Controversies in preoperative therapy in esophageal cancer: Current evidence and ongoing research

Ashok, Apurva; Tiwari, Virendra Kumar; Jiwnani, Sabita; Karimundackal, George; Pramesh, C.S.

doi:10.1002/ags3.12301

Cited by 7 publications

(7 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The postoperative complications of lung infection and anastomotic leakage are critical limitations. There could also be technical difficulties for future surgeries after radiation (20). In the real world, NARC is not accepted by most surgeons in China.…”

Section: Discussionmentioning

confidence: 99%

A phase III study on neoadjuvant chemotherapy versus neoadjuvant toripalimab plus chemotherapy for locally advanced esophageal squamous cell carcinoma: Henan Cancer Hospital Thoracic Oncology Group 1909 (HCHTOG1909)

Zheng¹,

Liu²,

Sun³

et al. 2021

Ann Transl Med

View full text Add to dashboard Cite

Background: Neoadjuvant chemotherapy (NAC) and neoadjuvant chemoradiotherapy (NACR) are the standard treatments for esophageal squamous cell carcinoma (ESCC). However, the 5-year overall survival (OS) rate is still far from satisfactory. In recent years, immune checkpoint inhibitors (ICIs) have shown promising results in the treatment of ESCC. More than 20 phase II clinical trials have been launched to explore combinations of ICIs in the neoadjuvant setting for ESCC. Based on our phase II clinical trial, a two-arm phase III trial was launched in Henan Cancer Hospital. ICIs combined with NAC may usher in a new era and may benefit locally advanced, resectable ESCC patients.Methods: A two-arm phase III trial was launched in April 2020 in Henan Cancer Hospital. Patient recruitment will be completed within 18 months. The primary endpoint is event-free survival (EFS).The secondary endpoints include pathologic complete response (pCR), disease-free survival (DFS) rate, overall response rate (ORR), R0 resection rate, major pathologic response (MPR), adverse events (AEs), complication rate and quality of life (QOL). A biobank of pretreatment, resected tumor tissue and paired blood samples will be built for translational research in the future.Discussion: This RCT directly compares NAC with neoadjuvant toripalimab plus chemotherapy in terms of EFS for locally advanced ESCC. The results may usher in a new era of resectable ESCC treatment.

show abstract

Section: Discussionmentioning

confidence: 99%

A phase III study on neoadjuvant chemotherapy versus neoadjuvant toripalimab plus chemotherapy for locally advanced esophageal squamous cell carcinoma: Henan Cancer Hospital Thoracic Oncology Group 1909 (HCHTOG1909)

Zheng¹,

Liu²,

Sun³

et al. 2021

Ann Transl Med

View full text Add to dashboard Cite

show abstract

“…In recent years, preoperative therapy has been the standard treatment strategy for advanced esophageal squamous cell carcinoma with lymph node metastasis 8 . It has also been reported that the extent of mediastinal lymphadenectomy during esophagectomy in surgical treatment influences prognoses, 9 particularly RLN lymph node dissection, which must be performed with extreme care in esophageal cancer surgery.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of intraoperative recurrent laryngeal neuromonitoring during surgery for esophageal cancer

Takeda

Iida

Kanekiyo

et al. 2020

Annals of Gastroent Surgery

View full text Add to dashboard Cite

Aim To evaluate the efficacy of intraoperative neuromonitoring in identifying recurrent laryngeal nerves and decreasing the incidence of nerve injury in minimally invasive esophagectomies for esophageal cancers. Methods A total of 167 minimally invasive esophagectomy patients were retrospectively reviewed. They were divided into intraoperative neuromonitoring (n = 84) and no intraoperative neuromonitoring (n = 83) groups, based on whether or not intraoperative neuromonitoring was used during surgery. We compared short‐term surgical outcomes and incidence of recurrent laryngeal nerve palsy between the two groups before and after propensity score matching. The association between the loss of signal and recurrent laryngeal nerve palsy was also evaluated. Results The incidence of recurrent laryngeal nerve palsy (grade 2 and higher) was lower in the intraoperative neuromonitoring group than in the no intraoperative neuromonitoring group (6.0% vs 21.2%, P = 0.02). The rate of recurrent laryngeal nerve palsy recovery within 6 months was also significantly higher in the intraoperative neuromonitoring group (87.5% vs 20.0%, P < 0.01). The positive and negative predictive values of intraoperative neuromonitoring for recurrent laryngeal nerve palsy were 60% (9/15) and 86.9% (60/69), respectively. The duration from paralysis to recovery was shorter in recurrent laryngeal nerve palsy cases with negative loss of signal results than in cases with positive loss of signal results (median: 43 days vs 95 days). Conclusion Intraoperative neuromonitoring is useful in identifying recurrent laryngeal nerves and may aid in reducing the incidence of recurrent laryngeal nerve injury during esophageal surgery.

