Stenting for Advanced Esophageal Carcinoma

AbstractEsophageal cancer is the eighth most common malignancy and the sixth leading cause of cancer-related deaths worldwide. Most patients with esophageal cancer are identified at an advanced stage of disease. Less than 20% of patients are candidates for curable surgical resection. Self-expandable metallic stents (SEMSs) have recently been used for the palliation of incurable esophageal cancer. Since their use was first reported in the late 1970s, stents have evolved rapidly from rigid plastic tubes to flexible SEMSs. This review covers various aspects of SEMS placement for advanced esophageal cancer and discusses multiple types of SEMSs, considerations in stent placement, complications, and recently developed radiation-emitting stents.

Download Full-text

Leptomeningeal Carcinomatosis Secondary to Esophageal Cancer Diagnosed on Cytology

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0040-1713576 ◽

2020 ◽

Vol 11 (03) ◽

pp. 495-497

Author(s):

Sunil Vitthalrao Jagtap ◽

Shoaib Khoja ◽

Shubham S. Jagtap ◽

Rashmi Gudur ◽

Hemant Janugade

Keyword(s):

Esophageal Cancer ◽

Cerebrospinal Fluid ◽

Lymph Nodes ◽

Esophageal Carcinoma ◽

Male Patient ◽

Leptomeningeal Carcinomatosis ◽

Advanced Stage ◽

Radiological Imaging ◽

Csf Cytology ◽

Common Malignancy

AbstractEsophageal carcinoma is considered a common malignancy across the globe. These patients usually present with an advanced stage of the disease at the time of diagnosis. Herein, we report a 55-year male patient who presented with leptomeningeal carcinomatosis, detected on cerebrospinal fluid (CSF) cytology in a case of adenocarcinoma lower third esophagus. On radiological imaging, he also had extensive metastatic deposits in the liver, pleura, and regional and paravertebral lymph nodes.

Download Full-text

Assesment of placement of the esophageal self-expandable metallic stent in esophageal cancer in patients with or without citorreduction therapy

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202007000300007 ◽

2007 ◽

Vol 20 (3) ◽

pp. 154-160

Author(s):

Gilson Kamiyama ◽

Paulo Sakai ◽

Eduardo Guimarães H. de Moura ◽

Shinichi Ishioka ◽

Ivan Cecconello ◽

...

Keyword(s):

Esophageal Cancer ◽

Survival Time ◽

Stent Placement ◽

Gastrointestinal Endoscopy ◽

Thoracic Esophagus ◽

Metallic Stent ◽

Advanced Esophageal Cancer ◽

Expandable Metallic Stent ◽

Stent Treatment ◽

Time Average

BACKGROUND: Placement of self-expanding metallic esophageal stent in patients with advanced esophageal cancer offers excellent palliation of dysphagia and tracheo-esophageal fistulas. However, the safety of stent in patients undergoing radio and/or chemotherapy is controversial, in terms of the greater risk of complications in cases where these two treatments are used in conjunction. AIM: To assess the use of stent in patients with advanced cancer of the mid-thoracic esophagus, by comparing patients undergoing cytoreductive therapy with patients who have not undergone this treatment, in relation to improvement in the dysphagia, rate of complications, period of effectiveness and survival time. METHODS: Fifty seven patients were evaluated retrospectively (16 women and 41 men, with an average age 62 years) with advanced squamous cell carcinoma of the mid-thoracic esophagus who underwent placement of the Ultraflex™ self-expandable metallic coated stent, at the Gastrointestinal Endoscopy Unit of São Paulo University Medical School between October 1988 and October 2004. Out of the 57 patients, 24 patients received adjuvant cytoreductive therapy, and 33 patients were only treated with the stent placement. RESULTS: After stent placement, there was improvement in dysphagia in both groups; there were no differences in the rate of complications, such as migration, pain, fistula, obstruction and compression of the airways; the period of effectiveness was significantly higher in the group submitted to cytoreductive therapy (average 123 days compared to 63 days), as was the survival time (average of 210 days, compared with 120 days). CONCLUSIONS: Improvement in dysphagia was statistically significant in both groups, irrespective of whether the patient had undergone adjuvant cytoreductive therapy; there were no differences in the rate of complications between the two groups and both the period of effectiveness of the stent treatment and the survival time were higher in the group with adjuvant cytoreductive therapy.

Download Full-text

Gallbladder cancer revisited: the evolving role of a radiologist

British Journal of Radiology ◽

10.1259/bjr.20200726 ◽

2021 ◽

Vol 94 (1117) ◽

pp. 20200726

Author(s):

Anupama Ramachandran ◽

Deep Narayan Srivastava ◽

Kumble Seetharama Madhusudhan

Keyword(s):

Gallbladder Cancer ◽

Surgical Resection ◽

Median Survival ◽

Multidisciplinary Approach ◽

Early Stage ◽

Survival Duration ◽

Advanced Stage ◽

Complete Surgical Resection ◽

Common Malignancy

Gallbladder cancer is the most common malignancy of the biliary tract. It is also the most aggressive biliary tumor with the shortest median survival duration. Complete surgical resection, the only potentially curative treatment, can be accomplished only in those patients who are diagnosed at an early stage of the disease. Majority (90%) of the patients present at an advanced stage and the management involves a multidisciplinary approach. The role of imaging in gallbladder cancer cannot be overemphasized. Imaging is crucial not only in detecting, staging, and planning management but also in guiding radiological interventions. This article discusses the role of a radiologist in the diagnosis and management of gallbladder cancer.

