Neoadjuvant chemotherapy for locally advanced carcinoma of the lower oesophagus and oesophago-gastric junction

Forshaw, Matthew; Gossage, James; Chrystal, K.; Cheong, K. A.; Atkinson, Simon; Botha, Abrie; Harper, Peter; Mason, Robert C.

doi:10.1016/j.ejso.2006.02.025

Cited by 11 publications

(12 citation statements)

References 29 publications

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“…Our data, consistent with other reports, indicates that stage IVA patients, on the basis of M1a disease, have a prognosis similar to that of stage III patients 29,30 . Several reports have documented M1a 2‐ to 3‐year survivals ranging from 10% to 31.5% 5,6,9–14,31 . A Japanese report 10 documented the 3‐year survival of 23% for patients with T4 disease, M1a disease, or both in patients undergoing aggressive treatment with combined chemotherapy and radiotherapy.…”

Section: Discussionsupporting

confidence: 91%

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The prognostic importance of pathologically involved celiac node metastases in node-positive patients with carcinoma of the distal esophagus or gastroesophageal junction: a surgical series from the Mayo Clinic

Schomas¹,

Quevedo²,

Donahue³

et al. 2010

Diseases of the Esophagus

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The management of esophageal cancer with involvement of celiac lymph nodes is controversial. The purpose of this retrospective study was to evaluate the clinical importance of metastases to celiac lymph nodes in patients with carcinoma of the distal esophagus or gastroesophageal junction (GEJ) who undergo surgical treatment with curative intent. We reviewed the medical records of 310 patients who underwent definitive esophagectomy at the Mayo Clinic, Rochester, Minnesota, between 1976 and 1999 for carcinoma of the distal esophagus or GEJ. The disease location was distal esophagus in 163 and GEJ in 147. Fifty-two patients (17%) were found to have celiac node involvement. The survival of these patients was compared with that of 97 N0 patients and 161 N1 patients without celiac node involvement. Squamous cell carcinoma and adenocarcinomas were found in 24% and 76%, respectively. Ivor Lewis esophagectomy was the most common surgical procedure (76%), followed by transhiatal resection (14%) and modified Ivor Lewis procedure (5%). The median number of nodes resected was 15 (range, 2-45). The median survival of the entire group was 18.8 months. The median survival was 48 months (range, 1.6 months-22 years) for N0 patients and 15.9 months (range, 0.03 months-14.4 years) for N1 patients without celiac node disease (P < 0.001). The median survival was 11.7 months (range, 2.2 months-15.7 years) for celiac node-positive patients, and this difference was statistically significant when compared with survival in N0 patients (P= 0.001) but not when compared with that in N1 patients without celiac node disease (P= 0.57). Survival at 3 and 5 years was 61% and 45% for N0 patients, 21% and 9% for N1 patients without celiac node disease, and 18% and 11% for patients with celiac node disease, respectively. At 10 years, 7% of patients with celiac node involvement in their resected specimen were alive. By multivariate analysis, patients with 4 or more positive lymph nodes had the worst prognosis (risk ratio [RR], 2.63; 95% confidence interval [CI], 1.98-3.48), regardless of their location. We concluded that celiac node metastases were not an adverse prognostic indicator in patients with celiac node involvement compared with N1 patients without celiac node disease. Overall, the number of positive nodes, not their location, correlated best with survival. Although median survival was poor, a small number of patients with resected celiac node disease had long-term survival. Patients with undetected celiac node disease at the time of surgical resection who were subsequently found to have celiac node involvement appeared to have a prognosis similar to that of patients with stage III disease. Therefore, treatment with curative intent should be considered for fit patients with celiac node disease.

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Section: Discussionsupporting

confidence: 91%

“…The presence of M1a disease, however, may not absolutely exclude patients from treatment with curative intent. Reports document M1a 2‐ to 3‐year survival ranging from 10% to 31.5% 5,6,9–14 …”

Section: Introductionmentioning

confidence: 99%

The prognostic importance of pathologically involved celiac node metastases in node-positive patients with carcinoma of the distal esophagus or gastroesophageal junction: a surgical series from the Mayo Clinic

Schomas¹,

Quevedo²,

Donahue³

et al. 2010

Diseases of the Esophagus

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“…12 The survival curves between N1 and M1a were found to be virtually interchangeable in previous reports, 7,44,47 as M1a 2-3-year survival ranged from 10% to 31.5%. [48][49][50][51][52][53][54] The presence of M1a disease, therefore, may not absolutely exclude patients from curative treatment. Therefore, M1a LN metastasis is not a good prognostic indicator.…”

Section: Previous and Current Tnm Classifi Cationsmentioning

confidence: 98%

The significance of lymph node status as a prognostic factor for esophageal cancer

Akutsu

Matsubara

2011

Surg Today

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The revision of the TNM Classification of Malignant Tumors, 7th Edition, suggests the lymph node (LN) status to be the most significant risk factor in esophageal cancer. This article reviews the current status of LNs as indicators of prognosis. The significance of the number of metastatic LNs, the number of resected LNs, and a novel index, the "LN ratio" (metastatic LNs/removed LNs) in patients with esophageal cancer, were reviewed. The number of metastatic LNs independently predicted the prognosis of both overall survival and relapse-free survival. The number of positive LNs was also the best predictive marker of survival. Furthermore, overall survival significantly depended on the number of surgically removed LNs, and the LN ratio closely correlated with survival. The LN status is considered to be the most significant information that can be used to predict the prognosis. However, there are many issues that still need to be resolved. Better knowledge of the N-status is therefore needed to effectively utilize this information. Further research should focus on the N-status of patients with esophageal cancer.

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“…This has generated significant interest in adjuvant and neo-adjuvant treatment. In theory, neoadjuvant chemoradiotherapy can downstage tumours and possibly convert a palliative surgical prospect to a potentially curative one [25]. In our study, 12 patients were T2 (T2N0M0-9/T2N0M1-1/T2N1M1-1, T2N1M0-1) according to the CT, but after preoperative EUS, more advanced T stage, T3 (T3N0-2, T3N1-5, T3N1M1-1), of cancer was detected in seven patients and T4 in one patient out of those 12 patients.…”

Section: Discussionmentioning

confidence: 99%

A Study Comparing Endoscopic Ultrasound (EUS) and Computed Tomography (CT) in Staging Oesophageal Cancer and their Role in Clinical Decision Making

Subasinghe

Samarasekera

2009

J Gastrointest Canc

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Neoadjuvant chemotherapy for locally advanced carcinoma of the lower oesophagus and oesophago-gastric junction

Cited by 11 publications

References 29 publications

The prognostic importance of pathologically involved celiac node metastases in node-positive patients with carcinoma of the distal esophagus or gastroesophageal junction: a surgical series from the Mayo Clinic

The prognostic importance of pathologically involved celiac node metastases in node-positive patients with carcinoma of the distal esophagus or gastroesophageal junction: a surgical series from the Mayo Clinic

The significance of lymph node status as a prognostic factor for esophageal cancer

A Study Comparing Endoscopic Ultrasound (EUS) and Computed Tomography (CT) in Staging Oesophageal Cancer and their Role in Clinical Decision Making

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