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.

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 Significance of Tumor Length as Prognostic Factor for Esophageal Cancer

2013 ◽  
Vol 98 (3) ◽  
pp. 234-240 ◽  
Author(s):  
Arife Zeybek ◽  
Abdullah Erdoğan ◽  
Kemal Hakan Gülkesen ◽  
Makbule Ergin ◽  
Alpay Sarper ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Specific Treatment ◽  
Disease Free Survival ◽  
Curative Surgery ◽  
Thoracic Esophageal Cancer ◽  
Clinicopathologic Characteristics ◽  
Term Survival ◽  
Tumor Length ◽  
Significant Difference

Abstract Our study indicated the relationship between tumor length and clinicopathologic characteristics as well as long-term survival in esophageal cancer. A total of 116 patients who underwent curative surgery for thoracic esophageal cancer with standard lymphadenectomy in 2 fields between 2000 and 2010 were included in the study. The medical records of these patients were retrospectively reviewed. The patients with tumor length ≥3 cm had a highly significant difference in the involvement of adventitia and lymph node stations. The patients with tumor length ≤3 cm had significantly lower rates of involvement of the adventitia and lymph node stations. Tumor length could have a significant impact on both the overall survival and disease-free survival of patients with resected esophageal carcinomas and may provide additional prognostic value to the current tumor, node, and metastasis staging system before patients receive any cancer-specific treatment.

RA07.05: DIAGNOSTIC VALUE OF INTRAOPERATIVE ULTRASONOGRAPHY IN ASSESSING THORACIC RECURRENT LARYNGEAL NERVE LYMPH NODES IN PATIENTS WITH ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 35-35
Author(s):  
Hong Yang
Keyword(s):  
Esophageal Cancer ◽  
Recurrent Laryngeal Nerve ◽  
Predictive Value ◽  
Conflicts Of Interest ◽  
Nodal Metastasis ◽  
Laryngeal Nerve ◽  
Intraoperative Ultrasonography ◽  
Nodal Metastases ◽  
Thoracic Esophageal Cancer ◽  
Significant Difference

Abstract Background To evaluate the ability of intraoperative ultrasonography (IU) to detect recurrent laryngeal nerve (RLN) nodal metastases in esophageal cancer patients. Methods Sixty patients with esophageal cancer underwent IU, computed tomography (CT), and endoscopic ultrasonography (EUS) to assess for RLN nodal metastasis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were compared. Results The sensitivities of IU, CT, and EUS in diagnosing right RLN nodal metastases were 71.4%, 14.3%, and 30.0%, respectively, and a significant difference among these three examinations was observed (c2 = 10.077, P = .006). The specificities of IU, CT, and EUS for diagnosing right RLN nodal metastasis were 67.4%, 97.8%, and 95.0%, respectively, and a significant difference was observed (c2 = 21.725, P < .001). No significant differences in either PPV or NPV were observed when diagnosing right RLN nodal metastases. For diagnosis of left RLN lymph nodal metastases, the sensitivities of IU, CT, and EUS were 91.7%, 16.7%, and 40.0% respectively. There was a significant difference among these diagnostic sensitivities (c2 = 14.067, P = .001). The specificities of IU, CT, and EUS for diagnosis of left RLN nodal metastases were 79.2%, 100%, and 82.5%, respectively and a significant difference was observed (c2 = 10.819, P = .004). No significant differences were observed in PPV or NPV for these examinations when diagnosing left RLN nodal metastases. Conclusion Intraoperative ultrasonography showed superior sensitivity compared with preoperative CT or EUS in detecting RLN lymph node metastasis in patients with thoracic esophageal cancer. Disclosure All authors have declared no conflicts of interest.

Preventive effect of rikkunshito, traditional Japanese medicine, for chemotherapy-induced nausea and vomiting.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 131-131
Author(s):  
Shinya Kajiura ◽  
Ayumu Hosokawa ◽  
Sohachi Nanjyo ◽  
Hiroki Yoshita ◽  
Nobuhiro Suzuki ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Complete Response ◽  
Nausea And Vomiting ◽  
High Dose ◽  
Preventive Effect ◽  
Major Toxicity ◽  
Traditional Japanese Medicine ◽  
Significant Difference ◽  
Anti Cancer ◽  
Cancer Anorexia

