• Esophageal cancer
• Obstruction
• Squamous cell carcinoma

• Humans
• Male
• Female
• Middle Aged
• Esophageal Squamous Cell Carcinoma/therapy
• Esophageal Squamous Cell Carcinoma/pathology
• Esophageal Squamous Cell Carcinoma/mortality
• Esophageal Squamous Cell Carcinoma/complications
• Prognosis
• Esophageal Neoplasms/mortality
• Esophageal Neoplasms/therapy
• Esophageal Neoplasms/pathology
• Esophageal Neoplasms/complications
• Aged
• Survival Rate
• Neoplasm Staging
• Retrospective Studies
• Esophagectomy
• Treatment Outcome
• Neoadjuvant Therapy/methods
• Adult

• Andrographis paniculata
• esophageal squamous cell carcinoma
• metastasis
• overall survival
• palliative management

• Humans
• Esophageal Squamous Cell Carcinoma/drug therapy
• Esophageal Squamous Cell Carcinoma/pathology
• Esophageal Neoplasms/drug therapy
• Esophageal Neoplasms/pathology
• Andrographis paniculata
• Quality of Life
• Carcinoma, Squamous Cell/drug therapy
• Carcinoma, Squamous Cell/pathology

• ITS/079/17FX Innovation and Technology Commission

• Chemoradiotherapy
• Clinical outcome
• Esophageal cancer
• Neoadjuvant chemotherapy
• Radiotherapy

Esophageal cancer is diagnosed with more than 480,000 patients per year and this disease became the eighth most common cancer worldwide.

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.

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.

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).

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.

• Chemoradiotherapy
• Dysphagia
• Esophageal cancer
• Pathology
• Surgery

• Argon plasma coagulation
• endoscopy
• oesophageal cancer
• palliation
• self-expandable metal stents

• chemotherapy
• endostar
• esophageal cancer
• stereotactic radiotherapy

• cervical esophagus
• postesophagectomy
• recurrence
• salvage

• Metastatic esophageal cancer
• Targeted therapies

• Animals
• Antineoplastic Agents/therapeutic use
• ErbB Receptors/antagonists & inhibitors
• ErbB Receptors/metabolism
• Esophageal Neoplasms/drug therapy
• Esophageal Neoplasms/metabolism
• Esophageal Neoplasms/pathology
• Esophagus/drug effects
• Esophagus/metabolism
• Esophagus/pathology
• Humans
• Molecular Targeted Therapy/methods
• Neoplasm Metastasis/drug therapy
• Neoplasm Metastasis/pathology
• Proto-Oncogene Proteins c-met/antagonists & inhibitors
• Proto-Oncogene Proteins c-met/metabolism
• Receptor, ErbB-2/antagonists & inhibitors
• Receptor, ErbB-2/metabolism
• Signal Transduction/drug effects
• TOR Serine-Threonine Kinases/antagonists & inhibitors
• TOR Serine-Threonine Kinases/metabolism
• Vascular Endothelial Growth Factor A/antagonists & inhibitors
• Vascular Endothelial Growth Factor A/metabolism

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.

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.

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).

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.

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.

• Esophageal Cancer
• Stents
• Chemoradiotherapy
• Three-dimensional imaging
• Case control study

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.

Data of all patients undergoing nonsurgical treatment for esophageal cancer were identified from a prospective database.

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.

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.

• chemoradiotherapy
• esophageal cancer
• metastases
• nonsurgical treatment
• survival