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.

PS02.031: DEFINITIVE CHEMORADIOTHERAPY WITH DOCETAXEL, CISPLATIN, AND 5-FLUOROURACIL (DCF-R) FOR ADVANCED CERVICAL ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 128-129
Author(s):  
Hiroshi Okamoto ◽  
Yusuke Taniyama ◽  
Tadashi Sakurai ◽  
Takahiro Heishi ◽  
Chiaki Sato ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Survival Rate ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Conflicts Of Interest ◽  
Clinical Stage ◽  
Stage Ii ◽  
Definitive Chemoradiotherapy

Abstract Background Recently, definitive chemoradiotherapy (dCRT) has become one of the essential treatment strategies for esophageal squamous cell carcinoma (ESCC) and has been especially gaining prevalence for cervical ESCC to preserve the larynx. There have been recent reports on favorable outcomes of docetaxel/CDDP/5-FU (DCF-R) for advanced esophageal cancer. Our department recently introduced DCF-R for treating advanced cervical ESCC. We analyzed the safety and outcomes of DCF-R in patients with advanced cervical ESCC. Methods We retrospectively evaluated 12 advanced cervical ESCC patients (clinical stage II–IV, including T4b and/or M1 lymph node) in our department who received DCF-R as the first-line treatment between December 2010 and February 2015. Results Our patient cohort comprised 9 males and 3 females (median age, 67.5 years; range: 54–76 years). All patients were squamous cell carcinoma. The median observation period was 34.5 (8–80) months with total irradiation dose of 64.0 (60–70) Gy. The pretreatment clinical stage (according to Union for International Cancer Center) included one stage II, seven stage III, and four stage IV cases (including 3 patients with T4b [2 trachea and 1 thyroid] and 4 patients with M1 lymph node. We attained complete response (CR) in 10 patients and stable disease in 2 patients. Of 10 patients with CR, 5 experienced recurrence and 5 continued exhibiting CR. Two persistent patients included one patient who died of cancer and one patient who underwent salvage surgery. Furthermore, grade 3 or more adverse events as defined in Common Terminology Criteria for Adverse Event version 4 included leucopenia (91.7%), neutropenia (91.7%), febrile neutropenia (50%), and pharyngeal pain (50%). There was no treatment-related mortality and treatment schedules were completed in all patients, although dose reduction of the second cycle of chemotherapy was required in four patients (33%) and change in the radiation schedule was required in one patient (8.3%). While the 2-/3-/5-year overall survival rate was 66.7%/48.6%/48.6%, the 2-/3-/5-year recurrent-free survival rate was 58.3%/50.0%/37.5%, respectively. Conclusion DCF-R treatment for advanced cervical ESCC could be completed by the careful administration, and although a strong blood toxicity might occur, a favorable prognosis can be obtained with larynx preservation. Disclosure All authors have declared no conflicts of interest.

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.

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

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.

Clinical characteristics of recurrent esophageal cancer after definitive chemoradiotherapy for stage II//III (non T4) esophageal squamous cell cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 137-137
Author(s):  
Akiko Nishikawa ◽  
Ken Kato ◽  
Yoshitaka Honma ◽  
Satoru Iwasa ◽  
Atsuo Takashima ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Clinical Stage ◽  
Locally Advanced ◽  
Disease Recurrence ◽  
Advanced Esophageal Cancer ◽  
Definitive Chemoradiotherapy ◽  
Locoregional Failure ◽  
Distant Failure ◽  
Time To Recurrence ◽  
Locally Advanced Esophageal Cancer

