Synchronous esophageal cancer impact on survival of head and neck squamous cell carcinoma (HNSCC) patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17513-e17513
Author(s):  
Paulo Henrique Amor Divino ◽  
Gustavo Duarte Ramos Matos ◽  
Karolina Lima ◽  
Gilberto Castro ◽  
Gustavo Nader Marta ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Early Stage ◽  
Locally Advanced ◽  
Definitive Treatment ◽  
Tobacco Exposure ◽  
Drinking Habits ◽  
Treatment Information ◽  
Impact On Survival ◽  
Frequent Site ◽  
Worse Prognosis

e17513 Background: Optimal treatment of synchronous tumors (ST) of the aerodigestive tract is debatable and care is often individualized. Our goal was to characterize patients with HNSCC and esophageal cancer (EC) ST and to establish prognostic factors that could aid therapeutic decision. Methods: In this retrospective observational study, we evaluated data from 1650 consecutive patients diagnosed with HNSCC from 2008 to 2016. Patients with ST of HNSCC and esophagus with an interval of ≤ 6 months between both diagnoses were included. Patients ≥ 6 months between both diagnoses, incomplete treatment information and presence of another tumor site were excluded. Results: 52 patients were eligible. Median age was 57 years (39-91). Most were male (98%), with smoking and drinking habits (98%) and ECOG 0-1 (73%). HNSCCs were mainly in oropharynx (54%) and locally advanced disease (LA, III-IVB) (88%). In contrast, EC was early stage (I-II, 62%), located in the thorax (94%) and squamous histology (96%). 14 (27%) had LA in both primaries. Most LA HNSCCs (85%) were treated with radiotherapy (RT) with a median dose of 70Gy (5-70Gy). 50% received platinum and taxane induction chemotherapy. 81% of initial EC received at least surgery, mucosectomy or RT (median 50.4Gy). Hospitalization due to toxicity occurred in 12 (23%) and 7 (14%) of HNSCC and EC treatments, respectively. 16 patients (31%) had no definitive treatment directed to EC, without apparent impact on survival. Median time to progression was 13.8 months, being HNSCC the most frequent site of progression/relapse (40%). Median survival was 23.9 months (IC 95% 9.2-38.6). Early HNSCC survival was comparable to LA HNSCC (17.3 vs. 23.9 mo, p = 0.98). In LA HNSCC, LA vs. initial EC carried a worse prognosis (16 vs. 36.3 mo, p = 0.008). Anemia, BMI, tobacco exposure had no impact on survival. Conclusions: The occurrence of EC and HNSCC ST leads to a dismal survival, even in patients with early stage HNSCC. The presentation of LA in both sites is particularly challenging and associated with worse prognosis. Given the rate of treatment-related toxicity in this population, cautious efforts should be employed when planning definitive treatment in ST pts.

scholarly journals Cetuximab Plus Cisplatin, Irinotecan, and Thoracic Radiotherapy as Definitive Treatment for Locally Advanced, Unresectable Esophageal Cancer: A Phase-II Study of The SWOG (S0414)

2012 ◽  
Vol 7 (5) ◽  
pp. 906-912 ◽  
Author(s):  
Michael B. Tomblyn ◽  
Bryan H. Goldman ◽  
Charles R. Thomas ◽  
Jacqueline K. Benedetti ◽  
Heinz-Josef Lenz ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Phase Ii ◽  
Phase Ii Study ◽  
Locally Advanced ◽  
Definitive Treatment ◽  
Thoracic Radiotherapy

scholarly journals Basal-Like Subgroup is Associated with Younger Age, Increased Expression of Androgen Receptor, and Worse Prognosis, while Non-basal-like Subtype is Associated with Higher BMI in Triple-Negative Breast Cancer Patients

