National Cancer Institute®
Last Modified: April 1, 2002
UI - 11686031
AU - Aiba K
TI - Upper gastrointestinal tumors.
SO - Cancer Chemother Biol Response Modif 2001;19():535-45
AD - Japanese Foundation for Cancer Research, Cancer Chemotherapy Center, Kami-Ikebukuro 1-37-1, Toshima-ku, Tokyo 170-8455, Japan.
UI - 11750229
AU - Stein HJ; Brucher BL; Sendler A; Siewert JR
TI - Esophageal cancer: patient evaluation and pre-treatment staging.
SO - Surg Oncol 2001 Nov;10(3):103-11
AD - Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universitat Munchen, Ismaningerstr. 22, D-81675, Munchen, Germany. email@example.com
Improvements in the overall survival of patients with esophageal cancer can in the future only be achieved by tailored therapeutic strategies which are based on the individual histologic tumor type, tumor location, tumor stage at the time of presentation, consideration of established prognostic factors and the physiologic status of the patient. The major aim of every diagnostic strategy is to assess whether a complete macroscopic and microscopic tumor resection (i.e. an R0 resection) can be achieved by primary surgical approach with a high degree of likelihood. This requires histologic classification of the tumor type (squamous cell cancer or adenocarcinoma), the exclusion of distant solid organ metastases, localization of the primary tumor in relation to the tracheobronchial tree, and determination of the T-category and the surrounding structures of the primary tumor. This is currently achieved by a combination of contrast radiography, endoscopy with biopsy, endoscopic ultrasonography and CT scan. PET scanning will in the future be more widely used in esophageal cancer staging because it appears to be superior to current imaging modalities in the exclusion of distant solid organ and lymph node metastases and allows early assessment of response of the primary tumor to neoadjuvant treatment. Systematic risk analysis with a dedicated composite scoring system is essential to assess the physiologic status of the patient and reduce postoperative mortality. Only hospitals with a sufficient case load of esophageal cancer patients ('hospital volume') and a dedicated interest in the management of this disease ('centers of excellence') can provide the required expertise and standards for patient evaluation and tailored therapy.
UI - 11750230
AU - Lerut T; Coosemans W; Decker G; De Leyn P; Nafteux P; Van Raemdonck D
TI - Cancer of the esophagus and gastro-esophageal junction: potentially curative therapies.
SO - Surg Oncol 2001 Nov;10(3):113-22
AD - Department Thoracic Surgery, Catholic University Leuven, U.Z. Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium. firstname.lastname@example.org
The definition of potential curative tumors of the esophagus and gastro-esophageal junction remains problematic. This is due to a lack of accuracy in clinical staging despite recent advances in CT, endoscopic ultrasonography (EUS), positron emission tomography scan and minimally invasive staging modalities. As a result much controversy persists regarding indications for surgery and extent of resection and lymphadenectomy. Today surgery with curative option results in five-year survival of over 30%. Multimodality regimens, especially neoadjuvant chemoradiotherapy, seem to be beneficial in patients with a complete response on pathologic staging. Other indications are investigational and should be studied within carefully monitored study protocols. In early carcinoma T(is)-T(1a) endoluminal ablation technique seem to open promising perspectives provided of discrimination between T(is)-T(1a) and T(1b) can be made by the use of 20mhz EUS probes.
UI - 11750232
AU - Blazeby JM
TI - Measurement of outcome.
SO - Surg Oncol 2001 Nov;10(3):127-33
AD - University Division of Surgery, Bristol Royal Infirmary, Level 7, BS2 8HW, Bristol, UK. email@example.com
The outcomes of treatment of oesophageal cancer include traditional biological and physical measures, such as mortality and morbidity data, disease free and overall survival, clinical and pathological response rates and symptom control. Such factors are essential and should be recorded prospectively for clinical audit. Using this type of information alone to evaluate effectiveness of treatment is inadequate, however, because the diagnosis and treatment of oesophageal cancer has a major impact on functional well-being (including psycho-social function), general health perceptions and overall quality of life (QL)/satisfaction with health and health care. These aspects of patients' well-being need to be considered, in addition to standard outcomes in the evaluation of treatment of oesophageal cancer. Recent needs to judge the economic efficiency of health care by comparing health outcomes with costs may also be part of treatment appraisal. This article reviews surgical, oncological, patient-based and economic outcomes in oesophageal cancer.
