Esophageal bypass in two patients with a complete response after definitive chemoradiotherapy for thoracic esophageal cancer

Esophagus ◽  
2014 ◽  
Vol 12 (3) ◽  
pp. 316-321
Author(s):  
Yukihiro Watanabe ◽  
Hiroshi Sato ◽  
Kenichiro Takase ◽  
Hiroki Takeshita ◽  
Shinichi Sakuramoto ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Complete Response ◽  
Definitive Chemoradiotherapy ◽  
Thoracic Esophageal Cancer

scholarly journals Comparison of the effects of radiotherapy doses of 50.4 Gy and 60 Gy on outcomes of chemoradiotherapy for thoracic esophageal cancer: subgroup analysis based on the Comprehensive Registry of Esophageal Cancer in Japan from 2009 to 2011 by the Japan Esophageal Society

Esophagus ◽  
2020 ◽  
Vol 17 (2) ◽  
pp. 122-126 ◽  
Author(s):  
Kenji Nemoto ◽  
Shohei Kawashiro ◽  
Yasushi Toh ◽  
Hodaka Numasaki ◽  
Yuji Tachimori ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Complete Response ◽  
Large Database ◽  
Definitive Chemoradiotherapy ◽  
Thoracic Esophageal Cancer ◽  
Significant Difference ◽  
Japan Esophageal Society ◽  
Using Data ◽  
First Time ◽  
Comprehensive Registry

Abstract Background In definitive chemoradiotherapy (CRTx) for esophageal cancer, a radiotherapy (RT) dose of 50.4 Gy in 28 fractions has been the standard in many countries, while 60 Gy in 30 fractions has been frequently used in Japan. To clarify the optimal RT dose in CRTx for esophageal cancer, we compared clinical outcomes with the two doses using data from the Comprehensive Registry of Esophageal Cancer in Japan by the Japan Esophageal Society (JES). Methods Of the patients enrolled in the registry for 2015–2017 surveys (patients treated between 2009 and 2011), 996 patients who received definitive CRTx with 50.4 Gy or 60 Gy for thoracic esophageal cancer were eligible for analysis. Results The complete response (CR) rates in the 50.4 Gy and 60 Gy groups were 49.1% and 46.4%, respectively (p = 0.5851). The 5-year overall survival (OS) rates in the 50.4 Gy group and 60 Gy group for stages I, II/III and IV were 64.2% and 57.2%, 35.0% and 27.0%, and 18.0% and 15.3%, respectively. Since no significant difference was found between the two groups, the 50.4 Gy group was not inferior to the 60 Gy group with regard to OS. Conclusions The analysis revealed that the 50.4 Gy group had a non-inferior outcome in comparison with the 60 Gy group for stages I, II/III and IV thoracic esophageal cancer. These results were obtained from a large database for the first time in Japan.

Influence of radiation field on safety and efficacy for stage II/III esophageal cancer treated with definitive chemoradiotherapy: An exploratory analysis of JCOG0909.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 104-104
Author(s):  
Azusa Komori ◽  
Shuichi Hironaka ◽  
Ryunosuke Machida ◽  
Yoshinori Ito ◽  
Hiroya Takeuchi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Nodes ◽  
Regional Lymph Node ◽  
Progression Free Survival ◽  
Complete Response ◽  
Tumor Location ◽  
Efficacy And Safety ◽  
Definitive Chemoradiotherapy ◽  
Safety And Efficacy ◽  
Upper Thoracic

