Preoperative radiation therapy for carcinoma of the esophagus

Marks, Richard D.; Scruggs, Hugh J.; Wallace, Keene M.

doi:10.1002/1097-0142(197607)38:1<84::aid-cncr2820380115>3.0.co;2-s

Cited by 110 publications

(14 citation statements)

References 5 publications

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“…The patients undergoing preoperative radiation and exploration in our series differ from those reported in Nakayama et al, 13 Marks et al, 14 and Katlic and Grillo" in that they were considered, by and large to have unresectable disease at presentation. The 14 of 15 patients undergoing exploration with esophagectomy had a survival of 33% at 18 months but 0% at 2 years, which may reflect the advanced nature of their disease.…”

Section: Discussioncontrasting

confidence: 61%

Radiation therapy alone or in combination with surgery in the treatment of carcinoma of the esophagus

Langer¹,

Choi²,

Orlow³

et al. 1986

Cancer

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The role of radiation in the treatment of squamous cell carcinoma of the esophagus was examined in a review of 74 patients treated with curative intent between 1974 and 1981. Aspects studied included the pattern of failure, the use of radiation as a surgical adjuvant, achievement of palliation, and the presence of technical or clinical factors predicting for a better outcome. The group was divided into 9 patients irradiated after esophageal resection, 14 patients irradiated before resection, and 51 patients treated with radiation and no resection. Median and 2-year survival rates among 51 patients treated by radiation without esophagectomy were 8.8 months and 11%, whereas they were 9.7 months and 0% in patients treated by radiation followed by resection, and 9.5 months and 28% in patients undergoing resection followed by radiation. Local failures were suffered in 28/51 patients treated without esophagectomy with rates of 2/4, 7/10, 7/15, and 5/10 after 50-55 Gy, 55-60 Gy, 60-65 Gy, and 65-69 Gy, respectively. Although prognosis for patients presenting with unresectable disease remains poor, a somewhat better outcome may be expected in patients treated with postoperative radiation after potentially unfavorable resections. Other predictors include sex and disease stage.

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Section: Discussioncontrasting

confidence: 61%

Radiation therapy alone or in combination with surgery in the treatment of carcinoma of the esophagus

Langer¹,

Choi²,

Orlow³

et al. 1986

Cancer

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“…Radiation, as neoadjuvant treatment, was initiated in the 1960s. (36)(37)(38)(39)(40) Parker and Gregorie stated that 45 Gy preoperative radiation raised the resectability from 54%, in patients without radiotherapy, to 70%. (36) In 1970, Akakura et al reported that a dose as high as 60 Gy of radiotherapy increased curative resectability from 26%, in a non-radiation treated group, to 65%, (38) although a dose of 45 Gy had been routinely used as neoadjuvant radiotherapy because of the risk of spinal cord necrosis resulting from high doses.…”

Section: Review Of the Resultsmentioning

confidence: 99%

“…Radiation, as neoadjuvant treatment, was initiated in the 1960s. ( 36–40 ) Parker and Gregorie stated that 45 Gy preoperative radiation raised the resectability from 54%, in patients without radiotherapy, to 70%. ( 36 ) In 1970, Akakura et al .…”

