaeifar
- Department of Gastroenterology, Gastrointestinal and Liver Diseases Research Center (RCGLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Fatemi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Darvishi
- Infectious Diseases and Tropical Medicine Research Center (IDTMRC), Department of Aerospace and Subaquatic Medicine, AJA University of Medical Sciences, Tehran, Iran, Iran
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Han J, Zhu W, Yu C, Zhou X, Li T, Zhang X. Clinical Study of Concurrent Chemoradiotherapy or Radiotherapy Alone for Esophageal Cancer Patients with Positive Lymph Node Metastasis. TUMORI JOURNAL 2018; 98:60-5. [DOI: 10.1177/030089161209800108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background Esophageal cancer patients with pathologic lymph node involvement generally have a poor prognosis. Many randomized controlled trials have not achieved consistent results similar to those of the RTOG8501 trial, and the long-term survival rate has not increased. The present study aimed to compare the efficacy and toxic side effects of concurrent chemoradiotherapy and radiotherapy alone to treat N1 esophageal carcinoma. Methods and Study Design A total of 130 N1 esophageal carcinoma patients were enrolled and randomly divided into two groups: concurrent chemoradiotherapy group (n = 65) and radiotherapy group (n = 65). Both groups received three-dimensional conformal radiotherapy with a total dose of 64–66 Gy. Meanwhile, to the concurrent chemoradiotherapy group, an additional chemotherapy protocol (nedaplatin, 20 mg/m2/d, 5-FU, 500 mg/m2/d for four days) was given from day 1, and such treatment was repeated until day 29. From day 21 after radiotherapy, two cycles of a consolidated chemotherapy protocol were given at an interval of 28 days. Results The survival rates at one, two, and three years were 72.3%, 55.3%, and 40% in the concurrent chemoradiotherapy group, respectively, and 75.3%, 38.5%, and 18.5% in the radiotheray group (P = 0.007), respectively. The survival rates of the patients in the concurrent chemoradiotherapy group who completed one to two cycles and three to four cycles at one, two, and three years were 70%, 53.3%, and 30%, and 74.2%, 57.1%, 48.6% (P = 0.128), respectively. Three-year distant metastasis rates were 10.7% in the concurrent chemoradiotherapy group and 16.9% in the radiotherapy group. Acute toxicity in the concurrent chemoradiotherapy group was higher than in the radiotherapy group. Late toxic side effects were similar in the two groups. Conclusions Compared with radiotherapy alone, concurrent chemoradiotherapy in the treatment of esophageal carcinoma with local lymph node enlargement can improve the three-year survival rate. Moreover, completion of three to four cycles of chemotherapy may have better efficacy than one to two cycles.
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Affiliation(s)
- Jihua Han
- Department of Radiation Oncology, First Hospital of Huaian, Nanjing Medical University, Huaian, China
| | - Weiguo Zhu
- Department of Radiation Oncology, First Hospital of Huaian, Nanjing Medical University, Huaian, China
| | - Changhua Yu
- Department of Radiation Oncology, First Hospital of Huaian, Nanjing Medical University, Huaian, China
| | - Xilei Zhou
- Department of Radiation Oncology, First Hospital of Huaian, Nanjing Medical University, Huaian, China
| | - Tao Li
- Department of Radiation Oncology, First Hospital of Huaian, Nanjing Medical University, Huaian, China
| | - Xiaoye Zhang
- Department of Radiation Oncology, First Hospital of Huaian, Nanjing Medical University, Huaian, China
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Sigounas DE, Krystallis C, Couper G, Paterson-Brown S, Tatsioni A, Plevris JN. Argon plasma coagulation compared with stent placement in the palliative treatment of inoperable oesophageal cancer. United European Gastroenterol J 2017; 5:21-31. [PMID: 28405318 PMCID: PMC5384556 DOI: 10.1177/2050640616650786] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 04/27/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Self-expandable metal stents (SEMSs) are the main palliative modality used in inoperable oesophageal cancer. Other palliative modalities, including argon plasma coagulation (APC), have also been used. OBJECTIVE The purpose of this study was to assess the relative efficacy of SEMS and APC regarding the survival of patients with inoperable oesophageal cancer, not receiving chemo/radiotherapy. METHODS Single centre, retrospective analysis of all patients (n = 228) with inoperable oesophageal cancer between January 2000 and July 2014, not receiving chemo-radiotherapy, treated with SEMS (n = 160) or APC (n = 68) as primary palliation modalities. Cox regression analysis was performed to identify individual factors affecting survival and Kaplan-Meier curves were created for patients treated with APC and SEMS for stage III and IV disease. Survival intervals were compared by the log-rank test. RESULTS Type of treatment was the only statistically significant factor affecting survival, after disease stage stratification (hazard ratio (HR): 1.36, 95% confidence interval (CI): 1.13-1.65 of SEMS over APC, p: 0.002). Median survival for patients treated with APC and SEMS was 257 (interquartile range (IQR): 414, 124) and 151 (IQR: 241, 61) days respectively in stage III disease. It was 135 (IQR: 238, 43) and 70 (IQR: 148, 32) days respectively in stage IV disease. Both differences were statistically significant (p = 0.02 and 0.05 respectively). CONCLUSIONS APC is a promising palliation modality in inoperable oesophageal cancer, when patients are not candidates for chemo-radiotherapy. A randomized controlled trial will be needed to confirm those results.
