Multidisciplinary Treatment for Intrathoracic Esophageal Cancer: CDDP Plus Irradiation

Summary Combined tracheal resection and anterior mediastinal tracheostomy (AMT) for esophageal cancer with tracheal invasion is a challenging treatment because of its high morbidity and the lack of evidence regarding long-term outcomes. The aim of this study was to assess the short- and long-term outcomes of AMT as part of the multidisciplinary treatment for esophageal cancer with tracheal invasion. This retrospective study included 27 consecutive patients with esophageal cancer with tracheal invasion who underwent combined tracheal resection and AMT in their multidisciplinary treatment for esophageal cancer. We evaluated postoperative complications, body weight loss, and survival and examined the prognostic value of preoperative factors. All patients underwent chemotherapy and/or chemoradiotherapy as prior treatment. R0 resection was achieved in all cases. Clavien–Dindo grade I or greater complications occurred in 17 patients (63%), and grade III or greater complications occurred in 12 (44%). Overall in-hospital mortality was 4%, with one patient dying on postoperative day 48 when the brachiocephalic artery ruptured from tracheal compression. The 30- and 90-day mortality rates were 0% and 4%, respectively. Median weight change in patients without recurrence in the year after surgery was −1.7% (−9.6–21%). All of these patients received nutrition by oral intake and were living independently at home without public assistance. The 3- and 5-year disease-free survival rates were 25.9% and 18.5%, respectively; 3- and 5-year overall survival rates were 38.6% and 25.7%, respectively. Multivariate analysis identified response to prior treatment as an independent prognostic factor in these patients. Combined tracheal resection and AMT may be adapted as part of the multidisciplinary treatment of esophageal cancer with tracheal invasion. Improving AMT safety and optimizing patient selection may improve prognosis among patients with this cancer.

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Effect of Multidisciplinary Treatment with High Dose Rate Intraluminal Brachytherapy on Survival in Patients with Unresectable Esophageal Cancer

Digestive Surgery ◽

10.1159/000018619 ◽

1998 ◽

Vol 15 (3) ◽

pp. 227-235 ◽

Cited By ~ 8

Author(s):

Masato Iwasa ◽

Yoshinobu Ohmori ◽

Yoshie Iwasa ◽

Akira Yamamoto ◽

Atsushi Inoue ◽

...

Keyword(s):

Esophageal Cancer ◽

Dose Rate ◽

Multidisciplinary Treatment ◽

High Dose Rate ◽

High Dose ◽

Intraluminal Brachytherapy

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Recent progress in multidisciplinary treatment for patients with esophageal cancer

Surgery Today ◽

10.1007/s00595-019-01878-7 ◽

2019 ◽

Vol 50 (1) ◽

pp. 12-20 ◽

Cited By ~ 7

Author(s):

Masayuki Watanabe ◽

Reiko Otake ◽

Ryotaro Kozuki ◽

Tasuku Toihata ◽

Keita Takahashi ◽

...

Keyword(s):

Esophageal Cancer ◽

Checkpoint Inhibitors ◽

Minimally Invasive Esophagectomy ◽

Clinical Stage ◽

Multidisciplinary Treatment ◽

Locally Advanced ◽

Early Esophageal Cancer ◽

Long Term Outcome ◽

Invasive Esophagectomy ◽

Less Invasive

Abstract Esophageal cancer is one of the most aggressive gastrointestinal cancers. This review focuses on eight topics within the multidisciplinary approach for esophageal cancer. As esophagectomy is highly invasive and likely to impair quality of life, the development of less invasive strategies is expected. Endoscopic resection (ER) of early esophageal cancer is a less invasive treatment for early esophageal cancer. A recent phase II trial revealed that combined ER and chemoradiotherapy (CRT) is efficacious as an esophagus-preserving treatment for cT1bN0 squamous cell carcinoma (SCC). Esophagectomy and definitive CRT are equally effective for patients with clinical stage I SCC in terms of long-term outcome. For locally advanced resectable cancers, multidisciplinary treatment strategies have been established through several clinical trials of neoadjuvant or perioperative treatment. Minimally invasive esophagectomy may improve the outcomes of patients and CRT is a curative-intent alternative to esophagectomy. CRT with 50.4 Gy radiotherapy combined with salvage surgery is a promising option to preserve the esophagus. Induction chemotherapy followed by esophagectomy may improve the outcomes of patients with locally advanced unresectable tumors. Immune checkpoint inhibitors are effective for esophageal cancer, and their introduction to clinical practice is awaited.

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A multidisciplinary treatment approach using docetaxel, nedaplatin, and 5-FU for advanced esophageal cancer

Annals of Oncology ◽

10.1093/annonc/mdx621.008 ◽

2017 ◽

Vol 28 ◽

pp. ix97-ix98

Author(s):

Hiroyuki Ohnuma ◽

Masahiro Hirakawa ◽

Shohei Kikuchi ◽

Yasushi Sato ◽

Koichi Takada ◽

...

Keyword(s):

Esophageal Cancer ◽

Treatment Approach ◽

Multidisciplinary Treatment ◽

Advanced Esophageal Cancer

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Prognostic significance of the endoluminal ultrasound defined lymph node metastasis count in esophageal cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.4558 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 4558-4558

Author(s):

C. Twine ◽

C. Rawlinson ◽

X. Escofet ◽

G. Blackshaw ◽

T. Crosby ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Node Metastases ◽

Multidisciplinary Treatment ◽

Prognostic Significance ◽

Endoluminal Ultrasound ◽

Node Metastasis ◽

Tumour Length ◽

Node Metastases

4558 Background: TNM histopathological staging system for esophageal cancer is controversial, and will soon be revised to account for the relative burden of the number of lymph node metastases. The aim of this study was to assess the prognostic significance of endoluminal ultrasound (EUS) defined lymph node metastasis count (eLNMC) in patients with esophageal cancer. Methods: Two hundred and sixty-seven consecutive patients (median age 63 yr, 187 m) underwent EUS followed by stage directed multidisciplinary treatment [183 esophagectomy (92 neoadjuvant chemotherapy), 79 definitive chemoradiotherapy, and 5 palliative therapy]. The eLMNC was subdivided into four groups (0, 1, 2 to 4, >4) and the primary measure of outcome was survival. Results: Survival was related to EUS T stage (p<0.0001), EUS N stage (p<0.0001), EUS tumour length (p<0.0001), and the eLNMC (p<0.0001). Multivariable analysis revealed EUS tumour length (HR 1.071, 95% CI 1.008 to 1.138, p=0.027) and eLNMC (HR 1.302, 95% CI 1.133 to 1.496, p<0.0001) to be significantly and independently associated with survival. Median and 2 year survival for patients with 0, 1, 2 to 4, and >4 lymph node metastases were: 44 months and 71%; 36 months and 59%; 24 months and 50%; and 17 months and 32% respectively. Conclusions: The eLNMC was an important and significant prognostic indicator in patients with esophageal cancer, which should in future be reported and used to revise the perceived radiological stage, in order to inform stage directed multimodal therapy. No significant financial relationships to disclose.

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