104 Background: JCOG0909, a single-arm confirmatory trial of definitive chemoradiotherapy (dCRT) including salvage treatment, demonstrated promising efficacy and safety for cStage II/III (UICC-TNM 6th) esophageal cancer (EC) (Ito Y, ASCO 2018). Radiation (RT) fields included the elective regional lymph node during initial 41.4 Gy, such as bilateral supraclavicular fossae and superior mediastinal lymph nodes for upper thoracic (Ut), and mediastinal and perigastric lymph nodes for middle thoracic (Mt)/lower thoracic (Lt) EC. It is unclear whether the safety and efficacy are associated with the tumor location in patients with cStage II/III EC treated with dCRT. Methods: Patients who were enrolled in JCOG0909 and underwent dCRT were analyzed. Patients were categorized into three groups according to primary tumor location (Ut/Mt/Lt). We compared adverse events during dCRT, complete response (CR) rate, progression-free survival (PFS) and overall survival (OS) among groups. Results: Ninety-four patients (Ut/Mt/Lt: 16/59/19) were analyzed. The proportions of cStage IIA/IIB/III were 31%/44%/25% in Ut group, 20%/42%/37% in Mt group, and 21%/32%/47% in Lt group, respectively. The summary of safety and efficacy was listed in Table 1. Grade 3-4 leukopenia, neutropenia and thrombocytopenia were more frequently observed in Mt and Lt groups than in Ut group. CR rate was 63% in Ut, 63% in Mt, and 42% in Lt, respectively. 3-year PFS in Ut/Mt/Lt was 60%/59%/47% and 3-year OS was 73%/78%/58%, respectively. Conclusions: The RT field by the tumor location might be associated with efficacy and safety of dCRT for cStage II/III esophageal cancer. [Table: see text]

PS02.039: SERUM CRP LEVEL IS A PROGNOSTIC FACTOR OF ESOPHAGEAL CANCER TREATED WITH DEFINITIVE CHEMORADIOTHERAPY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 131-131
Author(s):  
Daisuke Ishioka ◽  
Masaaki Saito ◽  
Jun Takahashi ◽  
Tamotsu Obitsu ◽  
Hirokazu Kiyozaki ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Conflicts Of Interest ◽  
Standard Dose ◽  
Clinical Stage ◽  
Univariate Analysis ◽  
Complete Response ◽  
Advanced Esophageal Cancer ◽  
Definitive Chemoradiotherapy ◽  
History Of ◽  
Serum Crp

Abstract Background In advanced esophageal cancer, definitive combined chemoradiotherapy (d-CRT) is considered to be one of standard therapy in Japan. However, there have been few studies of the correlation of clinical factors and response to chemoradiotherapy. The aim of this study is to clarify the correlation of serum CRP level and response to definitive chemoradiotherapy for advanced esophageal cancer. Methods A total of 78 patients with clinical stage II/III esophageal cancer who were treated with d-CRT at our institute from 2002 to 2014 were retrospectively reviewed. 57 patients received chemotherapy using low-dose 5-FU and cisplatin, and remaining 19 patients received chemotherapy using standard-dose 5-FU and cisplatin according to the protocol described in the RTOG trial combined with radiation therapy. The patients were stratified by response to chemoradiotherapy by two groups. 60 patients (54 patients had a complete response and 6 had a partial response) were in Responder group, and 18 patients (7 patients had a stable disease and 11 had a progressive disease) were in Non- responder group. The correlation of survival rate and serum CRP level before d-CRT was evaluated. Results At the time of analysis, the median follow-up period was 32 months (range 3–124 months). The overall survival of the Responder group was significantly better than that of Non- responder group (P < 0.001). Univariate analysis showed that white blood cell > 8000/m3 (P = 0.036), CRP > 1.0mg/dl (P = 0.002), adventitia invasion (P = 0.04) and history of the smoking (P = 0.037) were predictive for response of d-CRT. Multivariate analyses identified serum CRP level (P = 0.002) as independent prognostic factors for response of d-CRT. Conclusion Our findings suggest that serum CRP level may be a useful marker to predict a response to definitive chemoradiotherapy. However, further examinations in the future will be necessary to determine its efficacy. Disclosure All authors have declared no conflicts of interest.

scholarly journals Definitive Chemoradiotherapy and Salvage Esophagectomy for Esophageal Cancer Associated With Multiple Lung Metastases: A Case Report