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Affiliation(s)
- Dimitrios E Sigounas
- Centre for Liver and Digestive Disorders, University of Edinburgh, Edinburgh, UK
| | | | - Graeme Couper
- University Department of Surgery, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Simon Paterson-Brown
- University Department of Surgery, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - John N Plevris
- Centre for Liver and Digestive Disorders, University of Edinburgh, Edinburgh, UK
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XU MINGFANG, HUANG HUAN, XIONG YANLI, PENG BO, ZHOU ZEJUN, WANG DONG, YANG XUEQIN. Combined chemotherapy plus endostar with sequential stereotactic radiotherapy as salvage treatment for recurrent esophageal cancer with severe dyspnea: A case report and review of the literature. Oncol Lett 2014; 8:291-294. [PMID: 24959263 PMCID: PMC4063583 DOI: 10.3892/ol.2014.2087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 02/26/2014] [Indexed: 12/22/2022] Open
Abstract
For the majority of inoperable esophageal cancer cases, chemoradiotherapy is the most suitable treatment option. Cetuximab may provide certain benefits, however, this can be an expensive therapy. Additionally, stereotactic body radiation therapy (SBRT) is typically contraindicated for esophageal cancer due to the potential for esophageal perforation and stenosis. The use of combined chemotherapy plus endostar with sequential SBRT for the treatment of esophageal squamous cancer has not been reported. In the current study, the case of a 71-year-old female with esophageal squamous cancer diagnosed 2 years prior is presented. Surgery and four cycles of cisplatin plus 5-fluorouracil chemotherapy had been administered. The patient showed recurrence at the paratracheal lymph node, exhibited severe dyspnea (grade III) and required a semi-liquid diet. Four cycles of the docetaxel, 5-fluorouracil and nedaplatin regimen plus endostar (3 mg; days 1-14; intravenously) with sequential SBRT (3300 cGy in 10 fractions) was administered. Following treatment, the symptoms of the patient completely disappeared, and objective efficacy evaluation indicated complete remission. At the time of writing, the patient is living without discomfort and the progression-free survival is >8 months. In conclusion, the present case indicates that combined treatment of chemotherapy and endostar with sequential stereotactic radiotherapy is a safe and effective option for the management of esophageal cancer.
