Neoadjuvant Concurrent Chemoradiotherapy for Locally Advanced Esophageal Cancer in a Single High-Volume Center

Zanoni, Andrea; Verlato, Giuseppe; Giacopuzzi, Simone; Weindelmayer, Jacopo; Casella, Francesco; Pasini, Felice; Zhao, Enyue; Manzoni, Giovanni De

doi:10.1245/s10434-012-2822-4

Cited by 39 publications

(30 citation statements)

References 40 publications

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“…A 5-year overall survival of 43% was reported for the entire series of patients treated with our protocol, including those with esophageal SCC and EGJ adenocarcinomas. The 5-year disease-related survival was 49%, and the long-term survival was better in adenocarcinoma cases than in SCC cases [23].…”

Section: Neoadjuvant Therapy: Chemotherapy Versus Chemoradiotherapymentioning

confidence: 90%

“…In phase I and II trials implemented by our group [21][22][23], Siewert type I and II EGJ adenocarcinomas were treated with neoadjuvant CRT; they received 3 weeks of induction chemotherapy alone (5-fluorouracil administered by protracted intravenous infusion plus weekly administration of iv cisplatin and docetaxel) followed by 50.4 Gy of concurrent radiotherapy. Results showed an R0 resection rate of 88% and a pathologic complete response rate of 40%.…”

Section: Neoadjuvant Therapy: Chemotherapy Versus Chemoradiotherapymentioning

confidence: 99%

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Western strategy for EGJ carcinoma

et al. 2016

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In this paper, the epidemiological and clinicobiological behavior of esophagogastric junction (EGJ) adenocarcinoma in the West is compared and contrasted to that in the East, and an overview is provided of current therapeutic strategies employed for this type of tumor in Western countries. It is well known that multimodal treatment is the therapeutic standard in locally advanced EGJ adenocarcinoma, but whether neoadjuvant/perioperative chemotherapy (CT) or neoadjuvant chemoradiotherapy (CRT) is the optimal approach is still debated. Neoadjuvant CRT improves local control in locally advanced Siewert type I and II tumors, so it should be considered the treatment of choice. In the subset of these patients with microscopic systemic disease at diagnosis, more intensive exclusive chemotherapy protocols could be of benefit. Therefore, there is an urgent need to identify these patients before planning the treatment. For Siewert type III tumors, perioperative chemotherapy is the standard. While there is general agreement on the optimal surgical approach for Siewert types I and III (a two-field Ivor Lewis operation and a total gastrectomy with distal esophagectomy, respectively), no standard surgical treatment has been defined for Siewert type II tumors. When data from Western series on proximal and circumferential resection margins and on nodal spread in Siewert type II tumors are taken into account, the optimal surgical approach appears to be Ivor Lewis esophagectomy. Whether the extent of esophageal invasion can correctly predict nodal involvement in middle-upper mediastinal stations as a means to restrict indications for transthoracic esophagectomy requires further investigation in the West.

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Section: Neoadjuvant Therapy: Chemotherapy Versus Chemoradiotherapymentioning

confidence: 90%

Section: Neoadjuvant Therapy: Chemotherapy Versus Chemoradiotherapymentioning

confidence: 99%

Western strategy for EGJ carcinoma

et al. 2016

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“…Patients who underwent thoracotomy had significantly more severe complications compared with those who did not; therefore, the immunosuppression caused by the complications may be associated with the negative impact on survival rate. In Western countries, the standard therapy for patients with esophageal or EGJ cancer is preoperative chemoradiotherapy (9)(10)(11). However, the rate of locoregional recurrences in patients who received preoperative chemoradiotherapy was reported to be as high as 12.3 and 5.2% in patients with SCC and adenocarcinoma, respectively (10).…”

Section: Univariate Analysismentioning

confidence: 99%

“…In Western countries, the standard therapy for patients with esophageal or EGJ cancer is preoperative chemoradiotherapy (9)(10)(11). However, the rate of locoregional recurrences in patients who received preoperative chemoradiotherapy was reported to be as high as 12.3 and 5.2% in patients with SCC and adenocarcinoma, respectively (10). The use of chemotherapeutic drugs, including carboplatin and paclitaxel, or 5-fluorouracil and cisplatin did not appear to limit hematogenous recurrences.…”

Section: Univariate Analysismentioning

confidence: 99%

“…In Western countries, the standard treatment modality, other than surgery, for patients with esophageal or EGJ cancer is preoperative chemoradiotherapy (9)(10)(11). In Japan, a randomized controlled trial by the Japan Clinical Oncology Group (JCOG9204) which compared postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil with surgery alone for treatment of patients with esophageal SCC demonstrated superior disease-free survival rates in the group of patients who received postoperative chemotherapy (12).…”

Section: Introductionmentioning

confidence: 99%

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Prognoses of advanced esophago‑gastric junction cancer may be modified by thoracotomy and splenectomy

et al. 2017

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Abstract. Globally, the incidence of esophago-gastric junction (EGJ) cancer is rapidly increasing. However, the proposed strategies for the treatment of these types of cancer are so diverse that there is no established consensus on the optimal treatment. The aim of the present study was to identify independent prognostic factors to delineate the optimal strategies for the treatment of EGJ cancer. The medical records of 150 patients with EGJ cancer who underwent curative surgery at the Kitasato University were retrospectively reviewed. The median follow-up period was 48 months. The patients with tumors that were classified as post-treatment primary tumor stage 3 [(y)pT3] or higher had a 5-year disease-specific survival (DSS) rate of 53%, whereas those with tumors that were classified as (y)pT0-2 had a 5-year DSS rate of 90%. Therefore, prognostic analysis was restricted to those tumors that were designated (y)pT3 or higher. A multivariate Cox's proportional hazards model identified the following independent prognostic factors that negatively influenced the DSS: i) Presence of tumors classified as post-treatment regional lymph node stage 1-3 [(y)pN1-3] [hazard ratio (HR), 3.62; 95% confidence interval (CI), 1.39-12.36]; ii) not undergoing treatment with splenectomy (HR, 2.40; 95% CI, 1.15-5.15); and iii) undergoing treatment with thoracotomy (HR, 2.07; 95% CI, 1.02-4.23). In patients with (y)pN0 tumors, the DSS rate was significantly improved for those who underwent splenectomy than for those who did not (P=0.024). In patients with (y)pN1-3 tumors, the DSS rate was significantly worse for those who underwent thoracotomy compared with those who did not (P=0.004). Splenectomy and thoracotomy may critically affect prognosis in locally advanced EGJ cancer that are classified as (y)pN0 and (y)pN1-3, respectively. Surgical treatments require optimization in order to improve prognoses in advanced EGJ cancer.

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