Surgical Management of Esophageal Carcinoma

Surgery with or without adjuvant radiotherapy (RT) is the standard treatment of esophageal cancer. Preoperative radio- and chemotherapy (CT) have been introduced to improve prognosis. We report a phase II prospective non-randomized trial of preoperative RT (42 Gy/25) plus CT (cisplatin 20 mg/mq/day plus 5-fluorouracil 600 mg/mq/day, 1-5 weeks) for the treatment of thoracic esophageal cancer. From 1993, 50 patients were enrolled (40 men and 10 women, mean age 57 years, range 30-75 years). Squamous cell carcinoma accounted for 90% of cases; 10% were adenocarcinoma. Downstaging of the disease was obtained in 77.3% of cases; there were 13 (29.5%) complete responses (CR) and 21 (47.7%) partial responses (PR). Median survival was 28 and 25 months, respectively, for CR and partial response (PR) plus stable disease (SD) and progressive disease (PD) (P = 0.05). Progressive-free median survival was 22 and 17 months, respectively, for CR and PR + SD + PD (P = 0.08). Multimodal treatment of esophageal cancer showed promising results, although not significant, in terms of survival and disease progression for patients achieving a complete pathologic response.

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“…Indeed, surgical mortality for esophageal resection reported in the literature in the last decade is around 10% and 5%. 17…”

Section: Discussionmentioning

confidence: 99%

Preoperative chemoradiotherapy in cancer of the thoracic esophagus

Terrosu

Cedolini

Bresàdola

et al. 2003

Diseases of the Esophagus

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“…2 After complete surgical removal of the tumor, the five-year survival rate exceeds 95 percent for stage 0 disease, and is 50 to 80 percent for stage I disease, 30 to 40 percent for stage IIA disease, 10 to 30 percent for stage IIB disease, and 10 to 15 percent for stage III disease. [76][77][78] Patients with metastatic (stage IV) disease who are treated with palliative chemotherapy have a median survival of less than one year. 80 In addition to the TNM stage, multivariate analyses suggest that a weight loss of more than 10 percent of body mass, dysphagia, large tumors, advanced age, and lymphatic micrometastases (identified by immunohistochemical analysis) are independent predictors of a poor prognosis.…”

Section: Staging and Prognosismentioning

confidence: 99%

Esophageal Cancer

Enzinger¹,

Mayer²

2003

N Engl J Med

2,542

1,978

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sophageal cancer is one of the least studied and deadliest cancers worldwide. During the past three decades, important changes have occurred in the epidemiologic patterns associated with this disease. Recent advances in the diagnosis, staging, and treatment of this neoplastic condition have led to small but significant improvements in survival. These new observations serve as the focus of this review. Cancers arising from the esophagus, including the gastroesophageal junction, are relatively uncommon in the United States, with 13,900 new cases and 13,000 deaths anticipated in 2003. 1 The lifetime risk of this cancer is 0.8 percent for men and 0.3 percent for women. 2 The risk increases with age, with a mean age at diagnosis of 67 years. 2,3 Esophageal cancer is the seventh leading cause of death from cancer among American men, particularly black men, who have a higher incidence of this disease (13 cases per 100,000 persons) than do men in other racial or ethnic groups. 2 Worldwide, esophageal cancer is the sixth leading cause of death from cancer. 4 More than 90 percent of esophageal cancers are either squamous-cell carcinomas or adenocarcinomas. 3 On rare occasions, other carcinomas, melanomas, leiomyosarcomas, carcinoids, and lymphomas may develop in the esophagus as well. Approximately three quarters of all adenocarcinomas are found in the distal esophagus, whereas squamouscell carcinomas are more evenly distributed between the middle and lower third. 3,5 The cervical esophagus is an uncommon site of disease. The pathogenesis of esophageal cancer remains unclear. Data from studies in animals suggest that oxidative damage from factors such as smoking or gastroesophageal reflux, which cause inflammation, esophagitis, and increased cell turnover, may initiate the carcinogenic process. 6 Once cancer develops, it may spread rapidly; 14 to 21 percent of submucosal cancers (T1 lesions) and 38 to 60 percent of cancers that invade muscle (T2 lesions) are associated with spread to lymph nodes. 5,7 At the time of the diagnosis of esophageal cancer, more than 50 percent of patients have either unresectable tumors or radiographically visible metastases. Smoking is associated with an increased risk of both squamous-cell carcinoma and adenocarcinoma of the esophagus (Table 1). 8,9 The ingestion of tobacco condensates is thought to bring tobacco carcinogens, particularly nitrosamines, in contact with the esophageal mucosa. 10 The risk of esophageal cancer correlates directly with the quantity of cigarettes smoked per day and the duration of smoking.

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“…In this group of patients with locally advanced EC, surgery alone is not a standard treatment due to difficulties on achieving complete resection and poor results. Between 30 to 50% of cases do not achieve complete tumor resection (R0), and even after R0 surgery, relapse (local or metastatic) is common, with long-term survival around 20% (7). This fact prompted clinical research in locally advanced EC with major evolution in the last 15 years.…”

Section: 2locally Advanced Ecmentioning

confidence: 99%

Locally Advanced Esophageal Cancer: State of the Art

Martínez¹

2017

MRAJ

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Esophageal cancer is an important cause of death worldwide, with an increasing incidence in adenocarcinoma subtype (mainly affecting the esophago-gastric junction) in western countries. Nevertheless, squamous cell carcinoma remains the most incident worldwide. An appropriate pretreatment assessment is mandatory to select best treatment in each patient, usually within the consensus of a multidisciplinary tumor board. Esophagogastroduodenoscopy and chest-abdomen CT scan are basic work-up. Although complete surgical resection remains the cornerstone of the treatment for resectable disease, long-term results are poor and recurrences are common, especially in locally advanced setting. Multimodal therapy for locally advanced disease improves survival nevertheless; the optimal therapeutic approach remains controversial. Preoperative chemoradiotherapy and perioperative chemotherapy are the most common strategies. However, in some patients, definitive chemoradiotherapy without surgery is also an option. In this review, we will cover the epidemiology, diagnosis and staging of patients with esophageal cancer. We will also discuss the main clinical trials and meta-analysis in the treatment of local and locally advanced esophageal cancer, evidence for different multimodal approaches (with and without surgery) and finally we will propose a treatment algorithm.

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Surgical Management of Esophageal Carcinoma

Cited by 53 publications

References 58 publications

Preoperative chemoradiotherapy in cancer of the thoracic esophagus

Preoperative chemoradiotherapy in cancer of the thoracic esophagus

Esophageal Cancer

Locally Advanced Esophageal Cancer: State of the Art

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