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Query: UMLS:C0546837 (esophageal cancer)
 8,907 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Esophageal cancer is incurable in most patients. Tumor anatomy must be carefully defined using radiographic and endoscopic techniques. These techniques can also provide useful information to plan palliative treatment. The goals of palliation must be explicitly discussed and defined with the patient and family. Palliative manipulation is best done by a physician with experience in the procedures, after consideration of all available options to ensure effective palliation with minimal risk of complications. Esophageal dilation is an integral part of most palliative treatment programs, either as sole or adjunctive therapy. Dilation can maintain luminal patency in most patients and can be performed easily, effectively, and safely in an outpatient setting. An esophageal prosthesis can further alleviate symptoms in patients in whom more conventional palliative techniques are unsuccessful. Because prosthesis placement is associated with a relatively high rate of complications, it should be reserved for patients with advanced refractory disease or tracheo-esophageal fistula, for whom no other palliative alternatives exist.
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PMID:Palliative treatment of esophageal carcinoma using esophageal dilation and prosthesis. 172 68

Autologous frozen blood transfusion (AFBT) has advantages both of autologous and frozen blood transfusion. In AFBT there are no remarkable adverse effects which often emerge after usual heterologous blood transfusion. As a rule, four hundred milliliters of blood were drawn twice from patients and reserved as autologous frozen blood (AFB) preoperatively. It is supposed that radical operation of esophageal cancer using only AFB is difficult to perform because of various kinds of preoperative risks. In this paper three cases of radical esophageal cancer operations, in which only AFBT were used are reported. Pre- and postoperative liver functions were uneventful. RBC counts, Hb and Hct dropped after drawing blood and did not recover until the day of operation. Postoperatively, they deteriorated further but recovered to initial values without any specific treatment within 5 months after operation. Pre- and postoperative PaO2 values of AFBT were not different from those of the usual blood transfusion. Thus using only AFBT, esophageal cancer operations were performed without any disadvantageous effects.
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PMID:[Clinical use of autologous frozen blood in the surgery of three esophageal cancer patients]. 382 12

Laser therapy is a well-established, relatively safe, rapid, and highly effective method of palliation for the dysphagia that usually accompanies esophageal and esophagogastric cancer. It is the treatment of choice in many patients, although there remains some disagreement regarding technique and predictors of outcome. The major limitation of laser therapy is the need for repeated treatments, although the interval between treatments may be lengthened by concomitant external beam or endoluminal radiotherapy. When laser therapy is available, use of an esophageal stent should be reserved for special circumstances, such as esophagopulmonary fistulas or extrinsic compression. In addition, stent placement usually is effective when laser photoablation fails or must be performed too frequently. It remains to be seen whether or not technical improvements in esophageal stents will reduce the frequency of complications associated with these devices. Other promising modalities that may be less expensive and more readily available, such as the BICAP tumor probe or injection therapy, deserve further study. It appears that most of these methods are complementary and different modalities may be suited to different types of lesions. The results of phase III clinical trials with PDT, now underway, should help to define the role of this promising modality in the overall scheme of treatment for esophageal cancer. The concept of PDT is attractive, although refinements in photosensitive compounds and methods of light delivery may be needed. Current information suggests a moderately high complication rate for PDT, although this may decrease with technical improvements and increasing experience. Issues surrounding the palliation of esophageal cancer are complex. Whereas the tendency is to focus on technical aspects of therapy and the relief of dysphagia, broader aspects of a patient's quality of life cannot be ignored. Ultimately, the choice of therapy may depend as much on a patient's psychosocial circumstances as on the appearance of the lesion. For instance, the patient who lives at a great distance from the center where laser therapy is performed may be better served by placement of an esophageal stent despite the higher complication rate for this procedure. PDT would be inappropriate for the patient who wishes to spend the remaining few months of life outdoors in the sun. Guiding the patient to the best choice requires the skills of a physician as much as the technical ability of an endoscopist.
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PMID:Palliation of esophageal carcinoma. Laser and photodynamic therapy. 751 23

Perforation of esophageal cancer is an unusual complication that most often results from instrumentation. The management of this condition must be individualized on the basis of the patient's condition and the stage of the cancer. For patients who are otherwise well and have localized disease, a standard resection is performed. Stent placement and esophageal exclusion are sometimes used for patients in good condition but in whom resection is not feasible. Supportive care alone is reserved for patients who have end-stage disease or are otherwise not candidates for aggressive therapy. Although the overall mortality rate is 50%, the risk for patients who undergo resection is less than 10%. This risk is similar to that found in patients undergoing elective resection and supports the concept that aggressive therapy should be pursued in highly selected patients with perforated esophageal cancers.
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PMID:Esophageal perforation and caustic injury: management of perforated esophageal cancer. 917 76