UI - 11750227
AU - Pera M; Pera M
TI - Recent changes in the epidemiology of esophageal cancer.
SO - Surg Oncol 2001 Nov;10(3):81-90
AD - Service of Gastrointestinal Surgery, Institute of Digestive Diseases, IDIBAPS-Institut d'Investigacions Biomediques August Pi i Sunyer, Hospital Clinic, University of Barcelona Medical School, Barcelona, Spain. firstname.lastname@example.org
UI - 11803146
AU - Geh JI
TI - The use of chemoradiotherapy in oesophageal cancer.
SO - Eur J Cancer 2002 Jan;38(2):300-13
AD - The Cancer Centre at the Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK. email@example.com
The results of treatment for oesophageal carcinoma remain poor and few patients are curable by surgery alone. The use of chemoradiotherapy (CRT) given as a definitive treatment or in combination with surgery may improve locoregional control and survival, when compared with radiotherapy or surgery alone. Using the keywords "chemoradiotherapy" and "radiochemotherapy", a Medline-based literature review (1980-2001) was performed. Additional literature was obtained from original papers and published meeting abstracts. Two-year survival rates of 28-72% in squamous cell carcinoma and 14-29% in adenocarcinoma from definitive CRT were reported. This is comparable to results achievable by surgery alone. The use of preoperative CRT followed by surgery may further improve survival, but current data are insufficient to justify this approach within routine clinical practice. Acute treatment-related toxicity is increased with CRT. In selected patients with localised unresectable oesophageal cancer, definitive CRT is recommended. There are uncertainties about the role of routine surgery following CRT in patients with resectable disease. For the future, the pretreatment staging of patients needs to be improved and standardised, the optimal CRT regimen needs to be defined and the role of predictive markers for CRT response needs to be developed.
UI - 11875723
AU - Polee MB; Eskens FA; van der Burg ME; Splinter TA; Siersema PD; Tilanus
TI - HW; Verweij J; Stoter G; van der Gaast A Phase II study of bi-weekly administration of paclitaxel and cisplatin in patients with advanced oesophageal cancer.
SO - Br J Cancer 2002 Mar 4;86(5):669-73
AD - Department of Medical Oncology, University Hospital Rotterdam-Dijkzigt, Rotterdam, The Netherlands.
In a phase I study we demonstrated the feasibility of a bi-weekly combination of paclitaxel 180 mg x m(-2) with cisplatin 60 mg x m(-2). In this study we further assessed toxicity and efficacy of this schedule in the treatment of advanced cancer of the oesophagus or the gastro-oesophageal junction. Patients received paclitaxel 180 mg x m(-2) administered over 3 h followed by a 3-h infusion of cisplatin 60 mg x m(-2). Patients were retreated every 2 weeks unless granulocytes were <0.75x10(9) or platelets <75x10(9). Patients were evaluated after three and six cycles and responding patients received a maximum of eight cycles. Fifty-one patients were enrolled into the study. The median age was 56 years (range 32-78). WHO performance status were: 0 (19 patients); 1 (29 patients); 2 (three patients). All patients received at least three cycles of chemotherapy and all were evaluable for toxicity and response. Haematological toxicity consisted of uncomplicated neutropenia grade 3 in 39% and grade 4 in 31% of patients. Five patients (10%) were hospitalised, three patients because of treatment related complications and two patients because of infections without neutropenia. Sensory neurotoxicity was the predominant non-haematological toxicity; grade 1 and 2 neurotoxicity was observed in 43 and 20% of patients, respectively. Response evaluation in 51 patients with measurable disease: complete response 4%, partial response 39%, stable disease 43% and progressive disease in 14% of the patients. The median duration of response was 8 months. The median survival for all patients was 9 (range 2-29+) months and the one-year survival rate was 43%. Four patients who received additional local treatment (two patients surgery and two patients radiotherapy) are still disease free after a follow-up of 20-29 months. This bi-weekly treatment of paclitaxel and cisplatin is well tolerated by patients with advanced oesophageal cancer. The toxicity profile of this regimen compares favourable to that of previously used cisplatin- and paclitaxel-based regimens. Trials are underway evaluating this bi-weekly regimen in a neo-adjuvant setting. Copyright 2002 Cancer Research UK
UI - 11900221
AU - Bidoli P; Bajetta E; Stani SC; De CD; Santoro A; Valente M; Zucali R;
TI - Valagussa P; Ravasi G; Bonadonna G Ten-year survival with chemotherapy and radiotherapy in patients with squamous cell carcinoma of the esophagus.
