Chemo-radiotherapy in Locally Advanced Squamous Cell Oesophageal Cancer—are Upper Third Tumours more Responsive?
ABSTRACT Before neoadjuvant therapy was widely applied, the prognosis of oesophageal cancer had been considered dependent on the location
of the tumor, i.e. upper third cancers had had the worst prognosis. The aim of this retrolective study was to prove the efficiency
of the neoadjuvant treatment, and to compare the response of esophageal cancer in different locations. Between January 1998
and September 2005, 102 patients with locally advanced squamous cell oesophageal cancer received preoperative chemo-radiotherapy.
In 40 cases the tumor was located in the upper third and in 62 cases in the middle third of the oesophagus. After a four-week-long
treatment free period restaging was carried out and patients considered resectable were submitted to surgery. From 40 patients
with upper third oesophageal cancer 28 underwent oesophageal resection or pharyngo-laryngectomy. Thiry-five percent a complete
histopathological remission was observed. From 62 patients with middle third oesophageal cancer 43 underwent oesophageal resection.
Histological examination of the resected specimens documented complete response only in three patients. The median survival
and the R0 resection rate were similar in the two groups. Although the resection rate, perioperative morbidity, mortality
and the median survival were similar in the two groups, a significantly higher rate of complete response (p < 0,05) was observed in patients with upper third oesophageal cancer compared to patients with middle third oesophageal cancer.
It seems that upper third oesophageal cancer has superior sensitivity to multimodal treatment therefore our results may support
that upper third location is not an unfavorable prognostic factor any more.
KeywordsComplete response-Locally advanced tumor-Neoadjuvant therapy-Squamous cell oesophageal cancer
- SourceAvailable from: Björn L.D.M. Brücher[show abstract] [hide abstract]
ABSTRACT: To analyze the changing pattern in tumor type and postoperative deaths at a national referral center for esophageal cancer in the Western world and to assess prognostic factors for long-term survival after resection. During the past two decades, the epidemiology and treatment strategies of esophageal cancer have changed markedly in the Western world. The influence of these factors on postoperative deaths and long-term prognosis has not been adequately evaluated. Between 1982 and 2000, 1,059 patients with primary esophageal squamous cell cancer or adenocarcinoma had resection with curative intention at a single center. Patient and tumor characteristics and details of the surgical procedure and outcome were documented during this period. Follow-up was available for 95.8% of the patients. Changing patterns in tumor type and postoperative deaths were analyzed. Prognostic factors for long-term survival were assessed by multivariate analysis. The prevalence of adenocarcinoma in patients with resected esophageal cancer increased markedly during the study period. The postoperative death rate decreased from about 10% before 1990 to less than 2% since 1994, coinciding with the introduction of a procedure-specific composite risk score and exclusion of high-risk patients from surgical resection. In addition to the well-established prognostic parameters, tumor cell type "adenocarcinoma" was identified as a favorable independent predictor of long-term survival after resection. The independent prognostic effect of tumor cell type persisted in the subgroups of patients with primary resection and patients with primary resection and R0 category. Esophagectomy for esophageal cancer has become a safe procedure in experienced hands. Esophageal adenocarcinoma has a better long-term prognosis after resection than squamous cell carcinoma.Annals of Surgery 10/2001; 234(3):360-7; discussion 368-9. · 6.33 Impact Factor
Article: Gastrointestinal cancers in Europe.Alimentary Pharmacology & Therapeutics 12/2003; 18 Suppl 3:7-30. · 4.55 Impact Factor
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ABSTRACT: A pilot study of 43 patients with potentially resectable esophageal carcinoma treated with an intensive regimen of preoperative chemoradiation with cisplatin, fluorouracil, and vinblastine before surgery showed a median survival of 29 months in comparison with the 12-month median survival of 100 historical controls treated with surgery alone at the same institution. We designed a randomized trial to compare survival for patients treated with this preoperative chemoradiation regimen versus surgery alone. One hundred patients with esophageal carcinoma were randomized to receive either surgery alone (arm I) or preoperative chemoradiation (arm II) with cisplatin 20 mg/m2/d on days 1 through 5 and 17 through 21, fluorouracil 300 mg/m2/d on days 1 through 21, and vinblastine 1 mg/m2/d on days 1 through 4 and 17 through 20. Radiotherapy consisted of 1.5-Gy fractions twice daily, Monday through Friday over 21 days, to a total dose of 45 Gy. Transhiatal esophagectomy with a cervical esophagogastric anastomosis was performed on approximately day 42. At median follow-up of 8.2 years, there is no significant difference in survival between the treatment arms. Median survival is 17.6 months in arm I and 16.9 months in arm II. Survival at 3 years was 16% in arm I and 30% in arm II (P = .15). This study was statistically powered to detect a relatively large increase in median survival from 1 year to 2.2 years, with at least 80% power. This randomized trial of preoperative chemoradiation versus surgery alone for patients with potentially resectable esophageal carcinoma did not demonstrate a statistically significant survival difference.Journal of Clinical Oncology 02/2001; 19(2):305-13. · 18.04 Impact Factor