The two main approaches currently used for surgical treatment of esophageal cancer are transhiatal esophagectomy (THE) and esophagectomy through a right thoracotomy. Among technical variations of THE, wide opening of the diaphragm with ample mediastinal exposure allows resection under direct view with acceptable postoperative morbidity and mortality rates. Transthoracic esophagectomy, associated with extensive mediastinal lymphadenectomy, still offers the best chance of definitive cure in intermediate stages (stages II and III), but does not influence survival in advanced cases (stage IV). In early stages, the lymph node invasion rate is negligible and may be treated by other techniques (THE or endoscopic mucosectomy). THE restores oral ingestion and avoids respiratory complications of thoracotomy, and consequently can be reserved for early cases (mucosal or submucosal lesions) or for patients with poor clinical status. To improve results of surgical treatment, protocols of associated radiochemotherapy are currently under research.
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PMID:Transhiatal esophagectomy for esophageal cancer. 922 12

BACKGROUND: The standard of care for esophageal cancer has historically been surgical resection. However, survival following surgical treatment of esophageal cancer remains poor. In inoperable patients, both radiation therapy and chemotherapy alone and in combination have been used with some success. Consequently, these therapies have been utilized in the neoadjuvant setting to improve palliation and prolong survival. METHODS: The author reviewed the literature regarding clinical trials that employed neoadjuvant chemotherapy and radiation therapy in the treatment of squamous cell carcinoma and adenocarcinoma of the esophagus. RESULTS: In most patients, surgery alone is noncurative therapy, even when performed with curative intent. Most phase III trials of neoadjuvant therapy have not been designed with adequate statistical power to detect clinically relevant improvement. The available data are insufficient to determine a benefit to preoperative radiation therapy alone. Preoperative chemotherapy with 5-FU plus cisplatin followed by surgery probably offers little or no improvement over surgery alone. Trials of combined preoperative chemoradiation therapy have yielded promising but not definitive results. CONCLUSIONS: Outside of a clinical trial, neoadjuvant therapy for esophageal cancer should be reserved for only a select group of patients. Future clinical trials may determine a role for neoadjuvant chemoradiation and identify more active chemotherapeutic agents and populations most likely to benefit.
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PMID:Neoadjuvant Therapy for Cancer of the Esophagus. 1075 34

Clinical decision-making in esophageal cancer surgery is a process of balancing the risks of treatment against potential benefits, such as survival and quality of life. Various options are available for esophageal reconstruction. While these reconstructive options do not directly have an impact on cancer survival, they do affect operative morbidity and long-term quality of life. The affect of various interponats (reconstructive conduits) and routes of reconstruction on operative morbidity and foregut function is reviewed. Gastric interponats are preferred for esophageal reconstruction because of their reliable vascularity and the relative simplicity of the reconstructive operation. Colon interponats supposedly provide better long-term function as an esophageal substitute (unproven), but at the cost of increased operative complexity and morbidity. Colon interposition is therefore reserved for situations in which gastric transposition is not feasible. Both posterior and anterior mediastinal routes of gastric interponat reconstruction are acceptable (meta-analysis of randomized controlled trials). Posterior mediastinal reconstruction is usually preferred when a complete (R0) resection has been accomplished. Anterior mediastinal reconstruction may prevent secondary dysphagia after incomplete (R1, R2) resections.
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PMID:Does the interponat affect outcome after esophagectomy for cancer? 1155 22

The purpose of this study was to examine metastasis in different nodal stations and the extent of lymphadenectomy for esophageal carcinoma. Eighty-seven thoracic esophageal squamous carcinoma patients underwent esophagectomy with two-field or three-field lymphadenectomy based on cervical ultrasonography. Thirty-five patients (40.2%) with ultrasonography-detected cervical nodes underwent cervical dissection. Significantly more patients with primary tumors in the upper thoracic esophagus had cervical dissection than patients with tumors in the middle and lower esophagus (66.7%vs. 30.2%, P=0.002). Metastasis to cervical, superior mediastinal, mid-mediastinal, and abdominal nodes were 19.5%, 25.3%, 23%, and 24.1%, respectively. Cervical metastasis was 29.2%, 20.8%, and 10% for upper, middle, and lower thoracic esophageal tumors. Regional lymphadenopathy was found in 48 patients (55.2%) and was significantly related to cervical metastasis (31.3%vs. 5.1%, P=0.002). It was significantly less in upper (37.5%) than in middle (62.3%) and lower (60%) thoracic esophageal tumors (P=0.041). When cervical metastasis was included into regional lymphadenopathy, the difference was no longer significant (45.8%vs. 63.5%, P=0.135). Cervical dissection was associated with significantly more morbidities (60%vs. 34.6%, P=0.020), especially recurrent laryngeal nerve palsy (22.9%vs. 9.6%, P=0.089). Recurrent laryngeal nerve palsy was related significantly to anastomotic leakage (53.8%vs. 13.5%, P=0.001). There was no significant difference between the 2-year survivals for patients with or without cervical metastasis (50.0 vs. 72.0%, P=0.094). We conclude that cervical metastasis is of a similar rate as metastasis to mediastinal or abdominal nodes. Cervical nodes should be taken as regional lymph nodes for thoracic esophageal cancer. Cervical dissection is associated with increased morbidity and should be reserved for patients who may benefit from the procedure. Selective three-field dissection based on ultrasonography is helpful in reducing surgical morbidity while increasing the completeness of resection.
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PMID:Selective three-field lymphadenectomy for thoracic esophageal squamous carcinoma. 1750 16