SO - Cancer 2002 Jan 15;94(2):352-61
AD - Division of Medical Oncology B, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy. firstname.lastname@example.org
BACKGROUND: The effects of multimodality treatment on the survival of patients with esophageal carcinoma are unclear. The authors performed a prospective, Phase II study to assess the long-term results of chemotherapy plus radiotherapy (RT) on patients with esophageal squamous cell carcinoma. METHODS: Of 106 consecutive patients who were recruited between 1985 and 1992, 101 patients were evaluable. Cisplatin (100 mg/m2 per day) on Day 1 and fluorouracil (1000 mg/m2 per day) on Days 1-4 were given for two cycles, with concomitant RT (30 grays [Gy] in 15 fractions) over 19 days. Patients with potentially resectable tumors were then assessed for curative surgery; the other patients received two more courses of chemotherapy and further RT (20 Gy in 10 fractions). RESULTS. Of 40 patients who were candidates for surgery, 32 patients underwent surgery, and 24 patients had complete resection; 8 patients (25%) had no residual tumor in the specimen, and 12 patients (37%) had microscopic foci only. Surgical mortality was high (22%). Of 61 nonsurgical patients, 37 patients (61%) achieved complete clinical remission, and 14 patients (23%) achieved partial remission. The median survival for the entire series was 15 months (range, 1-136 months). The overall survival rate was 22% at 5 years and 12% at 10 years. At 10 years, freedom from disease progression was similar in the two groups (24%), whereas the median survival (22 months vs. 12 months) and the overall survival rates (17% vs. 9%) were better in nonsurgical patients compared with surgical patients, respectively, probably in relation to high surgical mortality. The larynx was preserved in 28% of 32 patients with cervical disease sites, with a 10-year disease free survival rate of 31%. Three deaths were attributed to nonsurgical treatments. CONCLUSIONS. Careful multidisciplinary pretreatment evaluation can identify patients who are ineligible for surgery without compromising long-term results. For patients with inoperable disease, chemoradiotherapy can produce relatively good long-term results. The combined approach without surgery can permit laryngeal preservation in a useful fraction of patients.
UI - 11900242
AU - Araki K; Ohno S; Egashira A; Saeki H; Kawaguchi H; Sugimachi K
TI - Pathologic features of superficial esophageal squamous cell carcinoma with lymph node and distal metastasis.
SO - Cancer 2002 Jan 15;94(2):570-5
AD - Department of Surgery and Science, Faculty of Medicine, Kyushu University, Fukuoka, Japan. email@example.com
BACKGROUND: Endoscopic mucosal resection (EMR) is a less invasive localized treatment for patients with esophageal carcinoma. However, indications for EMR use in cases of superficial esophageal carcinoma are controversial. The authors evaluated histopathologic risk factors for lymph node metastasis and recurrence. METHODS: In the specimens resected, the authors examined depth, the superficial area and the area attached to or infiltrating the lamina muscularis mucosa. RESULTS: The authors found that the superficial area and the attached or infiltrated area reflected the depth of the tumor. However, there was a recurrence of esophageal carcinoma even in m3 cases attached only to the lamina muscularis mucosa. CONCLUSIONS: The authors concluded that ml and m2 esophageal carcinoma had almost no risk of lymph node metastasis and recurrence no matter how extensive the superficial area. In addition, sm2 and sm3 carcinoma have a high frequency of lymph node metastasis and recurrence. M3 and sm1 carcinoma run the risk of lymph node metastasis and recurrence however small the superficial area and the area attached to or infiltrating the lamina muscularis mucosa. Treatment strategies for patients with superficial esophageal carcinoma, including EMR, should take the above findings into account.
UI - 11845368
AU - Javaid B; Watt P; Krasner N
TI - Photodynamic therapy (PDT) for oesophageal dysplasia and early carcinoma with mTHPC (m-tetrahydroxyphenyl chlorin): a preliminary study.
SO - Lasers Med Sci 2002;17(1):51-6
AD - Aintree Centre for Gastroenterology and Liver Disease, University Hospital Aintree, Liverpool, UK.
