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

Neoadjuvant chemotherapy before surgery has been proposed to improve the outcome in patients with early lower esophageal cancer. To evaluate its effectiveness, we performed a systematic retrospective analysis of consecutive patients treated at the Ottawa Regional Cancer Center with prospective inclusion criteria. Between 1988 and 1992 patients were treated with surgery alone. From 1992 until 1997, patients were uniformly treated with neoadjuvant chemotherapy consisting of cisplatin and 5-fluorouracil. Surgical resection was then performed. Nineteen patients received neoadjuvant chemotherapy and 15 received surgery alone. Although the two arms of the study were balanced for age and sex, there were more patients in the neoadjuvant arm with squamous histology, weight loss and regional nodes at diagnosis. In the neoadjuvant arm, two patients did not have surgery because of progression or toxicity. However, complete resection rates were similar. There was no difference in overall survival or disease-free survival between the two arms (p > 0.4). Multivariate analysis revealed that only the nodal status at diagnosis was predictive of outcome. Neoadjuvant chemotherapy with this regimen does not result in improved survival over surgery alone.
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PMID:Neoadjuvant chemotherapy before surgery for resectable carcinoma of the lower esophagus. 1046 48

We investigated micrometastasis in lymph nodes by detecting carcinoembryonic antigen (CEA) mRNA. A total of 400 lymph nodes obtained from 21 patients with esophageal carcinoma were examined by CEA-specific reverse transcription-polymerase chain reaction (RT-PCR). Serial sections of positive lymph nodes were reexamined histologically and immunohistologically. Twenty-seven lymph nodes of 11 patients were diagnosed as being positive by conventional histologic examination. CEA-mRNA positivity was found in 18 of 21 patients. Among 373 histologically negative nodes, 79 (21.2%) were positive for CEA mRNA. Of these, micrometastasis was detected in 2 by histological reexamination and in 11 by immunohistochemical staining using cytokeratin antibody. Two of 6 RT-PCR-positive patients (33.3%) had recurrent disease. Four of 11 patients (36.4%) whose nodal involvement was discovered by routine histological examination also had recurrent cancer. CEA-specific RT-PCR detected micrometastasis in lymph nodes at a higher rate than histological or immunohistochemical analysis of serial sections. Since the incidence of CEA-mRNA positivity is high in the lymph nodes of esophageal cancer patients except for those with early cancer, these patients should be treated with adjuvant therapy.
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PMID:Detection and clinical significance of lymph node micrometastasis determined by reverse transcription-polymerase chain reaction in patients with esophageal carcinoma. 1064 39

In 1986, several institutions in Japan began to employ extensive lymphadenectomy for thoracic esophageal cancer. The aim of this article is to point out several confusing factors concerning the use of the terms "tow-field" and "three-field" lymph node dissection for thoracic esophageal cancer. In two-field nodal dissection, two components are included with (modern two-field) or without (traditional two-field) nodal dissection around both recurrent laryngeal nerve chains in the upper mediastinum. We studied a series of 353 patients resected for thoracic esophageal cancer in our institution. The patients were divided into three groups. Group A was the traditional two-field group of patients who underwent thoracoabdominal lymphadenectomy without upper mediastinal lymph node dissection after preoperative irradiation; group B was the modern two-field group, with additional upper mediastinal lymph node dissection; and group C was the three-field group with additional neck lymph node dissection. Groups B and C were operated on during the same period and did not received preoperative irradiation. The 5-year survival rate in group B was 54.9%, which was better than the 47.6% rate after three-field dissection (group C). The key to extensive lymphadenectomy for thoracic esophageal cancer does not lie in "cervical dissection" but in the meticulous dissection of the lymph nodes around the right and left recurrent laryngeal nerves.
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PMID:Significance of extended systemic lymph node dissection for thoracic esophageal carcinoma in Japan. 1069 46

There have been no randomized studies of esophagectomy versus chemoradiation as primary management of esophageal cancer. Review of the literature indicates esophagectomy alone has limited applicability, significant morbidity, higher mortality, and a lesser chance for cure than chemoradiation for patients with squamous cell cancer of the esophagus. The majority of patients with esophageal cancer have disease extending through the esophageal wall or nodal involvement and the prognosis for such patients treated by esophagectomy alone is quite poor, with 5-year survival rate of 10% or less. Recent studies indicate 5-year survival rates with chemoradiation is 20% to 25%. Local failure rates are similar with chemoradiation versus esophagectomy, but swallowing function is superior with chemoradiation. Salvage surgery is possible following chemoradiation for the small percentage of patients who have local-only failure. Chemoradiation is preferred to esophagectomy for patients with squamous cell cancer of the esophagus, and offers significant palliation and the chance for cure for patients with adenocarcinoma of the esophagus as well.
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PMID:Chemoradiation: A Superior Alternative for the Primary Management of Esophageal Carcinoma. 1071 3