show abstract

“…[9][10][11] Indeed, the survival advantage of perioperative neoadjuvant strategy over surgery alone in SCC and AC was confirmed in multiple metaanalyses. [12][13][14] Still, the optimal neoadjuvant regimen has not been well identified.…”

mentioning

confidence: 99%

“…In the last few decades, the first line treatment for esophageal cancer has consisted of two to three neoadjuvant chemotherapeutic agents with or without concurrent radiotherapy. [12][13][14] The most frequently seen combination of neoadjuvant chemotherapy has been the combination of cisplatin and 5-fluorouracil (CF). However, the dosage, cycle, and interval of administration of the CF regimen has varied in clinical trials.…”

mentioning

confidence: 99%

“…However, the dosage, cycle, and interval of administration of the CF regimen has varied in clinical trials. [12][13][14] The combination of docetaxel, cisplatin, and 5-fluorouracil (DCF) are frequently utilized in advanced esophageal SCC and AC. Ferri and colleagues 15 conducted a phase II multicenter trial studying the effectiveness and toxicity of perioperative DCF (three 3-week cycles DCF [docetaxel 75 mg/m 2 on day 1, cisplatin 75 mg/m 2 on day 1, 5-FU 750 mg/m 2 for 120 hours] before and after surgery) for locally advanced esophageal and gastric adenocarcinoma.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Modified Docetaxel, Cisplatin, and Fluorouracil (mDCF) as a Neoadjuvant Chemotherapy for Non-metastatic Esophageal Cancer (nMEC)

et al. 2021

View full text Add to dashboard Cite

Perioperative chemotherapy can potentially downstage esophageal cancer, reducing the risk of early systemic dissemination. One recommended neoadjuvant regimen for managing gastroesophageal junction and esophageal cancer is docetaxel, cisplatin, and 5-fluorouracil (DCF). To address the high toxicity profile of DCF, modifications in dosages and treatment intervals have been studied. We integrated a modified DCF regimen (mDCF) into a multimodal treatment approach for non-metastatic esophageal cancer (nMEC). Retrospectively, we sought to describe our community experience of administrating neoadjuvant mDCF to patients with nMEC.Design: Patients diagnosed with nMEC between August 2008 and November 2017 and prescribed mDCF were identified for retrospective review. Outcomes of interest included disease-free survival (DFS), overall survival (OS), and hematologic toxicities. Analyses were performed using SAS 9.4. Results:Thirty patients met inclusion criteria with a median age of 64.9 years; 90% were male. The 2-year and 5-year DFS was 60.8% and 41.7%, respectively, for adenocarcinoma and 71.4% and 71.4% for squamous cell carcinoma (SCC). The 2-year and 5-year OS was 64.9% and 44.5%, respectively, for adenocarcinoma and 71.4% and 71.4% for SCC. Both DFS and OS decreased with increasing disease stage, histology (adenocarcinoma versus squamous), esophageal compared to esophagogastric-junction involvement, and without surgical intervention. Frequent toxicity grades for leukopenia and thrombocytopenia were Grades I and II. Conclusion:Using an mDCF regimen in combination with chemoradiation +/-surgical resection in a community setting appears to have an acceptable toxicity profile as well as DFS and OS outcomes compared to chemotherapeutic regimens reported in other similar studies.

show abstract

Controversies in preoperative therapy in esophageal cancer: Current evidence and ongoing research

Cited by 7 publications

References 33 publications

A phase III study on neoadjuvant chemotherapy versus neoadjuvant toripalimab plus chemotherapy for locally advanced esophageal squamous cell carcinoma: Henan Cancer Hospital Thoracic Oncology Group 1909 (HCHTOG1909)

A phase III study on neoadjuvant chemotherapy versus neoadjuvant toripalimab plus chemotherapy for locally advanced esophageal squamous cell carcinoma: Henan Cancer Hospital Thoracic Oncology Group 1909 (HCHTOG1909)

Efficacy of intraoperative recurrent laryngeal neuromonitoring during surgery for esophageal cancer

Modified Docetaxel, Cisplatin, and Fluorouracil (mDCF) as a Neoadjuvant Chemotherapy for Non-metastatic Esophageal Cancer (nMEC)

Contact Info

Product

Resources

About