131 Background: Supportive therapies are being developed for chemotherapy-induced nausea and vomiting (CINV). Rikkunshito is a Kanpo medicine, which is a part of traditionally practiced Japanese-based ancient Chinese medicine. It has been reported to be effective against cisplatin-induced anorexia in rats. In the present study, we evaluated the preventive effect of Rikkunshito for CINV in patients receiving high-dose cisplatin. Methods: We selected subjects who received chemotherapy including cisplatin (≥60mg/m2) for gastric or esophageal cancer between April 2010 and August 2012 at our institution. We targeted 20 cases treated without a reduction in the anti-cancer medication in the second course and added 7.5g/day of Rikkunshito, orally administered for seven days, to their second course treatment regimen. All cases were treated with 5-HT3 receptor antagonist and steroid, and palonosetron for the prevention of CINV in their first and second courses. We evaluated the complete response (CR, defined as no emesis and no rescue medication) rate and other toxicity, according to CTCAE v4.0, of the first and second courses. Results: The median age of the patients was 63 years (range, 49–77 years). The chemotherapy regimens were cisplatin + 5-FU in 15 cases with esophageal cancer, cisplatin + S-1 in five cases with gastric cancer. Anorexia in the first course was grade 0/1/2 = 5/11/4, but had been mitigated in the second course to grade 0/1/2 = 12/6/2 (P = 0.042). CR rate was 75.0% in the first course (95% CI, 56.0%–94.0%) and by the second course had improved to 95.0% (95% CI, 85.4%–100%). And about the other major toxicity, there was no significant difference between first and second courses. Conclusions: These results suggest that Rikkunshito has the potential to improve CINV in patients receiving high-dose cisplatin.

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]

scholarly journals Clinical Outcomes of Radiotherapy in Elderly and Younger Patients with T4 Esophageal Cancer: A Retrospective Single-Center Analysis

2021 ◽  
Author(s):  
Yosuke Takakusagi ◽  
Kio Kano ◽  
Satoshi Shima ◽  
Keisuke Tsuchida ◽  
Nobutaka Mizoguchi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Clinical Outcomes ◽  
Complete Response ◽  
The Elderly ◽  
Elderly Group ◽  
Cancer Center ◽  
Esophageal Fistula ◽  
Younger Patients ◽  
Significant Difference ◽  
T4 Esophageal Cancer

Abstract Background/AimThe standard of treatment for esophageal cancer with adjacent organ invasion (T4) has not been established. Radiotherapy (RT) is a treatment option, but its efficacy and safety in elderly patients remains unclear. We retrospectively analyzed the clinical outcomes of RT in elderly and younger patients with T4 esophageal cancer.Materials and MethodsSixty-nine patients with T4 esophageal cancer who underwent RT at the Kanagawa Cancer Center between January 2014 and November 2020 were included in this study. Patients aged ≥70 years were defined as the elderly group and those aged <70 years were defined as the younger group.The total dose of RT was set at 60 Gy in 30 fractions. Chemotherapy combined with 5-fluorouracil and cisplatin was administered concurrently with RT. The overall survival (OS) rate was estimated using the Kaplan–Meier method. Adverse events were assessed using the CTCAE v4.0. Clinical outcomes were compared between the elderly and younger groups.ResultsThe median survival time (MST) of the elderly group was 21.5 months, and the OS rates at 1, 3, and 5 years were 63.7%, 31.3%, and 15.6%, respectively. The MST of the younger group was 12.5 months, and the OS rates at 1, 3, and 5 years were 52.2%, 29.4%, and 29.4%, respectively. A significant difference in OS was not observed between the two groups (p = 0.767). Themultivariate analysis revealed thatthe complete response (CR) of the primary tumor and adjuvant chemotherapy (ACTx) were significant predictors of OS (p< 0.001 and<0.001, respectively). Regarding toxicity, the frequency of thrombocytopenia was significantly higher in the elderly group, whereas the frequency of esophageal fistula was significantly higher in the younger group (p = 0.012 and 0.022, respectively). Other toxicities were not significantly different between the two groups.ConclusionsOS was not significantly different between the elderly and younger groups. ACTx and CR were predictors of OS. The frequency of thrombocytopenia was higher in the elderly group and that of esophageal fistula was higher in the younger group. However, other toxicities were not significantly differentbetween the two groups.

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.

