280 CONVERSION SURGERY FOR BORDERLINE T4 ESOPHAGEAL CANCER

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Takashi Ogata
Keyword(s):  
Esophageal Cancer ◽  
Main Bronchus ◽  
Multidisciplinary Treatment ◽  
Treatment Strategies ◽  
Median Number ◽  
Additional Treatment ◽  
Postoperative Treatment ◽  
Conversion Surgery ◽  
Borderline Resectable ◽  
T4 Esophageal Cancer

Abstract   Due to development of neo-adjuvant chemotherapy or chemoradiotherapy, the possibility of surgical resection for borderlint T4 esophageal cancer that seems difficult to resect is emerging. We retrospectively examine the effects of conversion surgery in patients for esophageal cancer as part of multidisciplinary treatment. Methods We undergo 364 cases esophagectomy between Jan 2011 and Dec 2018, and of the 10 cases were diagnosed as borderline resectable esophageal cancer patients at first admission. These 10 cases were undergone conversion surgery after chemotherapy. We retrospectively examined preoperative and postoperative treatment and their prognosis. Results The chemotherapy regimens given above 10 cases were DCF (4cases) and FP (6 cases). Borderline target organs: Aorta (4 cases), Left main bronchus(6 cases), LN invasion to pancreas (1 case). R0 surgery was achieved in 8 of 10 cases, and the pathological response was G1a: 5 cases, G1b: 2 cases, G2: 3 cases. The median number of lymph node metastases is 3 (0–19), with recurrence in 6 cases, and the median time to recurrence is 7 months (2–21 months). Treatment was performed in all 6 cases after recurrence. Four patients had radiation therapy, but their prognosis was severe: 2 cases survived and 4 cases died. Conclusion Conversion surgery as a multidisciplinary treatment still can not provide a satisfactory prognosis, so additional treatment strategies including radiation and more effective utilization of other modalities are expected.

Radiofrequency Ablation of Spine Metastases: A Clinical and Technical Approach

2021 ◽  
Vol 25 (06) ◽  
pp. 795-804
Author(s):  
Steven Yevich ◽  
Stephen Chen ◽  
Zeyad Metwalli ◽  
Joshua Kuban ◽  
Stephen Lee ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Multidisciplinary Treatment ◽  
Treatment Algorithm ◽  
Treatment Strategies ◽  
Clinical Work ◽  
Additional Treatment ◽  
Vertebral Compression Fractures ◽  
Tumor Control ◽  
Technical Approach ◽  
Spine Metastases

AbstractPercutaneous radiofrequency ablation (RFA) is an integral component of the multidisciplinary treatment algorithm for both local tumor control and palliation of painful spine metastases. This minimally invasive therapy complements additional treatment strategies, such as pain medications, systemic chemotherapy, surgical resection, and radiotherapy. The location and size of the metastatic lesion dictate preprocedure planning and the technical approach. For example, ablation of lesions along the spinal canal, within the posterior vertebral elements, or with paraspinal soft tissue extension are associated with a higher risk of injury to adjacent spinal nerves. Additional interventions may be indicated in conjunction with RFA. For example, ablation of vertebral body lesions can precipitate new, or exacerbate existing, pathologic vertebral compression fractures that can be prevented with vertebral augmentation. This article reviews the indications, clinical work-up, and technical approach for RFA of spine metastases.

T4 esophageal cancer treated with radical resection

2020 ◽  
Vol 61 (4) ◽  
Author(s):  
Hai Zhong ◽  
Qianjun Li ◽  
Wenhui Gao ◽  
Xiang Li ◽  
Junhua Zhang ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Radical Resection ◽  
T4 Esophageal Cancer

scholarly journals Radiooncological View on Therapy Outcome after Multidisciplinary Treatment of Sinonasal Tumors

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2364
Author(s):  
Olena Klymenko ◽  
Anna Maria Stefanie Buchberger ◽  
Barbara Wollenberg ◽  
Klaus-Dietrich Wolff ◽  
Victoria Kehl ◽  
...  
Keyword(s):  
Tumor Volume ◽  
Multidisciplinary Treatment ◽  
Treatment Strategies ◽  
Entire Group ◽  
Sinonasal Carcinoma ◽  
Volume Delineation ◽  
Sequential Boost ◽  
Significant Difference ◽  
Integrated Boost ◽  
Primary Focus

