Multidisciplinary treatment of esophageal cancer: The role of active surveillance after neoadjuvant chemoradiation

Abstract

Esophageal cancer (EC) is an aggressive disease. The two most common types of EC are adenocarcinoma (AC) and squamous cell carcinoma (SCC). AC and SCC differ with regard to etiology, geographic distribution, response to chemotherapy/ radiotherapy, prognosis and possibly need for surgical resection. Esophagectomy is the cornerstone in the treatment of EC. During the last two decades, studies on the lymph node dissection during esophagectomy have shown improved survival in patients who underwent an extensive nodal dissection. 1 A total number of 23 lymph nodes were proposed as the optimal threshold in order to achieve a maximal survival benefit after esophagectomy. The extent of lymph node dissection expressed as the total number of nodes dissected was found to be an independent predictor of survival. 2 Whether the observed relationship between the number of nodes dissected and survival reflects a true benefit of more extensive surgery or is due to stage migration, is not clear yet. However, a transthoracic esophagectomy with a two-field nodal dissection is considered by many as the standard surgical approach nowadays. Esophagectomy is associated with major complications. 3-4 The diminished quality of life of patients after neoadjuvant therapy plus esophagectomy is another drawback. A patient's quality of life is substantially impaired after surgery including role and social functioning. 5 Reducing morbidity after esophagectomy is a challenge. The application of minimally invasive surgical techniques, better selection of surgical candidates, preoptimization of patient condition, and enhanced recovery protocols have shown to be associated with a reduction in complications and quicker return to normal functioning. 6-10

Association of Malnutrition, as Defined by the PG-SGA, ESPEN 2015, and GLIM Criteria, With Complications in Esophageal Cancer Patients After Esophagectomy

“…However, due to the recent advances in both the prevention and treatment of the disease, the mortality of EC has been exhibiting a decreasing trend in China ( 2 ). Thus, strategies that can improve the postoperative complications ( 3 ), clinical outcomes ( 4 ) and quality of life (QOL) ( 5 ) for EC patients are garnering accumulating interest in the oncology community, with newer approaches utilizing inter- or multi-disciplinary cancer treatment ( 6 , 7 ).…”

Neoadjuvant Chemo-Radiation Using IGRT in Patients with Locally Advanced Gastric Cancer

“…In other gastrointestinal malignancies, such as esophageal and rectal cancers, neoadjuvant and adjuvant therapy are generally accepted to improve disease-free survival (DFS) and overall survival (OS) [ 4 , 5 ]. Moreover, prospective data on preoperative therapy for patients with locally advanced gastric cancer (LAGC) is scarce [ 6 ].…”

Table_1.DOCX

“…However, due to the recent advances in both the prevention and treatment of the disease, the mortality of EC has been exhibiting a decreasing trend in China (2). Thus, strategies that can improve the postoperative complications (3), clinical outcomes (4) and quality of life (QOL) (5) for EC patients are garnering accumulating interest in the oncology community, with newer approaches utilizing inter-or multi-disciplinary cancer treatment (6,7).…”