2014 ◽  
Vol 99 (5) ◽  
pp. 640-644
Author(s):  
Yoshihiko Fujinaka ◽  
Masaru Morita ◽  
Takefumi Ohga ◽  
Yoshihiro Kakeji ◽  
Tokujiro Yano ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Case Report ◽  
Distant Metastasis ◽  
Multimodal Therapy ◽  
Lung Metastases ◽  
Salvage Surgery ◽  
Complete Response ◽  
Definitive Chemoradiotherapy ◽  
Node Metastases ◽  
Salvage Esophagectomy

Abstract The prognosis of esophageal cancer with distant metastasis is dismal. We report a 70-year-old man with esophageal cancer and multiple lung and lymph node metastases. Complete response was achieved following definitive chemoradiotherapy. Twenty-four months after the initial chemoradiotherapy, local recurrence was detected but there was no evidence of distant metastasis. Therefore, the patient underwent salvage esophagectomy. The surgery was well tolerated without any postoperative complications. The patient is still alive 48 months after the salvage surgery. Our experience suggests that salvage esophagectomy is an important component of multimodal therapy for the recurrence of esophageal cancer.

Salvage esophagectomy after definitive chemoradiotherapy for thoracic esophageal cancer

2009 ◽  
Vol 100 (6) ◽  
pp. 442-446 ◽  
Author(s):  
Hiroshi Miyata ◽  
Makoto Yamasaki ◽  
Shuji Takiguchi ◽  
Kiyokazu Nakajima ◽  
Yoshiyuki Fujiwara ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Definitive Chemoradiotherapy ◽  
Thoracic Esophageal Cancer ◽  
Salvage Esophagectomy

scholarly journals 18F-FAMT-PET Is Useful for Judging Clinical Complete Response in Advanced Esophageal Cancer Patients Who Have Received Definitive Chemoradiotherapy

2019 ◽  
Vol 103 (11-12) ◽  
pp. 561-566
Author(s):  
Makoto Sohda ◽  
Hiroaki Honjyo ◽  
Keigo Hara ◽  
Daigo Ozawa ◽  
Shigemasa Suzuki ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Fdg Pet ◽  
Complete Response ◽  
Mediastinal Lymphadenopathy ◽  
Definitive Chemoradiotherapy ◽  
Primary Tumors ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Node Metastases

We developed l-[3-18F]-α-methyltyrosine (18F-FAMT) as an amino acid tracer for positron emission tomography (PET) imaging. In esophageal cancer, the specificity of 18F-FAMT PET was significantly higher than that of fluoro-2-deoxy-d-glucose (18F-FDG) PET and computed tomography (CT) in the evaluation of individual lymph node groups. Definitive chemoradiotherapy (CRT) has been considered a potentially curative treatment for locoregional esophageal cancer and may achieve the same survival benefits as surgical resection. Clinical evaluation of complete response (CR) is important using several modalities. We evaluated 6 patients who had been diagnosed with clinical CR by FAMT-PET following definitive CRT for esophageal squamous cell carcinoma between June 2008 and July 2012. Treatment evaluation of 18F-FAMT was performed following CRT and approximately 1 month later. In primary tumors, 66.7% of patients (4/6) showed FDG uptake following CRT, whereas that of FAMT was 33.3% (2/6). In lymph node metastases, 50% of patients (3/6) showed FDG uptake following CRT, whereas that of FAMT was 0% (0/6). In the present study, FAMT-PET following CRT was a useful modality to predict clinical CR in esophageal cancer. There is a limit to judging clinical CR by CT or FDG-PET following CRT, because radiation-related esophagitis and reactive mediastinal lymphadenopathy by FDG and wall thickness by CT still remain 1 month following CRT. FAMT-PET is the most useful modality at the present time.

