• Esophageal cancer
• Local therapy
• Locoregional recurrence
• Salvage therapy

• Humans
• Salvage Therapy/methods
• Neoplasm Staging
• Neoplasm Recurrence, Local/therapy
• Neoplasm Recurrence, Local/drug therapy
• Retrospective Studies
• Esophageal Neoplasms/pathology
• Chemoradiotherapy
• Esophagectomy/methods
• Treatment Outcome

• Brain metastases
• Esophageal cancer
• Esophagectomy
• Oligometastatic
• Recurrence
• Trimodality

• Humans
• Neoplasm Recurrence, Local/epidemiology
• Neoplasm Recurrence, Local/therapy
• Esophageal Neoplasms/surgery
• Combined Modality Therapy
• Brain
• Esophagectomy
• Retrospective Studies

The prognosis for oesophageal carcinoma is poor, but once distant metastases emerge the prognosis is considered hopeless. There is no consistent protocol for the early identification and aggressive management of metastases.

To examine the outcome of a policy of active postoperative surveillance with aggressive treatment of confirmed metastases.

A prospectively maintained database of 205 patients diagnosed with oesophageal carcinoma between 1998 and 2019 and treated with curative intent was interrogated for patients with metastases, either at diagnosis or on follow-up surveillance and treated for cure. This cohort was compared with incomplete clinical responders to neoadjuvant chemoradiotherapy (nCRT) who subsequently underwent surgery on their primary tumour. Overall survival was estimated using the Kaplan-Meier method, and the log-rank test was used to compare survival differences between groups.

Of 205 patients, 11 (5.4%) had metastases treated for cure (82% male; median age 60 years; 9 adenocarcinoma and 2 squamous cell carcinomas). All had undergone neoadjuvant chemotherapy or chemoradiotherapy, followed by surgery in all but 1 case. Of the 11 patients, 4 had metastatic disease at diagnosis, of whom 3 were successfully downstaged with nCRT before definitive surgery; 2 of these 4 also developed oligometastatic recurrence and were treated with curative intent. Following definitive treatment, 7 had treatment for metachronous oligometastatic disease; 5 of whom underwent metastasectomy (adrenal × 2; lung × 2; liver × 1). The median overall survival was 10.9 years [95% confidence interval (CI): 0.7-21.0 years], which was statistically significantly longer than incomplete clinical responders undergoing surgery on the primary tumour without metastatic intervention [n = 62; median overall survival = 1.9 (95%CI: 1.1-2.7; P = 0.012]. The cumulative proportion surviving 1, 3, and 5 years was 100%, 91%, and 61%, respectively compared to 71%, 36%, and 25% for incomplete clinical responders undergoing surgery on the primary tumour who did not undergo treatment for metastatic disease.

Metastatic oesophageal cancer represents a unique challenge, but aggressive treatment can be rewarded with impressive survival data. In view of recent advances in targeted therapies, intensive follow-up may yield a greater number of patients with curative potential and thus improved long-term survival.

• Oesophageal metastases
• Oligometastases
• Active surveillance
• Treatment for cure
• Metastasectomy
• Survival

•

This nationwide study included patients with esophagogastric cancer and OMD.

This nationwide population-based study analyzed the outcomes of local treatment (i.e. stereotactic body radiotherapy [SBRT] or metastasectomy) or systemic therapy for oligometastatic disease (OMD) in patients with esophagogastric cancer in The Netherlands.

Between 2015 and 2016, all patients in The Netherlands with esophagogastric cancer and synchronous or metachronous OMD were eligible for inclusion. Patients who underwent local treatment of OMD (SBRT or metastasectomy) and/or systemic therapy were included. OMD was defined as distant metastases in 1 organ or 1 extra-regional lymph node region. The primary outcomes were overall survival (OS) and independent prognostic factors for OS. OS was calculated from diagnosis of OMD. Prognostic factors for OS were analyzed using a multivariable Cox proportional hazard model.

A total of 594 patients were included, of whom 83 underwent local treatment for OMD alone, 22 local treatment plus systemic therapy, and 489 systemic therapy alone. Median OS after local treatment for OMD alone was 16.0 months, local treatment plus systemic therapy 22.7 months, and after systemic therapy alone 8.5 months. Improved OS was independently associated with local treatment for OMD alone or combined with systemic therapy as compared with systemic therapy alone (hazard ratio [HR] 0.52, 95% CI: 0.31–0.90 and HR 0.42, 95% CI: 0.22-0.82, respectively) and a controlled primary tumor(HR 0.48, 95% CI: 0.27–0.86). Worse OS was independently associated with worse performance scores (HR 1.41, 95%: 1.32-1.75), poorly or undiffertumor as compared with good or moderadifferentiated tumor (HR 1.37, 95% CI: 1.06-1.76), and peritoneal as compared with lymph mode metastases (HR 1.39, 95% CI: 1.00-1.93).

