Management of Advanced-Stage Operable Esophageal Cancer

Division of Cardiothoracic Surgery, Washington University School of Medicine, Saint Louis, 3108 Queeny Tower, One Barnes-Jewish Hospital Plaza, St Louis, MO 63110-1013, USA.
Surgical Clinics of North America (Impact Factor: 1.88). 10/2012; 92(5):1179-97. DOI: 10.1016/j.suc.2012.07.012
Source: PubMed


The incidence of esophageal cancer is increasing in the developed world, with a relative increase in adenocarcinoma compared with squamous cell carcinoma. The distensible nature of the esophagus results in delayed development of symptoms associated with esophageal cancer; hence many patients have locally advanced or metastatic cancer at the time of initial presentation. Although resection remains the treatment of choice for early-stage esophageal cancer, the best treatment strategy for locally advanced esophageal cancer is debatable and, consequently, varies at different centers. This article discusses the published literature on various available therapeutic options for the treatment of locally advanced esophageal cancer.

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    • "There has not yet been a report on the establishment of an esophageal carcinoma model with VX2 fragments because it is more difficult to implant fragments than whole cells into the wall of the esophagus. The necessary open surgery for the implantation of VX2 fragments is more traumatic than whole cell implantation, and it risks post-surgical complications [23], [24]. As an alternative, the endoscopic method is a minimally invasive procedure but increases the incidence of esophageal perforation when using large needles to implant the VX2 fragments. "
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    ABSTRACT: This study was undertaken to establish a rabbit esophageal tumor model for mimicking human esophageal squamous carcinoma (ESC) by endoscopic and surgical implantation of VX2 tumors. Fragments of a VX2 tumour were endoscopically implanted in the submucosal layer of the thoracic esophagus of 32 New Zealand white rabbits, while 34 animals received surgical implantation into the muscular layer. Then, the animals were studied endoscopically and pathologically. The safety and efficiency of the two methods and the pathological features of the animal models were analyzed. Both the endoscopic and the surgical method had a relatively high success rate of tumor implantation [93.7% (30/32) vs. 97.1% (33/34)] and tumor growth [86.7% (26/30) vs. 81.8% (27/33)], and the variation in the results was not statistically significant (P>0.05). Compared with those produced by the surgical method, the models produced by the endoscopic method had a higher rate of severe esophageal stricture [61.5% (16/26) vs. 29.6% (8/27)] and of intra-luminal tumor growth [73.1% (19/26) vs. 37.0% (10/27)], and had a lower rate of tumor invasion of adjacent organs [53.8% (14/26) vs. 81.5% (22/27)]; all of these results were statistically significant (P<0.05). However, the difference in the survival time and the rates of tumor regional/distant metastasis [38.5% (10/26) vs. 51.8% (14/27)] between the two methods were not statistically significant (P>0.05). The endoscopic and surgical methods are both safe and effective for establishment of VX2 tumors in the rabbit esophagus. The models produced by the two methods have different pathologic features mimicking that of human ESC. We recommend the models for studies on surgical procedures and minimally invasive treatments.
    PLoS ONE 01/2014; 9(1):e85326. DOI:10.1371/journal.pone.0085326 · 3.23 Impact Factor
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    ABSTRACT: Introduction: The treatment for esophageal squamous cell carcinoma (SCC) depends on its etiology. For mucosal cancer, endoscopic resection is standard; while for locally advanced cancer, esophagectomy is the main treatment. When the tumor is more advanced, neoadjuvant or adjuvant therapy is added. For unresectable cancer, concurrent chemoradiotherapy is the standard therapy. Areas covered: The standard chemotherapy for esophageal SCC is a cisplatin- and 5-fluorouracil (CF)-based regimen. Chemoradiotherapy (CRT) is the standard treatment for unresectable esophageal SCC and is also an option for resectable tumors. For patients who are inoperable, concurrent CRT should be the standard of care. Docetaxel, cisplatin and 5-fluorouracil (DCF) therapy is a promising candidate for chemotherapy with or without radiotherapy because an excellent local control rate and pathological remission rate have been reported. Although salvage surgery after definitive CRT is a practical treatment, judicious patient selection is crucial. Expert opinion: Presently, the standard regimen for esophageal SCC is CF. DCF is expected to be the next standard regimen. In the near future, some new therapeutic options, such as molecular targeted therapy or particle beam therapy, may confer further advantages. A thorough understanding of these therapeutic modalities is important to achieve this endeavor.
    Expert Opinion on Pharmacotherapy 05/2013; 14(10). DOI:10.1517/14656566.2013.801454 · 3.53 Impact Factor
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    ABSTRACT: The members of the microRNA (miR)-17-92 cluster have been reported to be highly expressed in several cancers. However, whether their expression is associated with clinicopathologic factors, the prognosis of patients in esophageal squamous cell carcinoma (ESCC) remains unknown. Using SYBR green real-time quantitative reverse transcription polymerase chain reaction, we detected the expression of members of the miR-17-92 cluster, including miR-17, miR-18a, miR-19a, miR-20a, miR-19b, and miR-92a, in 105 surgical specimens from ESCC patients. We then investigated their impact on clinicopathologic factors and survival. All six members of the miR-17-92 cluster had a significantly higher level of expression in the 105 ESCC tissue specimens than in normal esophageal mucosa (p < 0.05). The miR-18a expression positively correlated with tumor stage (p = 0.025). Meanwhile, miR-92a expression positively correlated with clinical stage (p = 0.022), and miR-19b expression positively correlated with tumor size (p = 0.005), lymph node metastasis (p = 0.040), and clinical stage (p = 0.011). The overexpression of miR-17a was correlated positively with lymph node metastasis (p = 0.035) and clinical stage (p = 0.022). MiR-18a, miR-17, and miR-19a were prognostic indicators for progression-free survival and overall survival. both in univariate analysis and in multivariate analysis. This study suggests that miR-17, miR-18a, and miR-19a can serve as potential unfavorable prognostic biomarkers in ESCC which are associated with some clinicopathologic factors. However, the regulatory pathway associated with potential candidate miRNAs remains to be explored.
    The Annals of thoracic surgery 12/2013; 97(3). DOI:10.1016/j.athoracsur.2013.10.042 · 3.85 Impact Factor

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