Section: Should Definitive or Neoadjuvant Crt Be The First Treatment?mentioning

confidence: 99%

Treatment of thoracic esophageal carcinoma invading adjacent structures

Seto

Chìn²,

Gomi³

et al. 2007

Cancer Science

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T4 esophageal cancer is defined as the tumor invading adjacent structures, using tumor-node-metastasis (TNM) staging. For clinically T4 thoracic esophageal carcinoma, multimodality therapy, that is, neoadjuvant chemoradiotherapy (CRT) followed by surgery or definitive CRT, has generally been performed. However, the prognosis of patients with these tumors remains poor. Another strategy is needed to achieve curative treatment. In the present article, the treatment strategies employed to date are reviewed. Furthermore, the strategies for these malignancies are reassessed, based on our experiences. R1/2 and R0 resections are regarded as those with residual and no tumor after surgery. The present data show that patients who underwent R1/2 resection after neoadjuvant CRT experienced little survival benefit, while complete response (CR) cases after definitive CRT had comparatively better results. Therefore, curative surgery should not be attempted without down-staging, and definitive CRT should be the initial treatment. Then surgery is indicated for the eradication of residual cancer cells. Close surveillance is essential for early detection of relapse even after CR, because the operation will gradually become increasingly difficult due to post-CRT fibrosis. In conclusion, multimodality therapy consists of definitive CRT followed by R0 resection, which can be the treatment of choice for T4 esophageal carcinoma. These challenging treatments have the potential to constitute the most effective therapeutic strategy. (Cancer Sci 2007; 98: 937-942) T he incidence of stage T4, in which the tumor invades adjacent structures, is reported to be 8-30% among thoracic esophageal carcinomas.(1-9) A standard treatment for these diseases has not, however, been established. The variety of treatments currently available include surgery alone,(1,2) chemotherapy followed by surgery, (10) chemoradiotherapy (CRT) followed by surgery, (3)(4)(5)(6)(11)(12)(13)(14)(15) and definitive CRT. (6,7,(16)(17)(18)(19)(20) The extremely poor prognosis of patients with these T4 tumors is well known, irrespective of the treatments employed.(1-21) Therefore, curative treatment for T4 esophageal carcinoma remains an elusive challenge.The accurate diagnosis of T4 and the indications for combined resection of the invaded organs and additional surgery after definitive CRT are unresolved issues. The most serious problem is which treatment should be selected first. It is difficult to decide whether definitive or neoadjuvant CRT should be given initially to a patient with a potential T4 tumor. In the present article, these problems regarding the treatment of T4 thoracic esophageal carcinoma are reviewed. Furthermore, the strategy for managing these diseases is reassessed, based on results obtained by the authors' institute hospital. DiagnosisDepth of invasion is usually diagnosed using computed tomography (CT) (1)(2)(3)(4)(5)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) and/or endoscopic ultrasonography (EUS).(1,9-11, [13][14][15][16][17][18]20,21) The invade...

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“…It may also be used as the definitive treatment for esophageal cancer with 5-year survival rates comparable to or slightly worse than those of surgery [1,[6][7][8][9]. However, RT avoids the short-term morbidity and mortality associated with surgery.…”

mentioning

confidence: 99%

“…However, RT avoids the short-term morbidity and mortality associated with surgery. As a result, some investigators believe that it should be the primary modality for treating this disease [6,8].…”

mentioning

confidence: 99%

Radiation therapy of esophageal carcinoma: Correlation of clinical and radiographic findings

Levine

Langer

Laufer

et al. 1987

Gastrointest Radiol

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Seventeen patients with esophageal carcinoma treated by radiation therapy (RT) at our hospital between 1981 and 1984 had initial diagnostic esophagrams and 1 or more repeat esophagrams after completing RT. Total regression of the tumor was observed radiographically in 10 patients (59%) with a normal esophagus (24%) or benign-appearing residual stricture (35%) at the site of the previous lesion. Partial regression was observed in 4 patients, and progression of the tumor in 3. No correlation was found between the size, stage, or morphology of the lesion and its response to therapy. Although local recurrences were relatively uncommon, patient survival was often limited by the development of distant metastases. Fourteen of 15 patients with clinical follow-up initially had significant relief from dysphagia as the tumor regressed. However, 9 of those patients had recurrent or increased dysphagia over a subsequent 3-9-month period. Exacerbation of symptoms did not necessarily indicate recurrent carcinoma; it also resulted from benign radiation strictures, opportunistic esophagitis, or other complications of RT detected on esophagography.

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Preoperative radiation therapy for carcinoma of the esophagus

Cited by 110 publications

References 5 publications

Radiation therapy alone or in combination with surgery in the treatment of carcinoma of the esophagus

Radiation therapy alone or in combination with surgery in the treatment of carcinoma of the esophagus

Treatment of thoracic esophageal carcinoma invading adjacent structures

Radiation therapy of esophageal carcinoma: Correlation of clinical and radiographic findings

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