2020 ◽  
Vol 12 (4) ◽  
pp. 349-354
Author(s):  
Ibnu Purwanto ◽  
Didik Setyo Heiyanto ◽  
Ahmad Ghozali ◽  
Irianiwati Widodo ◽  
Iwan Dwiprahasto ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Androgen Receptor ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Early Stage ◽  
Locally Advanced ◽  
Clinicopathologic Feature ◽  
Younger Age ◽  
Depth Analysis ◽  
Worse Prognosis

BACKGROUND: Triple-negative breast cancer (TNBC) represents a heterogenous disease which differ in characteristic, treatment response and prognosis. We aim to perform in-depth analysis on the clinicopathologic feature and the prognostic value of basal-like and non-basal-like TNBC patients in an Indonesian tertiary hospital.METHODS: We retrospectively included patients diagnosed with TNBC between 2014-2017. Clinical variables were collected from medical record. Expression of epidermal growth factor receptor (EGFR), cytokeratin 5/6 (CK5/6), p53 mutant and androgen receptor (AR) were examined by using immunohistochemistry (IHC).RESULTS: We included 67 subjects, 67.1% were basal-like and the remaining 32.9% were non-basal-like, with mean age of 51 years old, 59.7% subjects had BMI <25 and 40.3% subjects had BMI ≥25; 16.4%, 65.7%, and 17.9% subjects presented with early stage, locally advanced stage, and distant metastasis respectively; T<5 cm was found in 29.9% subjects, while 70.1% subjects had T≥5; 67.2% subjects presented with N-, while 32.8% subjects were N+. The most common histological type was infiltrating ductal (82% of subjects). P53 mutant and AR expressions were positive in 44.8% and 15% subjects, respectively. Basal-like subtype presented with younger age at and had higher expression of AR, while non-basal-like subtype is associated with BMI ≥25 (p<0.05). Basal-like subjects had shorter overall survival (23.9 months (95% CI: 21.9-25.9) vs. 26.1 months (95% CI: 23-29.2).CONCLUSION: Basal-like subtype is associated with worse prognosis, younger age at diagnosis and increased expression of AR, while non-basal-like subtype is associated with higher BMI in Indonesian TNBC.KEYWORDS: TNBC, subtype; basal-like, young age, Indonesia

Esophageal Cancer—An Update Review

2013 ◽  
Vol 09 (01) ◽  
pp. 6
Author(s):  
Yang Liu ◽  
Michael K Gibson ◽  
◽  
Keyword(s):  
Quality Of Life ◽  
Esophageal Cancer ◽  
Early Stage ◽  
Metastatic Cancer ◽  
Locally Advanced ◽  
Phase Iii ◽  
Early Esophageal Cancer ◽  
Advantages And Disadvantages ◽  
Cancer Management

With the decrease of cancer incidences in a few major cancers, such as breast cancer and lung cancer, the incidence of esophageal cancer has still been climbing up steadily for the past decades, especially adenocarcinoma. Our views on esophageal cancer have been evolving as well. Modifications of the American Joint Committee on Cancer (AJCC) staging has been implemented in its recent edition in 2010. Diagnostic and follow-up standards are changing with more and more physicians and hospitals considering endoscopic ultrasound-guided biopsy as a minimal requirement for definitive diagnosis and accurate staging. In some large centers and by some physicians, laproscopic/ thorascopic biopsy are attempted to diagnose esophageal cancer with more accurate definitive staging. The widespread use of imaging studies, such as computed tomography and/or positon emission tomography, has improved the diagnosis in guiding the therapeutic options. In early stage esophageal cancer management, the acceptable modalities are still radiofrequency ablation, endoscopic mucosal resection, and photodynamic therapy. The advantages and disadvantages are discussed in this article. Surgical resection of early esophageal cancer of T2 or greater staging or N1 is still considered standard with potential to ‘cure’ while minimal invasive laproscopic surgery showed acceptable improved effects and quality of life but are still limited to some tertiary centers. Multi-modality therapies of esophageal cancer in locally advanced stage, both resectable and unresectable, are discussed in this review. For operable diseases, neoadjuvant therapy, peri-surgery therapy, adjuvant therapy, chemotherapy, and/or radiation therapy are discussed. Unresectable esophageal cancer of both adenocarcinoma and squamous cell carcinoma as well as cancer with Her2/neu expression are also considered. The attached table listed the major landmark phase III clinical trials involving esophageal carcinoma. Metastatic cancer management, including the importance of quality of life management among the survivors is also examined.

