Refining Esophageal Cancer Staging After Neoadjuvant Therapy: Importance of Treatment Response

Barbour, Andrew P.; Jones, Mark; Gönen, Mithat; Gotley, D. C.; Thomas, Janine; Thomson, Damien; Burmeister, Bryan; Smithers, B. Mark

doi:10.1245/s10434-008-0084-y

Cited by 70 publications

(69 citation statements)

References 36 publications

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“…Concerning the definition of T-status, the emphasis on tumor length (T1 or clinical stage I: tumor length ≤5 cm; T2 or clinical stage II: tumor length >5 cm length; T3 or clinical stage III: evidence of extra-esophageal spread; AJCC manual, 2nd edition, 1983) had been shifted to the depth of tumor invasion since 1988 (AJCC manual, 3-7th editions, 1988-2010) (4). Recently, the roles of tumor length in ESCC have been reappraised and some showed clinically relevance in the prediction of surgical resectability, survival outcomes, or acting as a criterion to select proper cases for neoadjuvant concurrent chemoradiotherapy (nCCRT) followed by surgical resection (5)(6)(7)(8)(9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Prognostic role of initial pan-endoscopic tumor length at diagnosis in operable esophageal squamous cell carcinoma undergoing esophagectomy with or without neoadjuvant concurrent chemoradiotherapy

Lin¹,

Liu²,

Cheng³

et al. 2017

J. Thorac. Dis.

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Background: The objective of this study was to appraise the prognostic role of initial pan-endoscopic tumor length at diagnosis within or between operable esophageal squamous cell carcinoma (ESCC) undergoing upfront esophagectomy or neoadjuvant concurrent chemoradiotherapy (nCCRT) followed by esophagectomy.Methods: Between Jan 2001 and Dec 2013 in Koo-Foundation Sun Yat-sen Cancer Center in Taiwan, 101 ESCC patients who underwent upfront esophagectomy (surgery group) and 128 nCCRT followed by esophagectomy (nCCRT-surgery group) were retrospectively collected. Prognostic variables, including initial pan-endoscopic tumor length at diagnosis (sub-grouped ≤3, 3-5 and >5 cm), status of circumferential resection margin (CRM), and pathological T/N/M-status and cancer stage, were appraised within or between surgery and nCCRT-surgery groups.Results: Within surgery group, longer initial pan-endoscopic tumor length at diagnosis (≤3, 3-5 and >5 cm; HR =1.000, 1.688 and 4.165; P=0.007) was an independent prognostic factor that correlated with advanced T/N/M-status, late cancer stage, and CRM invasion (all's P<0.001). Based on the initial panendoscopic tumor length at diagnosis ≤3, 3-5 and >5 cm, nCCRT-surgery group had a poorer (P=0.039), similar (P=0.447) and better (P<0.001) survivals than did surgery group, respectively. For those with initial pan-endoscopic tumor length at diagnosis >5 cm, nCCRT-surgery group had more percentage of T0/N0-status and stage 0 (all's P<0.05), and fewer rate of CRM invasion (P=0.036) than did surgery group.Conclusions: Initial pan-endoscopic tumor length at diagnosis could be a criterion to select proper ESCC cases for nCCRT followed by esophagectomy to improve survival and reduce CRM invasion.

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Section: Introductionmentioning

confidence: 99%

Prognostic role of initial pan-endoscopic tumor length at diagnosis in operable esophageal squamous cell carcinoma undergoing esophagectomy with or without neoadjuvant concurrent chemoradiotherapy

Lin¹,

Liu²,

Cheng³

et al. 2017

J. Thorac. Dis.

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“…Alte diferenţe majore faţă de clasificarea din 2002 includ: redefinirea tunorilor in situ ca şi displazie de grad înalt, subclasificarea tumorilor T 4 în funcţie de rezecabilitatea structurilor adiacente invadate, subclasificarea statusului ganglionar în funcţie de numărul de ganglioni regionali invadaţi, realocarea în grupe de stadiu utilizând categoriile T, N, M cât şi gradul de diferenţiere histologic, iar pentru tumorile scuamocelulare funcţie de localizarea tumorală, reîncadrarea tumorilor Siewert III (tumori localizate în primii 5 cm de stomac cu invazia joncţiunii gastro-esofagiene şi a esofagului proximal). Aşa cum a fost menţionat această nouă clasificare a fost reevaluată utilizând datele de supravieţuire la pacienţii la care nu a fost efectuat un tratament neoadjuvant, utilitatea acestei clasificări la pacienţii care au efectuat tratament multimodal este limitată şi este supusă verificării periodice [10,11]. O altă modificare majoră a clasificării din 2010 este legată de definirea adenopatiei locoregionale.…”