Download Full-text

Concurrent chemoradiotherapy with protracted infusion of 5-fluorouracil (5 FU) and cisplatin for locally advanced resectable esophageal cancer: A retrospective study.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.119 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 119-119

Author(s):

Khaldoun Almhanna ◽

Sarah Hoffe ◽

Ravi Shridhar ◽

Jonathan R. Strosberg ◽

William R. Dinwoodie ◽

...

Keyword(s):

Esophageal Cancer ◽

Surgical Resection ◽

Locally Advanced ◽

Complete Response ◽

R0 Resection ◽

Severe Toxicity ◽

Advanced Esophageal Cancer ◽

Resectable Esophageal ◽

Grade 3 ◽

Locally Advanced Esophageal Cancer

119 Background: Neoadjuvant CCRT has become the standard treatment for esophageal cancer. Most clinicians use a conventional cisplatin/5 FU combination which is associated with moderate to severe toxicity. For the last 15 years we have used contiuous low-dose 5-FU combined with two doses of cisplatin. Methods: Between July 1997 and June 2012, 155 patients with locally advanced esophageal cancer (T3 or N1 and higher), received CCRT consistent of cisplatin 75 mg/m2 on day 1 and day 29 and continuous infusion of 5-FU (225 mg/m2/day) on the days of radiation. Results: Median age of patients was 63 year (30-76).Seventeen percent of pts were female and 85% had adenocarcinoma. (3, 34, 86 and 31 pts had stage I, II, III and IVa disease respectively. One hundred and twenty seven pts had N1 disease. Radiation dose (RT) ranged from 45-60 Gy (median 56Gy). Median weight loss was 6.5%. All patients completed treatment. 20% of patients had >=grade 3 toxicity, with 29 patients requiring hospital admission. 53% of patients had surgical resection between 37-149 days following CCRT (median 62 days). R0 resection was achieved in 96% of patients. A pathological complete response was achieved in 38 of 83 pts (45%) who underwent surgical resection. With a median follow up of 26 months (1.2 -144 months), 36% of pts recurred and total of 50% died. Conclusions: Compared to conventional chemotherapy regimen, our CCRT regimen for locally advanced esophageal cancer is well tolerated and associated with a high pathological response rate.

Download Full-text

Treatment of Locally Advanced Esophageal Carcinoma: ASCO Guideline

Journal of Clinical Oncology ◽

10.1200/jco.20.00866 ◽

2020 ◽

Vol 38 (23) ◽

pp. 2677-2694 ◽

Cited By ~ 1

Author(s):

Manish A. Shah ◽

Erin B. Kennedy ◽

Daniel V. Catenacci ◽

Dana C. Deighton ◽

Karyn A. Goodman ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Esophageal Cancer ◽

Esophageal Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Clinical Decision Making ◽

Locally Advanced ◽

Preoperative Chemoradiotherapy ◽

Advanced Esophageal Cancer ◽

Locally Advanced Esophageal Cancer

PURPOSE To develop an evidence-based clinical practice guideline to assist in clinical decision making for patients with locally advanced esophageal cancer. METHODS ASCO convened an Expert Panel to conduct a systematic review of the more recently published literature (1999-2019) on therapy options for patients with locally advanced esophageal cancer and provide recommended care options for this patient population. RESULTS Seventeen randomized controlled trials met the inclusion criteria. Where possible, data were extracted separately for squamous cell carcinoma and adenocarcinoma. RECOMMENDATIONS Multimodality therapy for patients with locally advanced esophageal carcinoma is recommended. For the subgroup of patients with adenocarcinoma, preoperative chemoradiotherapy or perioperative chemotherapy should be offered. For the subgroup of patients with squamous cell carcinoma, preoperative chemoradiotherapy or chemoradiotherapy without surgery should be offered. Additional subgroup considerations are provided to assist with implementation of these recommendations. Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines .

Download Full-text

PS02.251: TWO CASES OF THE ADVANCED ESOPHAGEAL CANCER WHICH WAS ABLE TO IMPROVE QOL BY VATS- E AS PALLIATIVE OPERATION

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.251 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 194-195

Author(s):

Takayoshi Yoshida ◽

Chunyong Lee ◽

Takeshi Chouchi ◽

Yusuke Komekami ◽

Humio Konishi

Keyword(s):