Combination therapy with radiation and weekly paclitaxel/carboplatin as definitive treatment for locally advanced esophageal cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15196-e15196
Author(s):  
Mark Doherty ◽  
Darren Cowzer ◽  
Ciara Marie Kelly ◽  
Jodie Emma Battley ◽  
Gregory D. Leonard ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Surgical Resection ◽  
Treatment Option ◽  
Performance Status ◽  
Locally Advanced ◽  
Poor Performance ◽  
Definitive Treatment ◽  
Outpatient Basis ◽  
Grade 3 ◽  
Relapsed Disease

e15196 Background: Definitive chemoradiotherapy (CRT) is an established treatment option in localised esophageal cancer. While most patients are treated with cisplatin and fluorouracil, alternative chemotherapy regimens have been used. The combination of carboplatin and paclitaxel (CP) has been validated in a neoadjuvant CRT trial by the CROSS study. There has also been a phase II study (v. Meerten, ASCO 2010, e14508) showing efficacy and tolerability of this regimen in the definitive setting with radiation doses of 50.4Gy/28#. We report our experience using this strategy in two Irish centres. Methods: Patients treated with weekly CP and definitive radiation between Jan 2010 and Oct 2012 were identified from our pharmacy database. Clinicopathologic details were obtained from electronic medical records. The group contains patients with locally advanced unresectable disease, or those medically unfit for esophagectomy. Results: Between Jan 2010 and Oct 2012, we identified 22 patients. Thirteen patients had squamous histology, while 9 had adenocarcinoma. Staging was performed with CT, EUS, and PET/CT – 1 patient had T2 disease, while the remainder had T3/T4, and 10 patients had positive nodes. Reasons for not pursuing surgical resection were extent of disease and poor performance score. In total, 86% of patients received full dose treatment, with reasons for dose delay/reduction being grade 3 sepsis, grade 3 gastrointestinal toxicity, and decline in performance status. Overall 5 (23%) patients needed hospital admission during treatment. At a median follow up of 14 months (range 9-23months), 19 patients are alive with no evidence of disease, 2 patients have died of disease, and 1 patient is alive with relapsed disease. Our 1-year recurrence free survival rate is 86%. Conclusions: Definitive CRT with CP is a tolerable regimen that can be administered on an outpatient basis, and provides a treatment option in those who are unsuitable for surgical resection or Herskovic type CRT. Our results compare favorably with previous studies in this population. Further investigation is warranted in a prospective study to validate the efficacy of this approach.

Accuracy of clinical staging with EUS for early stage esophageal cancer: Are we denying patients beneficial neoadjuvant chemo-radiation?

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 163-163
Author(s):  
Carrie Luu ◽  
Norbert Garcia-Henriquez ◽  
Jason Klapman ◽  
Cynthia L. Harris ◽  
Khaldoun Almhanna ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Early Stage ◽  
Gastroesophageal Junction ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Significant Proportion ◽  
Surgical Pathology ◽  
Clinical Staging ◽  
Cancer Center