Purpose: We report the outcome of a mono-institutional retrospective study of sinonasal carcinoma with the primary focus on GTV (gross tumor volume) and the effect of radiotherapy. Methods: 53 patients with sinonasal carcinoma and that of the nasal cavity, paranasal sinus or both except lymphoma were included. All patients were treated between 1999 and 2017. For tumor volume delineation, all pre-therapeutic images were fused to the planning CT (computed tomography). Results: The median follow-up was 17 months [0.3–60], the median age 60 years, 35 males and 18 females were included. Squamous cell carcinoma (SCC) (60.4%) was the predominant histology, followed by adenocarcinoma (15.1%). The mean composite OS (overall survival) time was 33.3 ± 3.5 months. There was no significant difference in the 5 y composite OS between tumor localization or radiotherapy setting. The simultaneous integrated boost concept showed a trend towards improving five-year composite OS compared to the sequential boost concept. The only factor with a significant impact on the 5 y composite OS rate was the pre-therapeutic GTV (cutoff 75 cm3; p = 0.033). The GTV ≥ 100 cm3 has no effect on the 5 y composite OS rate for SCC. Conclusions: The pre-therapeutic GTV is a prognostic factor for five-year composite OS for the entire group of patients with sinonasal tumors, influencing the outcome after completion of all treatment strategies. The GTV seems to not influence five-year composite OS in SCC. For this rare tumor entity, an intensive, multidisciplinary discussion is essential to finding the best treatment option for the patient.

Cholangiocarcinoma therapeutics: an update

2021 ◽  
Vol 21 ◽  
Author(s):  
Mai Ly Thi Nguyen ◽  
Nguyen Linh Toan ◽  
Maria Bozko ◽  
Khac Cuong Bui ◽  
Przemyslaw Bozko
Keyword(s):  
Treatment Outcome ◽  
Targeted Therapies ◽  
Treatment Strategies ◽  
Favourable Outcome ◽  
High Rate ◽  
Postoperative Treatment ◽  
Clinical Indication ◽  
Tumour Resection ◽  
First Line ◽  
Treatment Methods

Background: Background: Cholangiocarcinoma (CCA) is the second most common hepatobiliary cancer and associated with poor prognosis. Only one-third of CCA cases are diagnosed at operable stages. However, a high rate of relapse has been observed post-operatively. Besides screening for operable individuals, efficacious therapeutic for recurrent and advanced CCA is urgently needed. Treatment outcome of available therapeutics is important to clarify clinical indication and facilitate development of treatment strategies. Objective: This review aims to compare the treatment outcome of different therapeutics based on both overall survival and progression-free survival. Methods: Over one hundred peer-reviewed articles were examined. We compared the treatment outcome between different treatment methods, including tumour resection with or without postoperative systematic therapy, chemotherapies including FOFLOX and targeted therapies, such as IDH1, K-RAS and FGFR inhibitors. Notably, the scientific basis and outcome of available treatment methods werecompared with the standard first-line therapy. Results: CCAs at early stages should firstly undergo tumour resection surgery, followed by postoperative treatment with Capecitabine. Chemotherapy can be considered as a preoperative option for unresectable CCAs. Inoperable CCAs with genetic aberrances like FGFR alterations, IDH1 and K-RAS mutations should be considered with targeted therapies. Fluoropyrimidine prodrug (S-1)/Gemcitabine/Cisplatin and nab-Paclitaxel/Gemcitabine/Cisplatin show favourable outcome which hints on the triplet regimen to be superior to Gemcitabine/Cisplatinon CCA. Thetriplet chemotherapeutic should be tested further compared toGemcitabine/Cisplatin among CCAs without genetic alterations.Gemcitabine plus S-1 was recently suggested as the convenient and equivalent standard first line for advanced/recurrent biliary tract cancer. Conclusions: Thisreview provides a comparative outcomebetween novel targeted therapies and currently available therapeutics.

scholarly journals Advances in targeted therapy for esophageal cancer

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Yan-Ming Yang ◽  
Pan Hong ◽  
Wen Wen Xu ◽  
Qing-Yu He ◽  
Bin Li
Keyword(s):  
Esophageal Cancer ◽  
Epidermal Growth Factor Receptor ◽  
Growth Factor ◽  
Epidermal Growth Factor ◽  
Targeted Therapies ◽  
Treatment Strategies ◽  
Growth Factor Receptor ◽  
Immune Checkpoints ◽  
Her 2 ◽  
Epidermal Growth