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Affiliation(s)
- MINGFANG XU
- Cancer Center, Daping Hospital, Third Military Medical University, Chongqing 400042, P.R. China
| | - HUAN HUANG
- Cancer Center, Daping Hospital, Third Military Medical University, Chongqing 400042, P.R. China
| | - YANLI XIONG
- Cancer Center, Daping Hospital, Third Military Medical University, Chongqing 400042, P.R. China
| | - BO PENG
- Cancer Center, Daping Hospital, Third Military Medical University, Chongqing 400042, P.R. China
| | - ZEJUN ZHOU
- Cancer Center, Daping Hospital, Third Military Medical University, Chongqing 400042, P.R. China
| | - DONG WANG
- Cancer Center, Daping Hospital, Third Military Medical University, Chongqing 400042, P.R. China
| | - XUEQIN YANG
- Cancer Center, Daping Hospital, Third Military Medical University, Chongqing 400042, P.R. China
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Chow VLY, Chan JYW, Wei WI. Salvage surgery for recurrent carcinoma of the cervical esophagus postesophagectomy. Head Neck 2014; 37:1170-5. [PMID: 24798320 DOI: 10.1002/hed.23730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 02/23/2014] [Accepted: 04/28/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Management of cervical esophageal tumor postesophagectomy is mainly palliative because of inadequate exposure of tumor in the cervicothoracic region. In this study, we propose a means of cure for these patients. METHODS Between January 2003 and June 2013, 6 patients underwent curative pharyngolaryngectomy and completion cervical esophagectomy via manubrial resection. Operative outcomes were analyzed and compared with a historical cohort who received palliative therapy. RESULTS One patient required prolonged hospital stay for pneumonia, resulting in a median hospital stay of 30 days (range, 21-55 days). All patients resumed oral feeding at a mean of 15.2 days (range, 14-19 days). Tracheostoma stenosis was noted in 2 patients. One patient developed nodal recurrence, another with distant metastasis, resulting in a median disease-free survival of 13 months (range, 4-20 months). Median overall survival was significantly longer than the cohort group (19.0 vs 3.0 months; p = .013). CONCLUSION Salvage surgery in patients with carcinoma of the cervical esophagus postesophagectomy is feasible with significantly prolonged survival.
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Affiliation(s)
- Velda L Y Chow
- Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong, China
| | - Jimmy Y W Chan
- Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong, China
| | - William I Wei
- Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong, China
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Mohamed A, El-Rayes B, Khuri FR, Saba NF. Targeted therapies in metastatic esophageal cancer: advances over the past decade. Crit Rev Oncol Hematol 2014; 91:186-96. [PMID: 24582516 DOI: 10.1016/j.critrevonc.2014.01.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 01/14/2014] [Accepted: 01/17/2014] [Indexed: 12/29/2022] Open
Abstract
Esophageal cancer is one of the most aggressive malignancies of the upper aerodigestive tract. Despite advances in surgical techniques and multi-modality therapies, the 5-year survival rate remains poor (14%). Over the past decade, efforts have been focused on the field of drug development with the advancement of novel molecularly targeted therapeutic agents. These agents target a variety of cancer relevant pathways such as vascular endothelial growth factor (VEGF) or its receptor, the cyclooxygenase-2 (COX-2), epidermal growth factor receptor (EGFR), and mammalian target of rapamycin (mTOR) pathways. The number of approved targeted agents remains few, with HER-2 inhibitors leading the list for treatment of HER-2 expressing metastatic adenocarcinomas. Novel agents have not yet been widely explored in esophageal cancer. In this review, we will provide a concise and systematic overview of the development of novel targeted therapies currently under investigation for the treatment of metastatic esophageal disease.
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Affiliation(s)
- Amr Mohamed
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Bassel El-Rayes
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA, USA
| | - Fadlo R Khuri
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA, USA.
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11
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Li SH, Huang YC, Huang WT, Lin WC, Liu CT, Tien WY, Lu HI. Is there a role of whole-body bone scan in patients with esophageal squamous cell carcinoma. BMC Cancer 2012; 12:328. [PMID: 22853826 PMCID: PMC3443043 DOI: 10.1186/1471-2407-12-328] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 07/27/2012] [Indexed: 11/24/2022] Open
Abstract
Background Correct detection of bone metastases in patients with esophageal squamous cell carcinoma is pivotal for prognosis and selection of an appropriate treatment regimen. Whole-body bone scan for staging is not routinely recommended in patients with esophageal squamous cell carcinoma. The aim of this study was to investigate the role of bone scan in detecting bone metastases in patients with esophageal squamous cell carcinoma. Methods We retrospectively evaluated the radiographic and scintigraphic images of 360 esophageal squamous cell carcinoma patients between 1999 and 2008. Of these 360 patients, 288 patients received bone scan during pretreatment staging, and sensitivity, specificity, positive predictive value, and negative predictive value of bone scan were determined. Of these 360 patients, surgery was performed in 161 patients including 119 patients with preoperative bone scan and 42 patients without preoperative bone scan. Among these 161 patients receiving surgery, 133 patients had stages II + III disease, including 99 patients with preoperative bone scan and 34 patients without preoperative bone scan. Bone recurrence-free survival and overall survival were compared in all 161 patients and 133 stages II + III patients, respectively. Results The diagnostic performance for bone metastasis was as follows: sensitivity, 80%; specificity, 90.1%; positive predictive value, 43.5%; and negative predictive value, 97.9%. In all 161 patients receiving surgery, absence of preoperative bone scan was significantly associated with inferior bone recurrence-free survival (P = 0.009, univariately). In multivariate comparison, absence of preoperative bone scan (P = 0.012, odds ratio: 5.053) represented the independent adverse prognosticator for bone recurrence-free survival. In 133 stages II + III patients receiving surgery, absence of preoperative bone scan was significantly associated with inferior bone recurrence-free survival (P = 0.003, univariately) and overall survival (P = 0.037, univariately). In multivariate comparison, absence of preoperative bone scan was independently associated with inferior bone recurrence-free survival (P = 0.009, odds ratio: 5.832) and overall survival (P = 0.029, odds ratio: 1.603). Conclusions Absence of preoperative bone scan was significantly associated with inferior bone recurrence-free survival, suggesting that whole-body bone scan should be performed before esophagectomy in patients with esophageal squamous cell carcinoma, especially in patients with advanced stages.
