Postoperative Adjuvant Therapy After Resection of Regionally Advanced Esophageal Cancer

2014 ◽  
pp. 377-385
Author(s):  
Elizabeth Won ◽  
David H. Ilson
Keyword(s):  
Esophageal Cancer ◽  
Adjuvant Therapy ◽  
Postoperative Adjuvant Therapy ◽  
Advanced Esophageal Cancer

The effect of adjuvant chemotherapy in patients without local nodal metastases following neoadjuvant chemoradiotherapy and esophagectomy for locally advanced esophageal cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 111-111
Author(s):  
Christopher Duane Nevala-Plagemann ◽  
Samual Francis ◽  
Courtney Christine Cavalieri ◽  
Shane Lloyd ◽  
Ignacio Garrido-Laguna
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Locally Advanced ◽  
Postoperative Chemotherapy ◽  
National Cancer Database ◽  
Nodal Metastases ◽  
Advanced Esophageal Cancer ◽  
Locally Advanced Esophageal Cancer

111 Background: Neoadjuvant chemoradiation therapy (CRT) followed by esophagectomy is the current standard of care for patients with locally advanced esophageal cancer. The potential benefit of additional postoperative chemotherapy is still under investigation. In this study, we utilized the National Cancer Database to assess the effect of adjuvant chemotherapy in patients who were found to have node negative disease (pN0) following surgery. Methods: Patients with locally advanced esophageal cancer who received neoadjuvant CRT followed by esophagectomy from 2004 to 2014 were retrospectively identified using the National Cancer Database. Patients who were postoperatively staged as pN0 were then separated based on whether or not they received adjuvant chemotherapy. Using Kaplan-Meier estimation and a multivariate cox regression analysis, the overall survival of those who received adjuvant therapy was then compared to those who received neoadjuvant CRT alone. Results: 3,159 patients with locally advanced esophageal cancer underwent neoadjuvant CRT and were found to be pN0 following surgery. 119 of these patients received postoperative chemotherapy. The 1, 5, and 8-year overall survival in those receiving adjuvant therapy was 95.9%, 49.9%, and 47.7% compared to 85.8%, 44.6%, and 33.0% in those receiving neoadjuvant CRT alone, respectively (p = 0.019). Based on multivariate analysis, receiving adjuvant chemotherapy was independently associated with increased overall survival (p = 0.011; HR 0.658; 95% CI, 0.476 to 0.908). Conclusions: Adjuvant chemotherapy may improve survival in patients with locally advance esophageal cancer who have no evidence of local nodal metastases following surgery. Additional clinical trials are needed to further confirm which patients may benefit from adjuvant therapy and to determine the optimal postoperative therapeutic regimen.

Analysis of new N descriptors on prognosis of esophageal cancer with positive lymph nodes in a Chinese population.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14678-e14678
Author(s):  
Yaping Xu
Keyword(s):  
Decision Making ◽  
Esophageal Cancer ◽  
Adjuvant Therapy ◽  
Lymph Nodes ◽  
Staging System ◽  
Postoperative Adjuvant Therapy ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
N Staging ◽  
Positive Lymph Nodes

e14678 Background: The 7th edition of the American Joint Committee on Cancer / Union International Against Cancer (AJCC/UICC) TNM staining system for esophageal cancer (EC) has been published. N descriptors are now divided into N0, N1, N2 and N3. In this study, we aimed to validate the prognostic ability of the new N staging system in patients with resectable EC and positive lymph nodes, and evaluate whether the new N staging system can help the decision-making for postoperative adjuvant therapy in this population. Methods: From 2002 to 2008, patients with stage T1-4N1-3M0 EC who underwent esophagectomy were retrospectively analyzed. EC was classified according to the new N staging system. Kaplan-Meier method and Cox regression analysis were employed to compare overall survival (OS). Results: A total of545 patients met the inclusion criteria: 346 (63.5%) received esophagectomy alone, 199 (36.5%) received esophagectomy and adjuvant radiotherapy, and 36.1% (197/545) received esophagectomy and adjuvant chemotherapy. Univariate analysis and multivariate analysis revealed significant difference in OS among patients with EC at different N stages (p<0.001). Significant difference in OS was also present among patients receiving radiotherapy (p<0.001) and those undergoing chemotherapy (p<0.001). Subgroup analysis indicated that postoperative adjuvant therapy did not significantly affect the OS among patients with EC at different N stages. Conclusions: Our results validated the prognostic ability of new N staging system. N descriptor is an independent prognostic factor in patients with resectable EC who were positive for lymph nodes. Further studies are required to clarify the role of new N staging system in the decision-making for postoperative adjuvant therapy in this population.