Section: Stadializarea Preoperatorieunclassified

Therapeutic Strategies in Oesophageal Cancer: The Place of Surgical Treatement

Filip¹,

Huțanu²,

Radu³

et al. 2013

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THERAPEUTIC STRATEGIES IN OESOPHAGEAL CANCER: THE PLACE OF SURGICAL TREATEMENT (Abstract):Any attempt to define the place of surgery in the treatement of oesophageal cancer should consider the major changes that occurred during the last two decades: major shift in histologic type, improved staging methods, spectacular reduction of operative risk, standardization of oncologic principles of resection and the development of multimodality therapeutic strategies. Surgical treatement plays an essential role in management of esophageal cancer and it is prefferable to be done by trained surgical teams in large volume centers. Optimal surgical treatment strategies include appropriate patient selection, accurate staging, and risk assesment, selection of appropriate surgical approach, and the use of multimodality treatement.Esophagectomy remaines the main treatement of esophageal carcinoma, but in half of cases patients are unresectable at the time of diagnosis due to presence of systemic disease.Two major surgical strategies to improve survival rates after esophagectomy have emerged during the past decades: limited (transhiatal esophagectomy) and extended (transthoracic esophagectomy) with two field lymphadenectomy. In the short term, transhiatal esophagectomy is accompanied by less morbidity, in the long term is preferable for tumors at gastro-oesophageal junction without involved lymph nodes of chest. For patiets suitable for surgery, transthoracic esophagectomy with mediastinal and abdominal lymphadenectomy is preferred. This article provides un up-to-date of options for surgical managing of esophageal cancer and outlines of surgical technique.

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“…By the time the patient seeks medical help, esophageal cancer is often locally advanced, with cancer invading deep into the esophageal wall, spreading to nearby lymph nodes and often advancing into adjacent structures. [8][9][10][11][12] Of these patients, 50% will have unresectable metastatic disease. 2,6,13,14 …”

Section: Anatomy and Physiologymentioning

confidence: 99%

“…undetected micrometastases not found at the time of diagnosis. 5,[9][10][11]16,17 The chemotherapy used in esophageal cancer often consists of a dual-medication approach such as use of cisplatin and 5-fluorouracil. 19 The drugs are generally given through a tunneled central venous catheter or a peripherally inserted central venous catheter.…”

Section: Esophagectomymentioning

confidence: 99%

“…Although the 5-year survival rate has not improved substantially with preoperative use of chemotherapy, the 2-year survival rate has improved. 10 The radiation therapy used in esophageal cancer is generally given twice daily for 3 weeks. The purpose of the radiation therapy is to shrink the tumor to a more resectable size and remove microscopic persistent disease remaining after chemotherapy.…”

Section: Esophagectomymentioning

confidence: 99%

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Road Map to Esophagectomy for Nurses

Logue

Scott

2011

Critical Care Nurse

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Esophageal cancer, although considered uncommon in the United States, continues to exhibit increased incidence. Esophageal cancer now ranks seventh among cancers in mortality for men in the United States. Even as treatment continues to advance, the mortality rate remains high, with a 5-year survival rate less than 35%. Esophageal cancer typically is discovered in advanced stages, which reduces the treatment options. When disease is locally advanced, esophagectomy remains the standard for treatment. Surgery remains challenging and complicated. Multiple surgical approaches are available, with the choice determined by tumor location and stage of disease. Recovery is often fraught with complications-both physical and emotional. Nursing care revolves around complex care managing multiple body systems and providing effective education and emotional support for both patients and patients' families. Even after recovery, local recurrence and distant metastases are common. Early diagnosis, surgical advancement, and improvements in postoperative care continue to improve outcomes. (Critical Care Nurse.

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Refining Esophageal Cancer Staging After Neoadjuvant Therapy: Importance of Treatment Response

Abstract: The current AJCC staging system for esophageal cancer is inadequate for patients that receive neoadjuvant CRT. Refinement of the AJCC staging system should include primary tumor response for patients receiving neoadjuvant CRT.

Cited by 70 publications

References 36 publications

Prognostic role of initial pan-endoscopic tumor length at diagnosis in operable esophageal squamous cell carcinoma undergoing esophagectomy with or without neoadjuvant concurrent chemoradiotherapy

Prognostic role of initial pan-endoscopic tumor length at diagnosis in operable esophageal squamous cell carcinoma undergoing esophagectomy with or without neoadjuvant concurrent chemoradiotherapy

Therapeutic Strategies in Oesophageal Cancer: The Place of Surgical Treatement

Road Map to Esophagectomy for Nurses

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