Local treatment of OMD alone or combined with systemic therapy was independently associated with improved OS as compared with systemic therapy alone in this population-based cohort study in The Netherlands. Randomized controlled trials are warranted to confirm these results.

Recurrent esophageal cancer is associated with dismal prognosis. There is no consensus about the role of surgical treatments in patients with limited recurrences. This study aimed to evaluate the role of surgical resection in patients with resectable recurrences after curative esophagectomy and to identify their prognostic factors.

We retrospectively reviewed patients with recurrent esophageal cancer after curative esophagectomy between 2004 and 2017 and included those with oligo-recurrence that was amenable for surgical intent. The prognostic factors of overall survival (OS) and post-recurrence survival (PRS), as well as the survival impact of surgical resection, were analyzed.

Among 654 patients after curative esophagectomies reviewed, 284 (43.4%) had disease recurrences. The recurrences were found resectable in 63 (9.6%) patients, and 30 (4.6%) patients received surgery. The significant prognostic factors of PRS with poor outcome included mediastinum lymph node (LN) recurrence and pathologic T3 stage. In patients with and without surgical resection for recurrence cancer, the 3-year OS rates were 65.6 and 47.6% (p = 0.108), while the 3-year PRS rates were 42.9 and 23.5% (p = 0.100). In the subgroup analysis, surgery for resectable recurrence, compared with non-surgery, could achieve better PRS for patients without any comorbidities (hazard ratio 0.36, 95% CI: 0.14 to 0.94, p = 0.038).

Mediastinum LN recurrence or pathologic T3 was associated with worse OS and PRS in patients with oligo-recurrences after curative esophagectomies. No definite survival benefit was noted in patients undergoing surgery for resectable recurrence, except in those without comorbidities.

• Esophageal cancer
• Oligo-recurrence
• Post-recurrence survival

Metastatic oesophageal cancer is commonly considered as a palliative situation with a poor prognosis. However, there is increasing evidence that well-selected patients with a limited number of liver metastases (ECLM) may benefit from a multimodal approach including surgery.

A systematic review of the current literature for randomized trials, retrospective studies, and case series with patients undergoing hepatectomies for oesophageal and oesophagogastric junction cancer liver metastases was conducted up to the 31st of August 2021 using the MEDLINE (PubMed) and Cochrane Library databases.

A total of 661 articles were identified. After removal of duplicates, 483 articles were screened, of which 11 met the inclusion criteria. The available literature suggests that ECLM resection in patients with liver oligometastatic disease may lead to improved survival and even long-term survival in some cases. The response to concomitant chemotherapy and liver resection seems to be of significance. Furthermore, a long disease-free interval in metachronous disease, low number of liver metastases, young age, and good overall performance status have been described as potential predictive markers of outcome for the resection of liver metastases.

Surgery may be offered to carefully selected patients to potentially improve survival rates compared to palliative treatment approaches. Studies with standardized patient selection criteria and treatment protocols are required to further define the role for surgery in ECLM. In this context, particular consideration should be given to neoadjuvant treatment concepts including immunotherapies in stage IVB oesophageal and oesophagogastric junction cancer.

• Liver metastases
• Liver resection
• Metastasectomy
• Multimodal treatment
• Oesophageal cancer
• Oesophagogastric junction cancer

• Adenocarcinoma/diagnosis
• Adenocarcinoma/secondary
• Adenocarcinoma/surgery
• Aged
• Brain Neoplasms/diagnosis
• Brain Neoplasms/mortality
• Brain Neoplasms/secondary
• Disease-Free Survival
• Esophageal Neoplasms/diagnosis
• Esophageal Neoplasms/surgery
• Esophagectomy/adverse effects
• Female
• Humans
• Liver Neoplasms/diagnosis
• Liver Neoplasms/etiology
• Liver Neoplasms/secondary
• Lung Neoplasms/diagnosis
• Lung Neoplasms/mortality
• Lung Neoplasms/secondary
• Male
• Middle Aged
• Neoplasm Metastasis
• Neoplasm Recurrence, Local
• Neoplasm Staging
• Prognosis
• Retrospective Studies
• Survival Rate/trends
• United States/epidemiology

• P30 CA008748 NCI NIH HHS

To investigate the capability of computed tomography (CT) radiomic features to predict the therapeutic response and local control of the locoregional recurrence lymph node (LN) after curative esophagectomy by chemoradiotherapy.