137 Background: Recurrence after definitive chemoradiotherapy (dCRT) for locally advanced esophageal cancer is associated with poor outcome. No standard treatment strategy exist for recurrence after complete response (CR) to dCRT. We examined patterns of recurrence and clinical outcomes in patients with disease recurrence after dCRT. Methods: We retrospectively investigated 197 patients who had achieved initial CR after dCRT for locally advanced esophageal cancer between January 2000 and December 2008. We analyzed data from the 69 patients who had developed disease recurrence after CR, excluding 11 who died of other causes. Time to event was calculated by the Kaplan-Meier method, and the Cox proportional hazard model was used in univariate and multivariate analyses. Results: Characteristics of the 69 patients were as follows: male: female = 61:8; median age = 65 years (range 47 to 82); clinical stage at diagnosis (UICC 6th edition) IIA/IIB/III = 15/22/32; and performance status at recurrence (0/1/2) = (35/32/2). Primary CRT consisted of 5-FU+cisplatin (n = 66), 5-FU+nedaplatin (n = 2), or S-1+cisplatin (n = 1). The pattern of recurrence was locoregional failure (n = 35), or any distant failure (n = 34). Median time to recurrence from the start of dCRT was 13.6 months, and median survival time after recurrence was 17.4 months. Median survival time according to pattern of failure was 27.5 months (locoregional failure), and 17.4 months (any distant failure). In the univariate analysis, locoregional failure (HR 0.51), time to recurrence >13 months (HR0.38), clinical stage II (HR0.48), and any treatment for recurrence (HR: 0.15) were associated with better prognosis after recurrence. In the multivariate analysis, only time to recurrence (>13 months) was associated with better prognosis with HR 0.31(95%CI:0.14-0.66) Conclusions: Our study suggested that patients with early recurrence have a poor prognosis. More intensive treatment is needed to improve survival.

PS01.203: PREOPERATIVE PATIENT-RELATED FACTORS ASSOCIATED WITH PROGNOSIS AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 107-107
Author(s):  
Hiroyuki Kitagawa ◽  
Jun Iwabu ◽  
Tsutomu Namikawa ◽  
Kazuhiro Hanazaki
Keyword(s):  
Esophageal Cancer ◽  
Conflicts Of Interest ◽  
Prognostic Score ◽  
Univariate Analysis ◽  
Poor Survival ◽  
Residual Cancer ◽  
Related Factors ◽  
History Of ◽  
The Impact ◽  
Preoperative Patient

Abstract Background To investigate the impact of the preoperative patient-related factors on survival after esophagectomy in patients with esophageal cancer. Methods We retrospectively reviewed 140 patients with esophageal cancer who underwent esophagectomy. Preoperative comorbidities, nutritional and inflammation status including the neutrophil to lymphocyte ratio (NLR) and Glasgow prognostic score (GPS), and their pathological findings were analyzed to assess their relationships with prognosis. Results Univariate analysis demonstrated that a history of cardiovascular disease (CVD), a GPS of 1 or 2, lack of neo-adjuvant chemotherapy (NAC), no thoracoscopic esophagectomy, blood loss volume ≥ 255 ml, the number of lymph node metastasis (LNM) ≥ 2, lymphatic invasion, venous invasion, and residual cancer were associated with poor survival. Multivariate analysis revealed that a history of CVD (hazard ratio [HR], 2.129; 95% confidence interval [CI], 1.327–4.226; P = 0.041), a GPS of 1 or 2 (HR, 3.232; 95% CI, 1.516–6.437; P = 0.003), LNM ≥ 2 (HR, 3.133; 95% CI, 1.355–7.760; P = 0.007), and pathological residual cancer (HR, 2.429; 95% CI, 1.050–5.105; P = 0.039) were independently associated with poor survival, and NAC was associate with better survival (HR, 0.289; 95% CI, 0.118–0.667; P = 0.003). Conclusion Preoperative patient-related factors including a history of CVD and a GPS of 1 or 2 were predictors of poor prognosis after esophagectomy in patients with esophageal cancer. Disclosure All authors have declared no conflicts of interest.

scholarly journals Standard-dose versus high-dose radiotherapy with concurrent chemotherapy in esophageal cancer: A prospective randomized study

2018 ◽  
Vol 07 (01) ◽  
pp. 27-30 ◽  
Author(s):  
Navin Nayan ◽  
M. Bhattacharyya ◽  
Vikas K. Jagtap ◽  
A. K. Kalita ◽  
R. Sunku ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Total Dose ◽  
Standard Dose ◽  
Randomized Study ◽  
Complete Response ◽  
Concurrent Chemotherapy ◽  
Prospective Randomized Study ◽  
High Dose ◽  
Large Sample Size