Barrett's oesophagus is a premalignant condition in which stratified squamous type mucosa of the normal oesophagus is replaced by specialised intestinal type columnar mucosa. Oesophageal resection was previously considered to be the treatment of choice for high-grade dysplasia or superficial carcinoma arising in this columnar-lined mucosa. We treated four patients with Barrett's oesophagus and high-grade dysplasia, and one patient with superficial oesophageal carcinoma with photodynamic therapy (PDT) using an argon-pumped dye laser light (652 nm). PDT was also delivered using a xenon arc lamp (Paterson lamp, light 652 nm +/- 15 nm) in two patients with Barrett's oesophagus and high-grade dysplasia. mTHPC (m-tetrahydroxyphenyl chlorin) 0.15 mg/kg was used as a photosensitiser in all the patients. We have been able to demonstrate the elimination of columnar-lined oesophageal mucosa, reduction in the length of the Barrett's segment or downgrading of the dysplasia in all of the patients. There is no evidence of recurrence in the patient who had oesophageal carcinoma, at 27 months follow-up. We conclude that mTHPC is useful as a photosensitiser for PDT in the management of Barrett's oesophagus with high-grade dysplasia or superficial carcinoma and the Paterson lamp is a potential alternative light source for PDT.
UI - 11904306
AU - Gupta RA; DuBois RN
TI - Cyclooxygenase-2 inhibitor therapy for the prevention of esophageal adenocarcinoma in Barrett's esophagus.
SO - J Natl Cancer Inst 2002 Mar 20;94(6):406-7
UI - 11788885
AU - Obara K; Ghazizadeh M; Shimizu H; Arai R; Tenjin T; Suzuki S; Moriyama
TI - Y; Kawanami O Comparative genomic hybridization study of genetic changes associated with vindesine resistance in esophageal carcinoma.
SO - Int J Oncol 2002 Feb;20(2):255-60
AD - Center for Digestive Disease, Nippon Medical School Second Hospital, Kawasaki, Kanagawa 211-8533, Japan. firstname.lastname@example.org
The acquisition of drug-resistance is a major problem for cancer patients undergoing chemotherapy. To clarify genetic alterations in cancer cells that develop drug-resistance, comparative genomic hybridization (CGH) was applied to esophageal squamous cell carcinoma cell lines (SH-1V1, SH-1V2, SH-1V4 and SH-1V8) and chemoresistance-related genes in altered chromosomal regions were evaluated. These cell lines were derived from the parental SH-1 cell line, after multiple steps of selection by an increasing exposure to vindesine. SH-1V8 cells were strongly resistant to vindesine. DNA copy number at 16p which includes the MRP (multidrug resistance related protein) gene was markedly increased in all cell lines examined. Increased DNA copy numbers were found at the regions of 5q31-32, 10q11.1-23, and 14q32-qter in SH-1V8 cells that acquired resistance to other drugs as well. Both SH-1V4 and SH-1V8 showed increased DNA copy numbers at 7q11.1-22, 16q12.1-qter, 19p13.2-13.3, 19q11-13.2 and 20q13.1-qter. The chromosomal region of 7q11.1-22 including MDR-1 (multidrug resistance-1) gene was highly amplified in SH-1V4 and SH-1V8. Amplification of the MRP region suggests the prerequisite of developing resistance to vindesine, and further amplification of MDR-1 may play a critical role in acquiring drug-resistance. Several unknown genes related to the induction of chemoresistance might be concealed in other altered chromosomal regions.
UI - 11788891
AU - Kase S; Osaki M; Adachi H; Kaibara N; Ito H
TI - Expression of Fas and Fas ligand in esophageal tissue mucosa and carcinomas.
SO - Int J Oncol 2002 Feb;20(2):291-7
AD - First Department of Pathology, Faculty of Medicine, Tottori University, Tottori 683-8503, Japan. email@example.com
The Fas ligand (FasL) and its receptor Fas play a key role in the initiation of an apoptotic pathway. We describe the expression of Fas receptor and ligand pair antigens in surgical samples collected from a cohot of 89 patients compared with 89 squamous cell carcinomas (SCCs), 45 dysplasias and 42 normal mucosae of the esophagus. TUNEL method was performed in 89 SCCs. Evaluation of FasL on normal mucosae displayed a heterogeneous immunoreaction in a minority of specimens, whereas SCCs exhibited a more extended and homogeneous reactivity. Fas-positive carcinoma cells revealed frequent apoptosis. Furthermore, a significantly longer disease-free survival can be observed in patients with Fas-positive tumors than in Fas-negative carcinomas and in patients with FasL-negative tumors than in FasL-positive carcinomas. In conclusion, FasL expression may play an important role in tumor progression. On the other hand, Fas-expressing carcinoma cells were associated with frequent apoptosis. Both FasL and Fas expressions correlate with prognostic significance in esophageal SCCs.