This retrospective study included 129 LN from 77 patients (training cohort: 102 LN from 59 patients; validation cohort: 27 LN from 18 patients) with postoperative esophageal squamous cell carcinoma (ESCC). The region of the tumor was contoured in pretreatment contrast‐enhanced CT images. The least absolute shrinkage and selection operator with logistic regression was used to identify radiomic predictors in the training cohort. Model performance was evaluated using the area under the receiver operating characteristic curves (AUC). The Kaplan–Meier method was used to determine the local recurrence time of cancer.

The radiomic model suggested seven features that could be used to predict treatment response. The AUCs in training and validated cohorts were 0.777 (95% CI: 0.667–0.878) and 0.765 (95% CI: 0.556–0.975), respectively. A significant difference in the radiomic scores (Rad‐scores) between response and nonresponse was observed in the two cohorts (p < 0.001, 0.034, respectively). Two features were identified for classifying whether there will be relapse in 2 years. AUC was 0.857 (95% CI: 0.780–0.935) in the training cohort. The local control time of the high Rad‐score group was higher than the low group in both cohorts (p < 0.001 and 0.025, respectively). As inferred from the Cox regression analysis, the low Rad‐score was a high‐risk factor for local recurrence within 2 years.

The radiomic approach can be used as a potential imaging biomarker to predict treatment response and local control of recurrence LN in ESCC patients.

• chemoradiotherapy
• computed tomography
• esophageal squamous cell carcinoma
• predictor
• radiomics analysis

There are no standard therapeutic strategies for local lymph node (LN) recurrence after radical resection of oesophageal squamous cell carcinoma (ESCC), and prognostic risk factors remain controversial. We assessed clinical outcomes and prognostic factors of chemoradiotherapy (CRT) or radiotherapy (RT) for LN recurrence of ESCC after curative resection.

A total of 117 ESCC patients with LN recurrence after radical resection receiving salvage treatment at our hospital were retrospectively reviewed from 2014 to 2017. Overall survival (OS) was estimated using the Kaplan–Meier method; clinical characteristics were assessed using the Log rank test in the univariate analysis. Multivariate prognostic analysis was performed using the Cox proportional hazard model.

With a median follow-up of 19 months, the 1-, 2- and 3-year OS rates were 75.2%, 40.2% and 27.4%, respectively. The median survival time (MST) was 19.0 months. On univariate analysis for OS, pathological TNM stage, number of LN metastasis, LN maximum (Max) diameter, salvage treatment mode and tumor response were significantly associated with OS (P = 0.0074, P = 0.015, P = 0.0011, P = 0.028, P < 0.000, respectively). On multivariate analysis, tumor response [Response vs No-response hazard ratio (HR), 2.43; 95% confidence interval (CI), 1.53–3.90, P < 0.000] and LN Max diameter (≤28 mm vs >28 mm HR, 2.07; 95% CI, 1.33–3.32, P = 0.012) were independent prognostic factors.

Salvage CRT or RT was safe and effective for treating LN recurrence after radical resection in ESCC. Patients with the small LN Max diameter (≤28 mm) and obtained response after salvage therapy appeared to achieve long-term OS.

• chemoradiotherapy
• lymph node recurrence
• oesophageal cancer

Surgery is still the mainstay of radical treatment for resectable esophageal cancer (EC). It is apparent that the presence or spread of lymph node metastasis (LNM) is a powerful prognostic factor in patients with EC who are eligible for curative treatment. Although the importance and efficacy of lymph node dissection in radical esophagectomy have been reported, the clinical or prognostic relevance of specific metastatic patterns within the mediastinal cavity and abdomen remains unclear.

We retrospectively analyzed the association of postoperative survival with clinical mediastinal LNM (cMLNM) and abdominal LNM (cALNM) in 157 patients who underwent radical EC surgery at our hospital between May 2012 and March 2018.

A significant difference in cause-specific survival (CSS) was observed between patients with and without cALNM (log-rank p = 0.000). A multivariate Cox regression analysis revealed that cALNM and thoracic surgery (mediastinal lymphadenectomy via conventional open right thoracotomy or video-assisted thoracoscopic surgery) independently predicted CSS (p = 0.0007 and 0.021, respectively). Moreover, a significant difference in systemic recurrence-free survival was observed between those with and without cALNM (log-rank p = 0.000). Multivariate Cox regression analysis revealed that cALNM and sex independently predicted systemic recurrence-free survival (p = 0.000 and 0.015, respectively).

cALNM was an independent poor prognostic factor for CSS after EC surgery. It may also be an independent prognostic factor for postoperative systemic recurrence, which can shorten the CSS. For patients with cALNM-positive EC who have a high potential risk of systemic metastases, more extensive treatment besides the conventional perioperative systemic chemotherapy may be necessary.