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Affiliation(s)
- Shau-Hsuan Li
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Jiang XJ, Song MQ, Xin YN, Gao YQ, Niu ZY, Tian ZB. Endoscopic stenting and concurrent chemoradiotherapy for advanced esophageal cancer: A case-control study. World J Gastroenterol 2012; 18:1404-9. [PMID: 22493556 PMCID: PMC3319969 DOI: 10.3748/wjg.v18.i12.1404] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 09/28/2011] [Accepted: 01/18/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the role of endoscopic stenting with or without concurrent 3-dimensional conformal chemoradiotherapy (3D-CRT) in patients with inoperable esophageal cancer.
METHODS: Advanced esophageal cancer patients indicated for esophagectomy received esophageal stents. A part of patients completed 3D-CRT after stenting. Efficacy was assessed by endoscopy and computed tomographic scan before and 4 wk after completion of the treatment. The median survival, 3D-CRT toxicity and complications were compared between 3D-CRT and control groups.
RESULTS: From 1999 to 2008, 99 consecutive patients with T3/T4 disease and unsuitable for esophagectomy were placed with esophageal stents. Sixty-seven patients received 3D-CRT, while 36 patients treated with endoscopic stents alone were recruited as controls. After 3D-CRT treatment, the median tumor volume of 3D-CRT patients were reduced significantly from 43.7 ± 10.2 cm3 to 28.8 ± 8.5 cm3 (P < 0.05). The complete and partial response rate was 85.1%, and no response was 14.9%. After 3D-CRT, the incidence rate of T2 and T3 disease evident on CT scan increased to 78.4% while T4 decreased from 66.7% to 21.6% (P < 0.05). 3D-CRT Karnofsky Performance Status improved in 3D-CRT patients compared with the control group (P = 0.031). 3D-CRT patients had a longer survival than the control group (251.7 d vs 91.1 d, P < 0.05). And the median half-year survival rate in 3D-CRT group (91%) was higher than in the control group (50%, P < 0.05). The most common toxicity was leukocytopenia in the 3D-CRT group (46.7% vs 18.8%, P = 0.008). The control group had a higher rate of restenosis than the 3D-CRT group (81.3% vs 9.0%, P < 0.05). The rate of nephrotoxicity was increased in 3D-CRT as compared with the control group (31.3% vs 15.6%, P < 0.05).
CONCLUSION: 3D-CRT can improve dysphagia in patients with inoperable esophageal carcinoma. 3D-CRT combined with stenting results in better survival as compared with endoscopic stents used alone.