UI - 11836677
AU - Zhang L; Xing D; He Z; Lin D
TI - [p53 gene codon 72 polymorphism and susceptibility to esophageal squamous cell carcinoma in a Chinese population]
SO - Zhonghua Yi Xue Yi Chuan Xue Za Zhi 2002 Feb;19(1):10-3
AD - Department of Pathology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 P. R. China.
OBJECTIVE: To investigate the relationship between p53 codon 72 polymorphism and susceptibility to esophageal squamous cell carcinoma in China. METHODS: The p53 genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism among 204 healthy controls and 91 patients with esophageal squamous cell carcinoma (ESCC). RESULTS: There was no significant difference between patients and controls with respect to allele frequency for the p53 Pro allele (0.480 versus 0.588, P=0.11); however, the Pro/Pro genotype of p53 among cases (39.6%) was significantly (P<0.05) more frequent than that among controls (21.1%). Subjects homozygous for the p53 Pro allele had a more than 2-fold increased risk of developing ESCC (OR=2.18; 95%CI=1.10-4.35, adjusted for age, sex, and smoking), whereas the Arg/Pro genotype was not associated with elevated risk of the cancer (adjusted OR=0.84; 95%CI=0.42-1.68). No interaction between smoking and Pro/Pro genotype was observed for risk of ESCC. CONCLUSION: The p53 codon 72 polymorphism may play a role in susceptibility to esophageal carcinogenesis.
UI - 11865364
AU - Sane S; Baba M; Kusano C; Shirao K; Yamada H; Aikou T
TI - Influence of exogenous fat emulsion on pulmonary gas exchange after major surgery.
SO - World J Surg 2002 Mar;26(3):297-302
AD - First Department of Surgery, Kagoshima University School of Medicine, 8-35-1, Sakuragaoka, Kagoshima 890-8520, Japan. firstname.lastname@example.org
The use of fat emulsion in total parenteral nutrition (TPN) is closely related to changes in respiratory function. The aim of this study was to evaluate the influence of exogenous fat emulsion on pulmonary gas exchange in the early period after major surgery. Total parenteral nutrition was administered to 18 patients for 6 days after esophagectomy for carcinoma. Half of the patients received glucose (glucose group), and the other half received glucose and fat (fat group). The fat emulsion was continuously infused for 24 hours over 6 days. Glucose utilization was significantly higher in the glucose group than in the fat group. Fat utilization was significantly higher in the fat group than in the glucose group. Carbon dioxide (CO2) production and respiratory quotient were significantly decreased in the fat group compared to the glucose group. There were no differences in the pulmonary vascular resistance index or alveolar-arterial difference in oxygen tension between the two groups. Although exogenous fat emulsion utilized as energy substrate decreases CO2 production after major surgery, it does not clinically influence the pulmonary hemodynamics or diffusion capacity.
UI - 11870157
AU - Minsky BD; Pajak TF; Ginsberg RJ; Pisansky TM; Martenson J; Komaki R;
TI - Okawara G; Rosenthal SA; Kelsen DP INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy.
SO - J Clin Oncol 2002 Mar 1;20(5):1167-74
AD - Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. email@example.com
PURPOSE: To compare the local/regional control, survival, and toxicity of combined-modality therapy using high-dose (64.8 Gy) versus standard-dose (50.4 Gy) radiation therapy for the treatment of patients with esophageal cancer. PATIENTS AND METHODS: A total of 236 patients with clinical stage T1 to T4, N0/1, M0 squamous cell carcinoma or adenocarcinoma selected for a nonsurgical approach, after stratification by weight loss, primary tumor size, and histology, were randomized to receive combined-modality therapy consisting of four monthly cycles of fluorouracil (5-FU) (1,000 mg/m(2)/24 hours for 4 days) and cisplatin (75 mg/m(2) bolus day 1) with concurrent 64.8 Gy versus the same chemotherapy schedule but with concurrent 50.4 Gy. The trial was stopped after an interim analysis. The median follow-up was 16.4 months for all patients and 29.5 months for patients still alive. RESULTS: For the 218 eligible patients, there was no significant difference in median survival (13.0 v 18.1 months), 2-year survival (31% v 40%), or local/regional failure and local/regional persistence of disease (56% v 52%) between the high-dose and standard-dose arms. Although 11 treatment-related deaths occurred in the high-dose arm compared with two in the standard-dose arm, seven of the 11 deaths occurred in patients who had received 50.4 Gy or less. CONCLUSION: The higher radiation dose did not increase survival or local/regional control. Although there was a higher treatment-related mortality rate in the patients assigned to the high-dose radiation arm, it did not seem to be related to the higher radiation dose. The standard radiation dose for patients treated with concurrent 5-FU and cisplatin chemotherapy is 50.4 Gy.