Low expression of bax predicts poor prognosis in patients with locally advanced esophageal cancer treated with definitive chemoradiotherapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 4597-4597
Author(s):  
S. Kang ◽  
J. Han ◽  
K. Lee ◽  
J. Choi ◽  
J. Park ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Locally Advanced ◽  
Complete Response ◽  
High Expression ◽  
Advanced Esophageal Cancer ◽  
Definitive Chemoradiotherapy ◽  
Clinical Complete Response ◽  
Galectin 3 ◽  
Low Expression ◽  
Locally Advanced Esophageal Cancer

4597 Background: The present study evaluated the prognostic significance of apoptosis-related proteins, p53, bcl-2, bax, and galectin-3 in patients with locally advanced esophageal cancer treated with definitive chemoradiotherapy (CRT). Methods: Sixty-three patients with locally advanced esophageal cancer (stage II-IV) were treated with definitive CRT using 5-fluorouracil and cisplatin combined with radiotherapy. Pretreatment tumor biopsy specimens were analyzed for p53, bcl-2, bax, and galectin-3 expression by immunohistochemistry. Results: High expression of bax, p53, bcl-2, and galectin-3 was observed in 67%, 47%, 24%, and 29% of patients, respectively. The median overall survival (OS) of total patients was 14 months with 16% of 3-year OS. High expression of p53, bcl- 2, and galectin-3 did not demonstrate correlation with clinicopathologic characteristics, including patient outcome. Low expression of bax was significantly correlated with clinical complete response (p=0.023). Low expression of bax was also associated with poor OS (median, 8 months vs. 16 months; P=0.0008) in univariate analysis. In multivariate analysis, low expression of bax was the most significant independent predictor of poor OS (p=0.01) followed by clinical complete response and low radiation dose. Conclusions: Low expression of bax was significantly associated with the poor survival of patients with locally advanced esophageal cancer treated with CRT using 5-fluorouracil and cisplatin. Immunohistochemical staining for bax with a pretreatment biopsy specimen might be useful to select the optimal treatment options for these patients. No significant financial relationships to disclose.

scholarly journals Definitive chemoradiotherapy for squamous cell carcinoma of the esophagus: outcomes for borderline-resectable disease

2020 ◽  
Vol 61 (3) ◽  
pp. 464-469
Author(s):  
Satoshi Ishikura ◽  
Takuhito Kondo ◽  
Taro Murai ◽  
Yoshiyuki Ozawa ◽  
Takeshi Yanagi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Low Dose ◽  
Standard Treatment ◽  
Complete Response ◽  
Definitive Chemoradiotherapy ◽  
Borderline Resectable ◽  
Carcinoma Of The Esophagus ◽  
Resectable Disease ◽  
Grade 3

Abstract Definitive chemoradiotherapy (dCRT) is the standard treatment for unresectable esophageal cancer. Induction chemotherapy has been actively investigated for borderline-resectable and unresectable disease, but the superiority over dCRT has yet to be confirmed. The purpose of this study was to evaluate the outcome of dCRT with special interest in borderline-resectable disease. Patients with esophageal cancer treated with dCRT between January 2004 and November 2016 were included in this retrospective analysis. Chemotherapy consisted of two cycles of cisplatin (70–75 mg/m2) on day 1 and 5-fluorouracil (700–1000 mg/m2 per day) on days 1–4 or low-dose cisplatin (10 mg/m2 per day) and 5-fluorouracil (175 mg/m2 per day) for 20 days. Radiotherapy was given with a daily fraction of 1.8–2 Gy to a total dose of 50–70 Gy. A total of 104 patients were included: 34 were resectable, 35 were borderline-resectable and 35 were unresectable. Complete response was achieved in 44 patients (42%). Eighteen patients (17%) suffered Grade 2 or greater cardiopulmonary toxicity and seven patients (7%) suffered Grade 3 cardiopulmonary toxicity. At the time of this analysis, 59 patients were dead and 45 were censored. The 3-year overall survival proportions for resectable, borderline-resectable and unresectable patients were 64%, 46% and 21%, respectively. The overall survival for borderline-resectable patients with complete response and noncomplete response was significantly different (P &lt; 0.001), with 3-year survival of 70% and 8%, respectively. The overall survival for complete response patients with borderline-resectable disease was encouraging. Further investigation to find a subgroup fit for esophagus-preserving treatment is warranted.

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