Esophageal Cancer ◽

Esophageal Carcinoma ◽

Conflicts Of Interest ◽

Clinical Stage ◽

Palliative Therapy ◽

Stage Iv ◽

Advanced Esophageal Cancer ◽

Oral Ingestion ◽

Palliative Operation ◽

Esophageal Stenting

Abstract Background We often troubled with the choice of the treatment for unresctable or elderly advanced esophageal cancer on the keeping of quality of life (QOL) . There are few cases to impair QOL remarkably, because of dysphagia with esophageal stenosis or esophago-tracheal fistula after Chemo-Radiation Therapy. Esophageal bypass including palliative esopagectomy and esophageal stenting are used for the oral intake of these cases. Methods We reported two cases of the elderly advanced esophageal cancer which were effective for QOL improvement by palliative Video-Assisted Thoracic Surgery of Esophagus (VATS-E). Results Case 1: A 72-year-old woman admitted with dysphagia was found to have advanced esophageal carcinoma, clinical stage IV (T3N2M1). We initiated definitive chemotherapy with combined 5-fluorouracil and cisplatin, to which the patient showed confirmed partial response. Dysphagia was not improved enough. Therefore, she received esophageal stenting with the antireflex valve. She was not able to have enough oral ingestion after stenting. So VATS-esophageal bypass was performed four months after initial treatment. At 2 years after surgery, she was alive and underwent outpatients chemotherapy. She can have normal diet. Case 2: A 79-year-old woman admitted with vomiting and body weight loss. The diagnosis was advanced esophageal carcinoma, clinical stage IV (T4N3M0). She received definitive Docetaxel chemotherapy because of renal dysfunction, malnutrition, to which patient showed progressive disease. So, VATS-esophageal resection (D0) was performed about 1 months after chemotherapy. There were not postoperative complications. She can have rice gruel diet. Conclusion It is difficult to determine which treatment is better esophageal stenting and esophageal palliative operation, because there are few reports that compared the esophageal palliative operation. In late years, VATS become able to be carried out safely. It is lower invasive treatment than thoracotomy. VATS is one of the palliative therapy, but it is necessary to decide the indication carefully in the case that a prognosis is limited. We think that it is useful to have satisfaction of the oral ingestion for cases with the severe stenosis and refractory cases of stenting. It is thought that VATS-E have possibilities to become the useful choice as one means of the palliative operation in consideration of the general status and the prognosis of the patients. Disclosure All authors have declared no conflicts of interest.

Download Full-text

LONG-TERM ADVERSE EVENTS DUE TO SELF-EXPANDABLE METALLIC STENTS IN PATIENTS WITH ADVANCED ESOPHAGEAL CANCER

10.1055/s-0038-1637449 ◽

2018 ◽

Author(s):

G Sirin ◽

AE Duman ◽

H Yılmaz ◽

Z Islamoglu ◽

A Celebi ◽

...

Keyword(s):

Esophageal Cancer ◽

Adverse Events ◽

Metallic Stents ◽

Advanced Esophageal Cancer ◽

Expandable Metallic Stents

Download Full-text

A study of human epidermal growth factor receptor-2 (HER-2) in carcinoma esophagus (Single Institutional Tertiary Cancer Centre study from Northeast part of India)

International Journal of Molecular and Immuno Oncology ◽

10.25259/ijmio_4_2020 ◽

2020 ◽

Vol 5 ◽

pp. 108-112

Author(s):

Deepjyoti Kalita ◽

Srinivas Bannoth ◽

Joydeep Purkayastha ◽

J. D. Sharma ◽

Abhijit Talukdar ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Esophageal Cancer ◽

Esophageal Carcinoma ◽

Cell Carcinoma ◽

Functional Status ◽

Squamous Cell ◽

Categorical Variables ◽

Advanced Stage ◽

Her 2 ◽

Poor Functional Status

Objectives: Esophageal cancer both squamous cell (SCC) and adenocarcinoma have poor outcomes with high morbidity and mortality. Our hospital-based registry for the year 2017–2018 showed that esophageal cancer constituted 22.7% of the annual caseload. The main objective of this study was to determine the presence of HER-2 receptors in patients with esophageal carcinoma in our region. Material and Methods: From September 2018 to September 2019, data regarding the expression of HER-2 receptors was analyzed in 133 patients of esophageal carcinoma. Data were statistically described as frequencies (number of cases) and percentages where appropriate. Chi-square and Fischer’s exact test was used to find out the association between categorical variables. A P < 0.05 was considered as statistical significant at 95% confidence interval. The statistical analysis was performed using SSPS software version 17.0. Results: A total of 133 patients were taken into study. The majority of patients were males (96) with a mean age of 52 years. Squamous cell carcinoma was predominant histology. HER-2 receptor positivity was seen in 6.01% of patients. Patients with HER-2 receptor positivity presented in advanced stage with poor functional status and poor grades of differentiation. Statistically significant correlation of Her-2 expression was seen with stage (P = 0.001) and pathology of tumor (P = 0.0001). Conclusion: Squamous cell carcinoma of esophagus still predominates in Northeast part of India. For studying the role of effective targeted therapies, knowledge of frequency of HER-2 receptor positivity is of utmost importance in our population and our study aims to answer this question. The present study shows a low prevalence of HER-2 neu overexpression in our community, probably due to the disproportionately high incidence of SCC compared to adenocarcinoma. Patients with HER-2 receptor positivity presented in advanced stage with poor functional status and poor grades of differentiation.

Download Full-text