Abstract Esophageal cancer (EC) is one of the most lethal cancers in the world, and its morbidity and mortality rates rank among the top ten in China. Currently, surgical resection, radiotherapy and chemotherapy are the primary clinical treatments for esophageal cancer. However, outcomes are still unsatisfactory due to the limited efficacy and severe adverse effects of conventional treatments. As a new type of approach, targeted therapies have been confirmed to play an important role in the treatment of esophageal cancer; these include cetuximab and bevacizumab, which target epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF), respectively. In addition, other drugs targeting surface antigens and signaling pathways or acting on immune checkpoints have been continuously developed. For example, trastuzumab, a monoclonal antibody targeting human epidermal growth factor receptor 2 (HER-2), has been approved by the Food and Drug Administration (FDA) as a first-line treatment of HER-2-positive cancer. Moreover, the PD-L1 inhibitor pembrolizumab has been approved as a highly efficient drug for patients with PD-L1-positive or advanced esophageal squamous cell carcinoma (ESCC). These novel drugs can be used alone or in combination with other treatment strategies to further improve the treatment efficacy and prognosis of cancer patients. Nevertheless, adverse events, optimal dosages and effective combinations still need further investigation. In this review, we expound an outline of the latest advances in targeted therapies of esophageal cancer and the mechanisms of relevant drugs, discuss their efficacy and safety, and provide a clinical rationale for precision medicine in esophageal cancer.

Endoscopically defined treatment strategies in patients with locally advanced esophageal cancer

1994 ◽  
Vol 8 (5) ◽  
pp. 384-388
Author(s):  
J. A. Greager ◽  
P. E. Donahue ◽  
K. Reichard ◽  
V. Kucich ◽  
M. Lubienski ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Locally Advanced ◽  
Treatment Strategies ◽  
Advanced Esophageal Cancer ◽  
Locally Advanced Esophageal Cancer

scholarly journals Esophageal Cancer: 10-Year Survival After Surgery

2021 ◽  
Author(s):  
Oleg Kshivets
Keyword(s):  
Neural Networks ◽  
Esophageal Cancer ◽  
Blood Cells ◽  
Treatment Strategies ◽  
Rank Test ◽  
Correct Prediction ◽  
Algorithm Selection ◽  
Cell Ratio ◽  
Prothrombin Index ◽  
Area Under Roc Curve

Abstract OBJECTIVE: 10-Year survival (10YS) after radical surgery for esophageal cancer (EC) patients (ECP) (T1-4N0-2M0) was analyzed. METHODS: We analyzed data of 551 consecutive ECP (age=56.5±8.9 years; tumor size=6±3.5 cm) radically operated (R0) and monitored in 1975-2021 (m=411, f=140; esophagogastrectomies (EG) Garlock=284, EG Lewis=267, combined EG with resection of pancreas, liver, diaphragm, aorta, VCS, colon transversum, lung, trachea, pericardium, splenectomy=154; adenocarcinoma=314, squamous=227, mix=10; T1=128, T2=115, T3=181, T4=127; N0=278, N1=70, N2=203; G1=157, G2=141, G3=253; early EC=109, invasive=442; only surgery=423, adjuvant chemoimmunoradiotherapy-AT=128: 5-FU+thymalin/taktivin+radiotherapy 45-50Gy). Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence.RESULTS: Overall life span (LS) was 1881.1±2230.6 days and cumulative 5-year survival (5YS) reached 52.1%, 10 years – 45.9%, 20 years – 33.7%. 184 ECP lived more than 5 years (LS=4308.7±2413.3 days), 99 ECP – more than 10 years (LS=5883±2296.6 days). 226 ECP died because of EC (LS=628.3±319.9 days). AT significantly improved 5YS (68.8% vs. 48.5%) (P=0.00025 by log-rank test). Cox modeling displayed that 10YS of ECP significantly depended on: phase transition (PT) N0—N12 in terms of synergetics, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), T, G, histology, age, AT, localization, blood cells, prothrombin index, hemorrhage time, residual nitrogen, protein (P=0.000-0.021). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 10YS and PT N0—N12 (rank=1), healthy cells/CC (2), PT early-invasive EC (3), thrombocytes/CC (4), erythrocytes/CC (5), lymphocytes/CC (6), eosinophils/CC (7), stick neutrophils/CC (8), segmented neutrophils/CC (9), monocytes/CC (10). leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).CONCLUSIONS: 10-Year survival after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) tumor localization; 10) anthropometric data; 11) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.

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