Abstract Objective: The objective of this study is comparision of local and distant control rates with high-dose versus standard-dose radiotherapy along with concurrent chemotherapy in esophageal cancer – a prospective randomized study. Materials and Methods: Histologically proven Stage I–III patients with carcinoma esophagus were randomized into two groups. One group has been treated with standard-dose radiotherapy, i.e., a total dose of 50.4 Gy (1.8 Gy/day, 28#, 5 days/week). The other group (study arm) has received high-dose radiotherapy, i.e. a total dose of 64.8 Gy (1.8 Gy/day, 36#, 5 days/week). Both groups have received 2 cycles of 3 weekly concurrent chemotherapy (cisplatin 75 mg/m[2] on day 1 and 5-fluorouracil 750 mg/m[2] continuous intravenous infusion over 24 h on day 1–4). Follow-up response evaluation was done by both endoscopy and computed tomography scan after 6–8 weeks and after 2 months thereafter. Results: Out of a total of 28 patients, 68% showed a complete response, 14% showed partial response, and 18% patients developed progressive disease at first and subsequent follow up (median follow-up of 21 months). Among the complete response patients, rates were higher in high-dose group compared to standard-dose radiotherapy group (71% vs. 64%, P = 0.38). Treatment-related toxicities were acceptable in both groups. Conclusion: High-dose radiotherapy with concurrent chemotherapy seems to be more effective with acceptable toxicity in our study. However, further follow-up and large sample size may be required to validate the current study conclusion.

PS01.236: MEDIASTINOSCOPIC SALVAGE ESOPHAGECTOMY FOR RECURRENT ESOPHAGEAL CANCER AFTER DEFINITIVE CHEMORADIOTHERAPY IN A PREVIOUSLY PNEUMONECTOMIZED PATIENT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 116-117
Author(s):  
Tomoyuki Okumura ◽  
Yasuyuki Seto ◽  
Susumu Aikou ◽  
Makoto Moriyama ◽  
Shinich Sekine ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Tumor Recurrence ◽  
Conflicts Of Interest ◽  
Primary Lung Cancer ◽  
Esophageal Wall ◽  
Thoracic Esophagus ◽  
Definitive Chemoradiotherapy ◽  
Transhiatal Approach ◽  
Salvage Esophagectomy ◽  
Sealing Device

Abstract Background Mediastinoscopic esophagectomy is a minimally invasive surgery for thoracic esophageal cancer avoiding one-lung ventilation or transthoracic procedure. Methods We performed for the first time in the literature, salvage esophagectomy with combination of mediastinoscopic cervical approach and laparoscopic/mediastinoscopic transhiatal approach for recurrent thoracic esophageal squamous cell carcinoma (ESCC) after definitive chemoradiotherapy (dCRT) in a patient who had previously undergone a left pneumonectomy for primary lung cancer. Results A 66-year-old man was diagnosed as local recurrence of lower ESCC (cT3N0M0 cStage II) at 9 years after dCRT. His medical history included left-sided pneumonectomy for lung adenocarcinoma 9 years previously. Then the patient was diagnosed as lower thoracic ESCC (cT3N1M0 cStage III) at 2 months after pneumonectomy. He received dCRT consisting of CDDP/5-FU infusion and irradiation (60 Gy) and achieved complete response. No evidence of tumor recurrence was observed at endoscopic surveillance up until 6 years after dCRT. For this present surgery, a cervical wound was made and the intramediastinal procedure was performed under pneumomediastinum. After mobilization of upper/middle thoracic esophagus, the esophageal wall was safely separated from the remaining part and the stump of the left main bronchus. Dense adhesions between the esophagus and fibrotic tissue at the site of previous left mediastinal pleural resection was divided using a sealing device. In the abdomen, 5 ports were inserted to perform abdominal and transhiatal procedures under CO2 insufflation. After mobilization of the stomach, fibrotic scar tissue around the lower esophagus was divided using a sealing device and the peri-esophageal space dissected from cervical and transhiatal approach were connected to completely mobilize the thoracic esophagus. The esophagectomy was uneventfully carried out followed by reconstruction with gastric conduit via retrosternal rout. Pathological findings demonstrated a moderately differentiated ESCC (pT3-AD pN1 M0 pStage III), indicating that R0 resection was successfully performed. The patient has been closely observed as an outpatient and was alive and healthy at 3 months after the operation without tumor recurrence. Conclusion Mediastinoscopic esophagectomy is a safe and curative treatment strategy for esophageal cancer patients who had a previous pneumonectomy, even in salvage surgery for recurrent cancer after dCRT. Disclosure All authors have declared no conflicts of interest.

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