scholarly journals PO-0685: The value of postoperative adjuvant therapy for pT2-3 esophageal cancer treated by radical resection

2017 ◽  
Vol 123 ◽  
pp. S358
Author(s):  
S. Zhu ◽  
L. Shuguang ◽  
L. Youmei ◽  
S. Wenbin ◽  
L. Juan ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Adjuvant Therapy ◽  
Radical Resection ◽  
Postoperative Adjuvant Therapy

scholarly journals Nutritional support for the patients with esophageal cancer during the postoperative adjuvant therapy.

1988 ◽  
Vol 21 (7) ◽  
pp. 1919-1923
Author(s):  
Yorikazu NIITSU ◽  
Kaoru ISHIDA ◽  
Kazumi OKAMOTO ◽  
Shunsuke SUZUKI ◽  
Kouji MURAKAMI ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Adjuvant Therapy ◽  
Nutritional Support ◽  
Postoperative Adjuvant Therapy

scholarly journals Postoperative adjuvant therapy for resectable esophageal cancer

Medicine ◽  
2019 ◽  
Vol 98 (20) ◽  
pp. e15485 ◽  
Author(s):  
Tianci Chai ◽  
Zhimin Shen ◽  
Peipei Zhang ◽  
Yuhan Lin ◽  
Sui Chen ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Adjuvant Therapy ◽  
Postoperative Adjuvant Therapy ◽  
Resectable Esophageal ◽  
Resectable Esophageal Cancer

Helical tomotherapy for advanced esophageal cancer improves target conformity and homogeneity: A comparison with fixed-field intensity-modulated radiotherapy

2015 ◽  
Vol 11 (3) ◽  
pp. 3146-3155
Author(s):  
Luhua Wang
Keyword(s):  
Esophageal Cancer ◽  
Field Intensity ◽  
Helical Tomotherapy ◽  
Intensity Modulated Radiotherapy ◽  
Matched Pair ◽  
Conformity Index ◽  
Target Coverage ◽  
Advanced Esophageal Cancer ◽  
Fixed Field ◽  
Intensity Modulated

Purpose: To evaluate the usefulness of helical tomotherapy (HT) in the treatment of advanced esophageal cancer (EC) and compare target homogeneity, conformity and normal tissue doses between HT and fixed-field intensity-modulated radiotherapy (ff-IMRT).Methods: In all, 23 patients with cT3-4N0-1M0-1a thoracic EC (upper esophagus, 9 patients; middle esophagus, 6; distal esophagus, 6 and esophagogastric junction, 2) who were treated with ff-IMRT (60 Gy in 30 fractions) were re-planned for HT and ff-IMRT with the same clinical require­ments. Comparisons were performed using the Wilcoxon matched-pair signed-rank test.Results: Compared with ff-IMRT, HT significantly reduced the homogeneity index for thoracic, upper, middle and distal ECs by 38%, 31%, 36% and 33%, respectively (P < 0.05). The conformity index was increased by HT for thoracic, upper and middle ECs by 9%, 9% and 18%, respectively (P < 0.05). Target coverage was improved by 1% with HT (P < 0.05). The mean lung dose was significantly reduced by HT for thoracic and upper ECs (P < 0.05). The V20 (volume receiving at least 20 Gy) and higher dose volumes of the lungs were decreased by HT in all cases, but the differences were significant for thoracic, upper and distal ECs (P < 0.05), with reductions of 2.1%, 3.1% and 2.2%, respectively. HT resulted in a larger lung V5 for thoracic, upper, middle and distal ECs, with increases of 3.5%, 1.5%, 7.2% and 3.2%, respectively. Heart sparing was significantly better with HT than with ff-IMRT in terms of the V30 and V40 for thoracic, upper, middle and distal ECs (P < 0.05).Conclusions: Compared to ff-IMRT, HT provides superior target coverage, conformity and homogeneity, with reduced the volume of high doses to the lungs and heart for advanced EC. HT may be a treatment option for advanced EC, especially upper EC.

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