UI - 11875696
AU - Ke L; Yu P; Zhang ZX; Huang SS; Huang G; Ma XH
TI - Congou tea drinking and oesophageal cancer in South China.
SO - Br J Cancer 2002 Feb 1;86(3):346-7
AD - Preventive Branch, Shantou University Medical College, Shantou 515031, China. firstname.lastname@example.org
The study from a large hospital-based case-control for 1248 cases with oesophageal cancer and the same number of controls in South China showed that Congou, a grade of Chinese black tea, may protect against cancers of the oesophagus and reduce the risk of a combination of alcohol drinking and smoking (especially smoking), regardless of temperature when drinking. Copyright 2002 The Cancer Research Campaign
UI - 11911344
AU - Cucino C; Sonnenberg A
TI - Occupational mortality from squamous cell carcinoma of the esophagus in the United States during 1991-1996.
SO - Dig Dis Sci 2002 Mar;47(3):568-72
AD - The Department of Veterans Affairs Medical Center and The University of New Mexico, Albuquerque 87108, USA.
The epidemiology of esophageal squamous cell cancer has remained poorly understood. The occupational distribution of this cancer may provide clues about its yet unknown etiology. Data files from the National Center for Health Statistics (NCHS) of the United States offer a unique source to study causes of death, broken down by occupation and industry. The number of deaths from esophageal cancer was retrieved from the computerized US vital statistics. Mortality by occupation or industry was expressed as standardized proportional mortality ratio (PMR), adjusted by age, gender, and ethnicity. Between 1991 and 1996, 63,717 subjects died from esophageal squamous cell carcinoma. Mortality was particularly high among nonwhites and men. The industrial and the occupational distributions shared a similar pattern. Mortality from esophageal squamous cell carcinoma occurred more frequently among subjects exposed to silica dust, such as brickmasons and stonemasons, concrete and terrazzo finishers, roofers, and construction laborers. It was also high in such industries as unspecified machinery or manufacturing and such occupations as unspecified material handlers, janitors, or cleaners. It was low in industries and occupations associated with agriculture, clergy, work in religious organizations, and textiles. In conclusion, mortality from esophageal squamous cell carcinoma appeared to be low in occupations associated with less consumption of alcohol and tobacco. It was high among occupations potentially associated with exposure to silica dust and chemical solvents or detergents.
UI - 11908337
AU - Righini C; Mouret P; Wu D; Blanchet C; Reyt E
TI - [Is hepatic ultrasonography necessary in the initial check-up of patients with squamous cell carcinoma of the upper respiratory and digestive tract?]