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Ikeda E, Kojima T, Kaneko K, Minashi K, Onozawa M, Nihei K, Fuse N, Yano T, Yoshino T, Tahara M, Doi T, Ohtsu A. Efficacy of concurrent chemoradiotherapy as a palliative treatment in stage IVB esophageal cancer patients with dysphagia. Jpn J Clin Oncol 2011; 41:964-72. [PMID: 21742654 DOI: 10.1093/jjco/hyr088] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To retrospectively assess the efficacy and safety of palliative chemoradiotherapy in Stage IVB esophageal cancer patients with dysphagia due to the primary lesion. METHODS Forty patients with dysphagia caused by metastatic esophageal cancer, which had been treated between January 2004 and June 2009, were retrospectively investigated. The treatment consisted of two courses of chemotherapy (5-fluorouracil and cisplatin) and concurrent irradiation of 40 Gy in 20 fractions to the esophageal primary tumor. The grade of dysphagia was evaluated; nutrition-support-free survival was evaluated using the status of nutritional support of patients. Response to treatment, overall survival, progression-free survival and toxicities were also evaluated. RESULTS Dysphagia score improved in 75% of the patients. Seventeen of the 20 patients (85%) who had required nutritional support at baseline improved their oral intake to no longer need the support, in a median time of 43 days. The median nutrition-support-free survival was 301 days in the 20 patients who had had adequate oral intake before the treatment. Disease control rate of the primary lesion was 95%, including 12 patients (30%) who achieved a complete response. The overall response rate was 55%. The median survival was 308 days, and the 1-year-survival rate was 45.0%. The median progression-free survival was 139 days. Toxicities were generally well tolerated. Major toxicities (Grade 3 or 4) involved hemoglobin (23%), leukocytes (15%), neutrophils (20%), anorexia (10%), nausea (3%), esophageal perforation (5%) and febrile neutropenia (3%). Two patients (5%) died within 30 days of terminating radiotherapy. CONCLUSIONS Palliative chemoradiotherapy using 5-fluorouracil plus cisplatin combined with concurrent 40 Gy irradiation effectively improved the symptom of dysphagia in Stage IVB esophageal cancer with acceptable toxicity and favorable survival.
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Affiliation(s)
- Eiji Ikeda
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
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Shenfine J, McNamee P, Steen N, Bond J, Griffin SM. A randomized controlled clinical trial of palliative therapies for patients with inoperable esophageal cancer. Am J Gastroenterol 2009; 104:1674-85. [PMID: 19436289 DOI: 10.1038/ajg.2009.155] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES A dramatic rise in incidence, an aging population, and expensive palliative treatments have led to an escalating burden on clinicians managing inoperable esophageal cancer with only limited evidence of effectiveness. This study compares the clinical effectiveness and cost-effectiveness of self-expanding metal stents (SEMSs) with other palliative therapies to aid clinicians in making an evidence-based treatment choice. METHODS We conducted a prospective, multicenter, randomized, controlled, clinical trial with 215 patients followed until death or study closure. The primary outcome measures were dysphagia, quality of life (QL) 6 weeks following treatment, and total cost of treatment. Secondary outcome measures included treatment-associated morbidity, mortality, survival, and cost-effectiveness. An intention-to-treat analysis was carried out. RESULTS There was a significant difference in mean dysphagia grade between treatment arms 6 weeks following treatment (P=0.046), with worse swallowing reported by rigid stent-treated patients (mean dysphagia score difference=-0.49; 95% confidence interval (CI) -0.10 to -0.89, P=0.014). Global QL scores were lower at both 1 and 6 weeks following treatment for patients treated by SEMSs (mean difference QL index week 1=-0.66; 95% CI: -0.02 to -1.30, P=0.04; mean difference QL index week 6=-1.01; 95% CI -0.30 to -1.72, P=0.006). These findings were associated with higher post-procedure pain scores in the SEMS patient group (mean difference of the European Organisation for Research and Treatment of Cancer QLQ C-30 pain symptom score at week 1=11.13; 95% CI: 2.89-19.4; P=0.01). Although mean EQ-5D QL values differed between the treatments (P<0.001), this difference dissipated following generation of quality-adjusted life year values. Total costs varied between treatment arms but these findings canceled out when SEMSs were compared with non-SEMS therapies (95% CI -845.15-1,332.62). These results were robust to sensitivity analysis. There were no differences in the in-hospital mortality or early complication rates, but late complications were more frequent after rigid stenting (risk ratio=2.47; 95% CI 1.88-3.04). There was a survival advantage for non-stent-treated patients (log-rank statistic=4.21, P=0.04). CONCLUSIONS The treatment choice for patients with inoperable esophageal cancer should be between a SEMS or a non-stent treatment after consideration has been given to both patient and tumor characteristics and clinician and patient preferences.