Because of the poor prognosis for patients with esophageal cancer and the risks associated with surgical intervention, accurate staging is essential for optimal treatment planning. Positron emission tomography (PET) with 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) is a useful adjunct to more conventional imaging modalities in this setting. FDG PET is not an appropriate first-line diagnostic procedure in the detection of esophageal cancer and is not helpful in detecting local invasion by the primary tumor, and further studies are required to determine its efficacy in the detection of local nodal metastases. However, FDG PET is superior to anatomic imaging modalities in the ability to detect distant metastases. Metastases to the liver, lungs, and skeleton can readily be identified at FDG PET. In addition, FDG PET has proved valuable in determining the resectability of disease and allows scanning of a larger volume than is possible with computed tomography. Recurrent disease is readily diagnosed and differentiated from scar tissue with FDG PET. In addition, FDG PET may play a valuable role in the follow-up of patients who undergo chemotherapy and radiation therapy, allowing early changes in treatment for unresponsive tumors. The management of most patients with esophageal cancer can be improved with use of FDG PET.
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PMID:Imaging features of primary and recurrent esophageal cancer at FDG PET. 1125 13

CT is readily available to all patients. It is relatively inexpensive and fees are usually reimbursed. It provides exquisite anatomic detail of the chest and abdomen in patients with esophageal cancer. The only reliable use of CT in the determination of T is the exclusion of T4 tumors, which is suggested by the preservation of fat planes. Enlarged lymph nodes are suspicious for metastatic disease but require further study or tissue sampling if nodal metastases will determine treatment. Its major use is in the detection of distant metastatic disease; however, 30% to 60% of distant metastases may be radiographically occult. There is a significant learning curve for EUS staging of esophageal cancer. It is suggested that this study be performed at institutions where there is a dedicated, experienced endoscopic ultrasonographer with adequate instrumentation that allows specialty imaging and EUS-FNA. EUS is the best means of clinically determining T. The addition of EUS-FNA to routine EUS evaluation of lymph nodes allows an accuracy similar to the EUS determination of T. EUS has no purpose in assessment of non-nodal distant metastatic disease; however, the serendipitous finding of distant metastases in adjacent structures visualized during the evaluation of the primary tumor and lymph nodes has, on occasion, detected M1b disease. FDG-PET represents an advance over CT scanning in the screening for distant metastases. The major problems with FDG-PET staging of esophageal cancer is failure to detect metastatic deposits less than 1 cm in diameter and lack of anatomic definition. It is unable to determine T and has been inaccurate in the detection of lymph node metastases. Because this test is not readily available, is expensive, and is not routinely reimbursed, its use in staging esophageal cancer continues to be limited. Today, CT and EUS are the mainstays in the clinical staging of esophageal carcinoma. When possible, FDG-PET should be added to CT to improve the evaluation of non-nodal M1b disease. Results of these studies should determine the necessity for invasive staging techniques and direct their use.
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PMID:Clinical staging of esophageal carcinoma. CT, EUS, and PET. 1096 51

Carcinomas of the esophagus represent on average about 1% to 2% of all malignant tumors. The incidence shows extreme regional differences, reflecting the established environmental and acquired risk factors for cancer of the esophagus. There has been a major shift in tumor location and histology over the last decades, with the lower third/gastroesophageal junction becoming the most common location and adenocarcinoma the most common histology in white males. There has been a striking improvement in surgical resection rates and operative mortality; however, the curative potential of surgery is likely to be highest in early-stage disease. The poor prognosis for locally advanced tumors motivated the search for multimodal approaches to improve results. While neither perioperative radiotherapy nor perioperative chemotherapy alone have significantly improved survival rates, combined radiochemotherapy, used as neoadjuvant or definitive therapy, appears more promising. For patients with advanced tumors or extensive nodal involvement, first principles and extrapolation from other tumors of the gastrointestinal tract suggest that a combination of chemotherapy and radiation is likely to be of benefit, as compared to surgery alone. As this treatment is difficult to tolerate in the postoperative setting, neoadjuvant approaches have been emphasized. Although there are promising data, and preoperative chemoradiation is widely utilized, we do not consider the benefit of this approach to have been proven unequivocally. Future progress in the treatment of esophageal cancer may require that systemic therapy be improved to the point where occult metastatic disease can be controlled, enabling the local control provided by surgery and radiation to lead to improved survival.
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PMID:Perioperative radiotherapy for cancer of the esophagus. 1129 Nov 30