SO - Ann Otolaryngol Chir Cervicofac 2001 Dec;118(6):359-64
AD - Service ORL, CHU de Grenoble, BP 217, 38043 Grenoble. CRighini@chu-grenoble.fr
PURPOSE OF THE STUDY: The purpose of our study was to determine the position and value of ultrasound scan of the liver in the initial check-up of patients treated for a squamous cell carcinoma of the upper respiratory and digestive tract. MATERIAL AND METHODS: Our study is based on a retrospective review of 267 patients (249 males and 18 females) managed in the E.N.T. Department of Grenoble universitary hospital from 1993 to 1995 for a upper respiratory and digestive tract malignant tumor. No patient has been previously treated. The site of the primary tumor was: the oropharynx (108 cases), the hypopharynx (88 cases), the oral cavity (44 cases), the larynx (20 cases), the rhinopharynx (6 cases) and the cervical oesophagus (1 case). Endoscopic procedure with biopsy was performed for all the patients. Histologic examination revealed an invasive squamous cell carcinoma in all the cases. The complete check up included a ultrasound scan of the liver and a chest X-ray for all the patients. RESULTS: Ultrasound scan of the liver revealed one or several metastases in 4 cases (1.5%). The primary tumor was hypopharyngeal in 3 cases (2 stages III, 1 stage IV) and oropharyngeal in 1 case (stage III). In three cases, carcinoma was poorly differentiated. Ultrasound scan of the liver was doubtful for 8 patients (3%). The primary tumor was oropharyngeal in 6 cases (1 stage I, 3 stages III, 2 stages IV), laryngeal in 1 case (stage III) and hypopharyngeal in case (stage IV). In six cases carcinoma was well differentiated. All the complementary examinations concluded to a benign liver disease, with a mean diagnosis delay of 4 weeks for the 8 patients. The mean follow-up duration of the 8 patients was 22 months (range 9 to 42 months). None presented any metastases during the follow up. CONCLUSION: Our results compared with those of the literature revealed that ultrasound scan of the liver is a few specific examination which may be recommended for hypopharyngeal tumors, or for a large cervical adenopathy (N2 or N3), a poor differentiated tumor wherever the site of the primary tumor is.
UI - 11869316
AU - Blant SA; Ballini JP; Caron CT; Fontolliet C; Monnier P; Laurini NR
TI - Evolution of DNA ploidy during squamous cell carcinogenesis in the esophagus.
SO - Dis Esophagus 2001;14(3-4):178-84
AD - Institute of Pathology University of Lausanne, CH-1011, Lausanne, Switzerland. email@example.com
Image and flow cytometry was used to study the nuclear DNA content (ploidy) during the squamous cell carcinogenesis in the esophagus. The present retrospective study comprised 26 surgical specimens of squamous cell carcinomas (SCC) in patients who underwent surgery alone at the lymph node metastases. Diploid DNA histogram patterns were observed in all non-pathologic tissues analyzed, either distant or proximal to the lesion. Aneuploidy was observed in 30 (70%) of 43 lesions; 20 (62.5%) of 32 early squamous-cell carcinomas; and 10 (91%) of 11 advanced carcinomas. In patients with various tumor stages or with multicentric synchronous or metachronous tumors, DNA content was not different among different tumor stages. Four of six lymph node metastases had the same DNA content as the primary tumor. In four patients, discordance between image and flow cytometry analysis was observed for malignant lesions only. Ploidy status was not statistically associated with the differentiation of the tumor, but it was associated with the stage of tumor (P < 0.001). These findings suggest that early malignant changes in the esophagus are already associated with alteration in DNA content, and aneuploidy tends to correlate with progression to invasive SCC. This cell kinetic information could help clinicians in selecting the optimal treatment for the individual patient.
UI - 11869317
AU - Fagundes RB; Mello CR; Tollens P; Putten AC; Wagner MB; Moreira LF;
TI - Barros SG p53 protein in esophageal mucosa of individuals at high risk of squamous cell carcinoma of the esophagus.
SO - Dis Esophagus 2001;14(3-4):185-90
AD - Gastroenterology Service, Pathology Department of the Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, RS, Brazil. firstname.lastname@example.org
Squamous cell carcinoma of the esophagus (SCCE) is diagnosed late and carries a poor prognosis. Biomarkers such as p53 protein expression may be present in the esophageal mucosa long before esophageal symptoms or lesions appear and may point toward early diagnosis. Asymptomatic subjects at high risk for SCEE (consumption of more than 80 g of ethanol and 10 cigarettes/day for at least 10 years) underwent upper gastrointestinal endoscopy with biopsies of the esophageal mucosa, and expression of p53 protein was compared with conventional histologic findings. In 182 subjects studied, p53 protein was expressed in a stepwise fashion according to the severity of the histologic findings: normal mucosa (12/103 or 11.7%), mild chronic esophagitis (6/43 or 14%), moderate chronic esophagitis (4/18 or 22.2%), severe chronic esophagitis (1/3 or 33.3%), low-grade dysplasia (4/11 or 36.4%), high-grade dysplasia (2/2 or 100%), and squamous cell carcinoma (2/2 or 100%) (P=0.00025). The odds ratio and confidence intervals were calculated by logistic regression, with multivariate adjustment for potentially confounding variables. The risk for p53 expression was twofold for moderate and severe chronic esophagitis and 10-fold for dysplasia and cancer (P=0.001). p53 protein was expressed not only in cancerous lesions, high-grade and low-grade dysplasia, as expected, but also in mucosa considered normal or with chronic esophagitis using conventional histology. Smokers and alcohol drinkers with normal mucosa or chronic esophagitis that express p53 protein may represent an unrecognized subgroup of individuals that may benefit from surveillance. Follow-up studies of these asymptomatic subjects and molecular analysis of the p53 gene are needed to clarify this point.