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Affiliation(s)
- Jonathan Shenfine
- Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
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White RE, Parker RK, Fitzwater JW, Kasepoi Z, Topazian M. Stents as sole therapy for oesophageal cancer: a prospective analysis of outcomes after placement. Lancet Oncol 2009; 10:240-6. [PMID: 19230771 DOI: 10.1016/s1470-2045(09)70004-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Therapies for inoperable oesophageal cancer include chemoradiotherapy and placement of a self-expanding metal stent (SEMS). Few data are available regarding SEMS as sole therapy for patients with inoperable disease who have not already received, or are unfit for, chemoradiotherapy. The aim of this study was to determine survival, adequacy of palliation, and complications after SEMS placement as sole therapy for inoperable oesophageal cancer in a resource-limited setting. METHODS Data were prospectively gathered on all patients with oesophageal cancer treated with SEMS between Jan 1, 1999, and May 20, 2008, at a hospital in Kenya where chemoradiotherapy is unavailable. Dysphagia scores, morbidity, mortality, and survival were assessed. Follow-up was done during clinic visits, home visits, and by mobile phone. FINDINGS 1000 stents were placed in 951 patients. Long-term follow-up was obtained for 334 patients (35%) with a median survival of 250 days (IQR 130-431, 95%CI 217-301). Mean dysphagia scores improved from 3.3 (SD 0.6) pre-SEMS (n=697) to 1.0 (SD 1.3) for patients (n=78) still alive and 1.8 (SD 1.2) at time of death (n=165). Survival of 17 patients with follow-up who had perforation during tumour dilation (treated with SEMS) was 283 days (IQR 227-538) similar to the 317 patients with follow-up data who did not have a perforation (245 days, 124-430). 20 patients with a tracheo-oesophageal fistula lived a median of 142 days (IQR 73-329). Early complications occurred in 6% (54 of 951 patients) and late complications occurred in 19% (62 of 334 patients). SEMS-related mortality was 0.3% (three of 951). INTERPRETATION SEMS effectively palliate inoperable oesophageal cancer. Survival may be longer than previously reported when SEMS are placed in all patients with inoperable oesophageal cancer, as in our study, rather than those failing or unfit for chemoradiotherapy. SEMS seem to be an appropriate technology for palliation of oesophageal cancer in resource-limited settings. Given the proportion of patients lost to follow up, these findings merit further confirmation.
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Affiliation(s)
- Russell E White
- Tenwek Hospital, Bomet, Kenya; Department of Surgery, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
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Zingg U, Divalentino D, McQuinn A, Mardzuki A, Thompson SK, Karapetis CS, Watson DI. Outcome for esophageal cancer following treatment with chemotherapy and radiotherapy but not esophagectomy: Nonsurgical treatment of esophageal cancer. Clin Exp Gastroenterol 2009; 2:75-83. [PMID: 21694830 PMCID: PMC3108630 DOI: 10.2147/ceg.s6273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Indexed: 11/23/2022] Open
Abstract
Background: More than 50% of patients with esophageal cancer are not suitable for surgery. The aim of this study was to analyze the outcome of patients undergoing standard nonsurgical treatment. Methods: Data of all patients undergoing nonsurgical treatment for esophageal cancer were identified from a prospective database. Results: Seventy-five patients were treated for localized disease, and 52 for metastatic disease at diagnosis. Except for age, which was higher in patients without metastases, there were no significant differences between the patients with vs. without metastatic disease. Kaplan–Meier analysis showed a median survival of 10.8 months for all patients. There was a significant difference in survival (p < 0.001) between the groups with versus without metastases, with median survival in the patients without metastases 13.6 months versus 6.5 months in patients with metastases. Patients undergoing nonsurgical treatment for localized disease had a five-year survival of 12%. No significant difference between adenocarcinoma and squamous cell carcinoma was identified. Subanalysis of patients who received chemoradiotherapy revealed similar results to the overall group of patients. Conclusion: In patients with localized disease at diagnosis, long-term survival can be achieved in some patients, whereas five-year survival is rare in patients who present with metastatic disease.
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Affiliation(s)
- Urs Zingg
- Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
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none. Bibliography. PROGRESS IN PALLIATIVE CARE 2008. [DOI: 10.1179/096992608x296987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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