Three-field lymphadenectomy for esophageal cancer remains controversial. The high prevalence of cervical lymph node involvement is the basis of cervical lymphadenectomy. Studies of recurrence patterns after esophagectomy, however, indicate that clinically relevant cervical nodal recurrence is uncommon, and that the incidence of such recurrence is similar to that of two-field lymphadenectomy. Moreover, a convincing survival benefit cannot be proven for the more extended lymphadenectomy. The emphasis of three-field lymphadenectomy has shifted to lymphadenectomy of the superior mediastinum and along the recurrent laryngeal nerve chains. Radical dissection of these areas may improve local disease control; the price to pay is increased postoperative morbidity and impaired long-term quality of life. Furthermore, the selection of appropriate patients for extended lymphadenectomy is difficult. Formal three-field lymphadenectomy seems unnecessary, but the controversy of the optimal extent of lymphadenectomy and its impact on survival remains unanswered.
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PMID:Two-field dissection is enough for esophageal cancer. 1155 17

Patients diagnosed with adenocarcinoma or squamous cell carcinoma of the esophagus should undergo computed tomography of the chest and abdomen and positron emission tomography to look for evidence of distant metastatic disease. In the absence of systemic metastases, locoregional staging should be performed with endoscopic ultrasonography and fine needle aspiration of accessible periesophageal lymph nodes and any detectable celiac lymph nodes. Patients found to have T3 tumors (transmural extension), T4 tumors (invasion of adjacent structures), or N1-M1a (lymph node-positive) disease do poorly when treated with surgery alone; 5-year survival is less than 20%. These patients should be considered for combined modality therapy. Patients with T4 disease are generally not deemed candidates for surgical resection; they may be considered for definitive chemoradiotherapy. Patients with T3 disease or lymph node-positive disease may be treated with neoadjuvant chemoradiotherapy followed by surgery or definitive chemoradiotherapy alone. Patients considered for trimodality therapy should be fully restaged before surgery to assess their response to neoadjuvant treatment. This should include repeat endoscopic ultrasound and fine needle aspiration of lymph nodes. Patients whose lymph node metastases do not completely respond to neoadjuvant therapy are unlikely to benefit from the addition of surgery. Patients with persistently positive celiac lymph nodes have a very poor prognosis and should not undergo surgery. Patients with persistent nodal disease who have good performance status may be considered for additional chemotherapy. Patients with locally advanced esophageal cancer who have poor performance status are not good candidates for combined modality therapy. These individuals are best managed with palliative intent. Particular attention should be given to alleviating the common problem of dysphagia, which causes significant morbidity.
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PMID:Locally advanced esophageal cancer. 1239 37

It is not fully understood whether oesophageal cancer, associated with solitary lymph node metastasis, is still a local disease or already a systemic one. Among 283 patients with squamous oesophageal cancer who underwent oesophagectomy and 3-field lymphadenectomy, 37 patients had single metastasized nodes. Clinicopathologic factors, following Japanese Guideline for the Clinical and Pathological studies on Carcinoma of the Esophagus, related to survival and pre-operative predictability of nodal involvement was studied. Five-year survival was 48%. Initial pattern of recurrence was mostly haematogenous. Among the factors related to survival, grade of lymph node metastasis (pN1 vs. pN2, pN3, p=0.006) was more closely related than depth of invasion (pT1, pT2 vs. pT3, pT4, p=0.037). Five-year survival was 71.7% for pN1 patients, whereas it was 22% for pN2 or pN3 patients. Of the metastasized nodes 65% were <10 mm, and 27% was <5 mm in the maximum diameter. Oesophageal cancer is still a local disease in half of the patients with a solitary metastasized node. For these patients, dissection along the recurrent laryngeal nerve is necessary to retrieve the node possibly metastasized.
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PMID:Prognostic factors in patients with squamous oesophageal cancer associated with solitary lymph node metastasis after oesophagectomy and extended lymphadenectomy. 1246 48


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