163 Background: Esophagectomy alone has been considered the standard of care for early stage esophageal cancer (EC) while neoadjuvant therapy is now standard for locally advanced disease. The choice of treatment therefore hinges on accurate locoregional staging by endoscopic ultrasound (EUS). Our objective is to evaluate the accuracy of EUS performed in a high-volume tertiary cancer center in clinical stage T1N0 (cT1N0) and T2N0 (cT2N0) esophageal cancer patients undergoing esophagectomy without neoadjuvant therapy. Methods: A retrospective review of the esophageal cancer database at a single institution was performed. Patients with cT1N0 and cT2N0 esophageal cancer based on EUS undergoing esophagectomy without neoadjuvant treatment were evaluated. Patient demographics, tumor characteristics, and treatment were reviewed. Surgical pathology was compared to EUS staging. Results: Between 2000 and 2015, 139 patients were identified. There were 25 (18%) female and 114 (82%) male patients. The tumor location included the middle 1/3 of the esophagus in 11 (8%) and lower 1/3 and gastroesophageal junction in 128 (92%) patients. Eighty-one percent of patients had adenocarcinoma, 9% had squamous cell carcinoma, 9% had Barrett’s dysplasia, and 1% had mixed histology. Clinical staging were as follows: 110 (79%) patients had cT1N0 and 29 (21%) patients had cT2N0 tumors. For the entire cohort, preoperative EUS matched the final surgical pathology in 76/139 patients for an accuracy rate of 53%. Twenty-nine patients (21%) were under-staged by EUS; of those, 19 (14%) had unrecognized nodal disease. This included 12/109 (11%) of cT1N0 and 7/29 (24%) of cT2N0 patients. Conclusions: The accuracy of preoperative EUS staging in early esophageal cancer remains sub-optimal. Interestingly, a significant proportion (24%) of cT2N0 EC patients were found to have positive lymph nodes on surgical pathology, and perhaps these patients could have benefitted from neoadjuvant therapy. In light of these findings, the current management of cT2N0 esophageal cancer should be reconsidered.

Adenocarcinoma of the appendix occurring in a patient treated with paclitaxel for locally advanced esophageal cancer

2017 ◽  
Vol 24 (2) ◽  
pp. 150-152 ◽  
Author(s):  
Constantin A Dasanu ◽  
David M Hyams ◽  
Frank J Senatore
Keyword(s):  
Esophageal Cancer ◽  
T Cell Activation ◽  
Cell Activation ◽  
Early Stage ◽  
Locally Advanced ◽  
Colonic Polyps ◽  
Lung Cancer Patients ◽  
Poorly Differentiated ◽  
Locally Advanced Esophageal Cancer

Paclitaxel has been linked with a number of immunosuppressive effects such as decreased numbers and activity of dendritic cells, NK-cells and monocytes, which may in turn lead to defective T-cell activation. In addition, this agent was shown to cause mitotic arrest resembling high-grade dysplasia throughout the gastrointestinal tract, including the appendix. We have previously documented a series of lung cancer patients who developed pre-malignant colonic polyps and/or colon cancer either during or weeks following chemotherapy with paclitaxel, suggesting a potential role of this agent in their pathogenesis. We describe herein a patient who developed adenocarcinoma of the appendix five months after paclitaxel therapy for a locally advanced lower esophageal cancer. Although the cancer of the appendix was in early stage, it was poorly differentiated and showed lymphovascular invasion. The context, timeline and existing experience suggest that this second cancer was triggered by a pre-existing insult, conceivably delivered by paclitaxel.

Combination therapy with radiation and weekly paclitaxel/carboplatin as definitive treatment for locally advanced esophageal cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 133-133
Author(s):  
Mark Doherty ◽  
Darren Cowzer ◽  
Ciara Marie Kelly ◽  
Jodie Emma Battley ◽  
Gregory Leonard ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Surgical Resection ◽  
Treatment Option ◽  
Performance Status ◽  
Locally Advanced ◽  
Poor Performance ◽  
Definitive Treatment ◽  
Outpatient Basis ◽  
Grade 3 ◽  
Relapsed Disease