Self-expandable metal stents (SEMS) have been mostly reserved for palliation of dysphagia because of advanced esophageal cancer. Fully covered SEMS (FCSEMS) (ALIMAXX-E, Alveolus Inc, Charlotte, NC, USA) offer the choice of removability if complications occur or maximum therapeutic benefit is achieved. To our knowledge, their use has not been studied in patients undergoing neoadjuvant therapy. The objectives of this study were the following: (i) to evaluate whether FCSEMS are useful in patients receiving neoadjuvant therapy; and (ii) to assess ease of removability and tissue reaction to FCSEMS. FCSEMS (ALIMAXX-E, Alveolus Inc) were deployed in consecutive patients with locally advanced esophageal cancer over a period of 14 months. All patients were referred for neoadjuvant chemoradiation therapy after stenting. Dysphagia scores were assessed at 0 month, 1 month, 3 months, and 6 months. Barium swallow and endoscopy were performed for new symptoms and follow-up. Eleven patients were treated with FCSEMS prior to neoadjuvant therapy (mean age 60.5 years, 55% white, 91% male). All but one stent were successfully placed. Strictures were located in the upper esophagus (n= 1), middle esophagus (n= 4), lower esophagus (n= 2), and gastroesophageal junction (n= 4). Dysphagia was significantly improved at 1 month (mean difference 3.12; 2.53-3.79 95% confidence interval [CI]), 3 months (mean difference 2.86, 2.19-3.53 95% CI), and 6 months (mean difference 2.56, 1.79-3.34 95% CI) compared with baseline. Three patients (27%) experienced chest pain or heartburn immediately following deployment. Only two patients ultimately underwent surgical resection. The others were diagnosed with metastatic disease prior to surgery, had disease progression in spite of neoadjuvant treatment, or died with the stent in place. Three patients developed delayed complications: recurrent dysphagia (n= 2) and tracheal-esophageal fistula (n= 1). Eight (73%) stents were subsequently removed, one because of complication (tracheal-esophageal fistula), one because of migration (recurrent dysphagia), one was incorrectly deployed, and five were felt to have satisfied their purpose. Stents remained in place for a mean duration of 100.36 days (range 0-105, median 84). Removal was characterized as very easy in all cases. Upon removal, ulcerations at the proximal or distal edge of stents were noted in six patients (75%), polyps in four (50%), and granulation in six (75%). One stent (13%) became embedded but was easily lifted from tissue. There were no perforations. Neoadjuvant treatment may have contributed to improvement in dysphagia scores. FCSEMS can be used to re-establish esophageal luminal patency in patients undergoing neoadjuvant therapy for locally advanced esophageal cancer, resulting in significant improvement in dysphagia over baseline. Tissue reaction to stents occurs but does not appear to impair removability.
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PMID:A pilot study of fully covered self-expandable metal stents prior to neoadjuvant therapy for locally advanced esophageal cancer. 2054 82

Oesophageal cancer is the eighth most common cancer diagnosed worldwide, with almost half a million new cases diagnosed each year. Despite improvements in surgical and radiotherapy techniques and refinements of chemotherapeutic regimens, long-term survival, even from localized oesophageal cancer, remains poor. Surgical resection alone remains the standard approach for very early stage disease (stage I), but whilst surgery remains fundamental to the treatment of stage II-III resectable adenocarcinoma, multimodality therapy with chemotherapy or chemoradiation (CRT) is internationally accepted as the standard of care. Data from two large, randomized phase III trials support the use of perioperative combination chemotherapy in lower oesophageal and oesophagogastric junction adenocarcinomas, but the contribution of the adjuvant therapy is uncertain. There are conflicting data from randomized studies of a purely neoadjuvant approach; however, recent meta-analyses have demonstrated that chemotherapy or CRT given prior to radical surgery improves survival in patients with adenocarcinoma of the oesophagus. Neoadjuvant CRT but not chemotherapy alone is also beneficial for patients with squamous cell carcinoma. Definitive CRT has emerged as a useful option for the treatment of resectable squamous cell carcinoma of the oesophagus, avoiding potential surgical morbidity and mortality for most patients, with salvage surgery reserved for those with persistent disease. In this review, we focus on the pharmacotherapy of resectable oesophageal and oesophagogastric junction cancers and how clinical trials and meta-analyses inform current clinical practice.
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PMID:Optimal therapeutic strategies for resectable oesophageal or oesophagogastric junction cancer. 2144 80


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