• Abdominal lymph node metastasis
• Esophageal cancer
• Survival

• COVID-19
• Case report
• Cerebellar metastasis
• PPE
• Suboccipital craniectomy

• Metastatectomy
• Oesophageal cancer
• Oligometastasis

• AEG
• Adenocarcinoma of esophagogastric junction
• Lymph node mapping
• Lymph node metastasis

• brain metastasis
• esophageal cancer
• recurrence

• Adenocarcinoma/mortality
• Adenocarcinoma/secondary
• Adenocarcinoma/surgery
• Adult
• Aged
• Brain Neoplasms/mortality
• Brain Neoplasms/secondary
• Brain Neoplasms/therapy
• Cancer Care Facilities
• Carcinoma, Squamous Cell/mortality
• Carcinoma, Squamous Cell/secondary
• Carcinoma, Squamous Cell/surgery
• Cause of Death
• Chemoradiotherapy/methods
• Databases, Factual
• Disease-Free Survival
• Esophageal Neoplasms/mortality
• Esophageal Neoplasms/pathology
• Esophageal Neoplasms/surgery
• Esophagectomy/methods
• Esophagectomy/mortality
• Female
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Multivariate Analysis
• Neoadjuvant Therapy/methods
• Neoplasm Recurrence, Local/mortality
• Neoplasm Recurrence, Local/pathology
• Neoplasm Recurrence, Local/therapy
• Prognosis
• Proportional Hazards Models
• Retrospective Studies
• Risk Assessment
• Survival Analysis
• Treatment Outcome
• United States

• P30 CA008748 NCI NIH HHS

• surveillance
• esophageal cancer
• adenocarcinoma
• early stage

• Adenocarcinoma/mortality
• Adenocarcinoma/pathology
• Adenocarcinoma/surgery
• Adult
• Aged
• Aged, 80 and over
• Barrett Esophagus/complications
• Esophageal Neoplasms/mortality
• Esophageal Neoplasms/pathology
• Esophageal Neoplasms/surgery
• Female
• Humans
• Lymphatic Metastasis
• Male
• Middle Aged
• Neoplasm Recurrence, Local/epidemiology
• Prospective Studies
• Risk Factors
• Smoking/adverse effects

• P30 CA008748 NCI NIH HHS

• Korean Gastric Cancer Association

• 3D extracellular matrix
• chemoresistance
• esophageal cancer
• fibronectin
• signaling cascade
• stroma
• targeted therapy
• type I collagen

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Agents/pharmacology
• Apoptosis
• Carcinoma, Squamous Cell/drug therapy
• Carcinoma, Squamous Cell/pathology
• Cell Cycle
• Cell Line, Tumor
• Cell Movement
• Cell Proliferation
• Collagen/metabolism
• Drug Resistance, Neoplasm
• Esophageal Neoplasms/drug therapy
• Esophageal Neoplasms/genetics
• Esophageal Neoplasms/pathology
• Extracellular Matrix
• Female
• Fibronectins/metabolism
• Gene Expression Profiling
• Humans
• Laminin/metabolism
• Male
• Middle Aged
• Signal Transduction
• Tumor Microenvironment

• MC_PC_16097 Medical Research Council

• Esophageal cancer
• Isolated recurrence
• Metastasectomy
• Metastasis
• Solitary lesions
• Surgical management

• Esophageal Neoplasms/mortality
• Esophageal Neoplasms/pathology
• Esophageal Neoplasms/surgery
• Esophagectomy/mortality
• Humans
• Neoplasm Recurrence, Local/mortality
• Neoplasm Recurrence, Local/pathology
• Neoplasm Recurrence, Local/surgery
• Prognosis
• Survival Rate

• esophagogastric junction cancer
• granulocyte colony-stimulating factor
• leukocytosis
• upper gastrointestinal tract cancer

Brain metastasis is very rare in esophageal squamous cell carcinoma (ESCC). We retrospectively analyzed 4494 patients diagnosed with ESCC between 2010 and 2015 at a single institute; 15 of these patients developed brain metastases. All 15 patients had neurologic symptoms and were diagnosed by imaging or biology. Of the 15 patients, 67% had a solitary brain lesion and 73% had lesions larger than 3 cm. After treatment of the brain lesions, including surgery (53%) or stereotactic radiotherapy with or without whole brain radiation (20%), the median progression free survival time and the 2-year overall survival rate calculated from diagnosis of brain metastasis were 14.4 months and 36%, respectively. A graded prognostic assessment (GPA) score > 2.0 was associated with significantly better overall survival. Patients with brain metastases from ESCC achieve good overall survival after appropriate treatment of the brain lesion(s); GPA score may represent a prognostic factor for treatment decision-making.

• bran metastases
• esophageal squamous cell carcinoma
• survival
• treatment

• Esophageal cancer
• Oligo-recurrence
• Oligometastases
• Salvage chemoradiation therapy
• Salvage radiation therapy