133 Background: Definitive chemoradiotherapy (CRT) is an established treatment option in localised esophageal cancer. While most patients are treated with cisplatin and fluorouracil, alternative chemotherapy regimens have been used. The combination of carboplatin and paclitaxel (CP) has been validated in a neoadjuvant CRT trial by the CROSS study. There has also been a phase II study (v. Meerten, ASCO 2010, e14508) showing efficacy and tolerability of this regimen in the definitive setting with radiation doses of 50.4Gy/28#. We report our experience using this strategy in two Irish centres. Methods: Patients treated with weekly CP and definitive radiation between Jan 2010 and Aug 2012 were identified from our pharmacy database. Clinicopathologic details were obtained from electronic medical records. The group contains patients with locally advanced unresectable disease, or those medically unfit for esophagectomy. Results: Between Jan 2010 and Aug 2012, we identified 22 patients. Thirteen patients had squamous histology, while 9 had adenocarcinoma. Staging was performed with CT, EUS, and PET/CT – 1 patient had T2 disease, while the remainder had T3/T4, and 10 patients had positive nodes. Reasons for not pursuing surgical resection were extent of disease and poor performance score. In total, 86% of patients received full dose treatment, with reasons for dose delay/reduction being grade 3 sepsis, grade 3 gastrointestinal toxicity, and decline in performance status. Overall 5 (23%) patients needed hospital admission during treatment. At a median follow up of 14 months (range 9-23 months), 19 patients are alive with no evidence of disease, 2 patients have died of disease, and 1 patient is alive with relapsed disease. Our 1-year recurrence free survival rate is 86%. Conclusions: Definitive CRT with CP is a tolerable regimen that can be administered on an outpatient basis, and provides a treatment option in those who are unsuitable for surgical resection or Herskovic type CRT. Our results compare favorably with previous studies in this population. Further investigation is warranted in a prospective study to validate the efficacy of this approach.

Neoadjuvant chemotherapy in pregnant patients with cervical cancer: a Latin-American multicenter study

2021 ◽  
Vol 31 (3) ◽  
pp. 468-474
Author(s):  
Aldo Lopez ◽  
Juliana Rodriguez ◽  
Erick Estrada ◽  
Alejandro Aragona ◽  
Carlos Chavez ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Latin American ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Locally Advanced ◽  
Complete Response ◽  
Oncologic Outcomes ◽  
Definitive Treatment ◽  
Obstetric Outcomes

ObjectiveTo describe oncologic and obstetric outcomes in patients diagnosed with cervical cancer during pregnancy who had a successful delivery after neoadjuvant chemotherapy.MethodsA multicenter retrospective review was conducted in 12 institutions from six Latin American countries, between January 2007 and December 2018. Data collected included clinical characteristics, neoadjuvant chemotherapy agents, treatment, obstetric and oncologic outcomes.ResultsThirty-three patients were included. Median age was 34 years (range 31–36). Twenty (60.6%) women were diagnosed at early stage (IB), and 13 (39.4%) with locally advanced stage (IIA–IIIB) according to FIGO 2009 classification. Carboplatin and paclitaxel was the most frequent combination used (60.6%). Partial and complete response rates were 27.3% and 9.1%, respectively. Median gestational age at delivery was 35 weeks (range 34–36). All patients had live births delivered by cesarean section. Obstetric pathology: pre-term labor, placenta percreta or intra-uterine growth restriction, was documented in seven patients (21.2%). Two (6.1%) neonates had low birth weight. Definitive treatment was primary chemo-radiation in 19 (57.6%) patients, radical hysterectomy in 11 (33.3%), abandoned radical hysterectomy with para-aortic lymphadenectomy and ovarian transposition in 1 patient (3.0%), and no further treatment in 2 (6.1%) patients. After a median follow-up of 16.3 months (range 2.0–36.9), 8 (26.7%) patients had recurrent disease. Of these, four (13.3%) died due to disease.ConclusionNeoadjuvant chemotherapy may be offered to patients wishing to preserve an ongoing pregnancy in order to achieve fetal maturity. Long-term consequences of chemotherapy in the child are yet to be determined.

Sign in / Sign up

Export Citation Format

Share Document