PS02.246: SURGICAL OUTCOMES OF SURGICAL T4B THORACIC ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 192-192
Author(s):  
Norihisa Uemura ◽  
Tetsuya Abe ◽  
Eiji Higaki ◽  
Takahiro Hosoi ◽  
Byonggu An
Keyword(s):  
Esophageal Cancer ◽  
Prognostic Factor ◽  
Surgical Outcomes ◽  
Curative Resection ◽  
Conflicts Of Interest ◽  
Post Treatment ◽  
R0 Resection ◽  
Preoperative Treatment ◽  
Thoracic Esophageal Cancer ◽  
Significant Difference

Abstract Background Patients with surgical T4b (sT4b) thoracic esophageal cancer undergo exploratory thoracotomy or non-curative resection. However, in some cases, it is difficult to decide whether to perform exploratory thoracotomy without resection, or perform non-curative resection to the extent possible. The purpose of this retrospective study was to analyze surgical outcomes of sT4b thoracic esophageal cancer to clarify the optimal treatment strategy. Methods A total of 12 patients with sT4b thoracic esophageal cancer underwent exploratory thoracotomy (n = 7) or non-curative resection (n = 5) between January 2011 and December 2015. Of the seven patients who underwent exploratory thoracotomy, two underwent bypass surgery. In the five patients who underwent non-curative resection, gastric reconstruction was performed. Clinical data from these 12 patients were analyzed retrospectively. Results Compared to the seven patients who underwent exploratory thoracotomy (Ex group), the five patients who underwent non-curative resection (NC group) had a significantly longer period until the start of post-treatment (median, 23/57 (Ex/NC) days; P = 0.0027). No significant difference was observed in the postoperative survival period between the two groups (Median survival time (MST), 9/12 (Ex/NC) months; P = 0.55). In the prognostic factor analysis, patients with progressive disease (PD) responsiveness to preoperative treatment had a significantly poorer prognosis (MST, 13.5/5.5 (partial response-stable disease/PD) months; P = 0.01). On the other hand, patients with cStage 3 disease and who received postoperative chemoradiotherapy had a relatively good prognosis (cStage 3/4; MST 12.5/5.5 month, P = 0.09, postoperative chemoradiotherapy received/not received; MST 13/5 month, P = 0.11). The period until the start of post-treatment was not a prognostic factor. Conclusion Responsiveness to preoperative treatment was found to be a prognostic factor in patients with sT4b thoracic esophageal cancer. Thus, if patients show a poor response to preoperative treatment, R0 resection should be performed without exploratory thoracotomy. On the contrary, for patients with a good response to preoperative treatment, administration of post-operative chemoradiotherapy should be considered, while maintaining performance status without causing serious secondary injury. Disclosure All authors have declared no conflicts of interest.

Esophagectomy versus definitive chemoradiotherapy as initial treatment for clinical stage I esophageal cancer: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Li-Xiang Mei ◽  
Jun-Xian Mo ◽  
Yong Chen ◽  
Lei Dai ◽  
Yong-Yong Wang ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Initial Treatment ◽  
Tumor Recurrence ◽  
Clinical Stage ◽  
Stage I ◽  
Current Evidence ◽  
Cochrane Library ◽  
Definitive Chemoradiotherapy ◽  
Randomized Controlled ◽  
Significant Difference

Abstract Background Esophagectomy and definitive chemoradiotherapy are commonly used in the treatment of stage I esophageal cancer (EC). The present study aims to compare the efficacy and safety of esophagectomy and definitive chemoradiotherapy as the initial treatment for clinical stage I EC. Methods This study was registered with the International Prospective Register of Systematic Reviews (CRD42020197203). Relevant studies were identified through PubMed, Web of Science, EMBASE, and Cochrane Library from database inception to June 30, 2020. Hazard ratio (HR) with 95% confidence intervals (CI) was employed to compare overall survival (OS) and progression-free survival (PFS). Odds ratio (OR) with 95% CI was employed to compare treatment-related death, complications, and tumor recurrence. Results A total of 13 non-randomized controlled studies involving 3,346 patients were included. Compared with definitive chemoradiotherapy, esophagectomy showed an improved OS (HR 0.69, 95% CI 0.55–0.86; P &lt; 0.001), PFS (HR 0.47, 95% CI 0.33–0.67; P &lt; 0.001), and a lower risk of tumor recurrence (OR 0.43, 95% CI 0.30–0.61; P &lt; 0.001). There was no significant difference in the incidence of complications (OR 1.11, 95% CI 0.75–1.65; P = 0.60) and treatment-related death (OR 1.15, 95% CI 0.31–4.30; P = 0.84) between the two treatments. Conclusions Current evidence shows esophagectomy has superior survival benefits as the initial treatment for clinical stage I EC. It is still the preferred choice for patients with clinical stage I EC. However, future high-quality randomized controlled trials are needed to validate this conclusion.

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