UI - 11869318
AU - Shiozaki H; Yano M; Tsujinaka T; Inoue M; Tamura S; Doki Y; Yasuda T;
TI - Fujiwara Y; Monden M Lymph node metastasis along the recurrent nerve chain is an indication for cervical lymph node dissection in thoracic esophageal cancer.
SO - Dis Esophagus 2001;14(3-4):191-6
AD - Department of Surgery and Clinical Oncology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
This study examined whether recurrent nerve chain node metastasis serves as an indicative factor for cervical lymph node dissection in thoracic esophageal cancer. The association of recurrent nerve chain lymph node metastasis and cervical node metastasis was analyzed for 91 patients with thoracic esophageal cancer who had undergone three-field lymph node dissection. In patients with upper thoracic esophageal cancer, the incidence of cervical lymph node metastasis was similar regardless of recurrent nerve chain node metastasis. On the other hand, in patients with middle or lower esophageal cancer, the incidence was significantly higher in recurrent nerve-positive (16/31, 51.6%) than in recurrent nerve-negative (5/43, 11.6%) patients. The prognosis of patients with recurrent nerve chain node metastasis was significantly better in the three-field dissection group than in the two-field dissection group, while in patients with no recurrent nerve chain node metastasis, survival was similar between the two groups. In conclusion, cervical lymphadenectomy can be omitted for recurrent nerve chain node-negative patients with middle and lower thoracic esophageal cancer.
UI - 11869319
AU - Ikeda K; Ishida K; Sato N; Koeda K; Aoki K; Kimura Y; Iwaya T; Ogasawara
TI - S; Iijima S; Nakamura R; Uesugi N; Maesawa C; Saito K Chemoradiotherapy followed by surgery for thoracic esophageal cancer potentially or actually involving adjacent organs.
SO - Dis Esophagus 2001;14(3-4):197-201
AD - Department of Surgery 1, Iwate Medical University, Morioka, Japan. email@example.com
The objective of this study was to evaluate the therapeutic usefulness of chemoradiotherapy (CRT) followed by surgery in patients with clinically T4 (cT4) esophageal cancer involving adjacent organs such as the trachea, main bronchi, and large vessels. Thirty-seven patients with cT4 squamous cell carcinoma of the thoracic esophagus were enrolled in this study. The CRT regimen comprised cisplatin (70 mg/m2) on day 1, 5-fluorouracil (700 mg/m2) on days 1-4 and external irradiation (200 cGy/day, total 30 Gy) on either days 8-26 (sequential schedule, n=15) or days 1-19 (concurrent schedule, n022). Two courses of CRT were given. The results of CRT were complete response in nine patients, partial response in 19, no change in three (minor response in two), and progressive disease in six patients. The median response duration in all responders was 172 days (range: 56-2469, n=19). After CRT, 13 patients received surgery. In 12 of these patients, tumors were completely resected. Histopathologic examination of the resected specimen revealed a discrepancy between clinical response and histopathologic effect. The median duration of survival and the 1-, 2- and 5-year survival rates were 304 days (84-3155), 45%, 35% and 23% in all patients, respectively, 866 days (190-3155), 83%, 83% and 57% in the 13 patients whose tumors were resected, and 187 days (84--2630), 25%, 5% and 5% in the 24 patients whose tumors were not resected. Grade 3 toxicity, especially hematological reactions, was noted in 13.5% (5/37) of the patients. There was one toxicity-related death (sepsis). A good outcome may be obtained with CRT, followed by surgery when feasible. However, CRT can cause toxic reactions, and close monitoring of patients is required.
UI - 11869320
AU - Chan R; Morrill S; Freeman D Jr; Colman M; Zwischenberger J
TI - Bi-modality (chemo-radiation) versus tri-modality (chemo-radiation followed by surgery) treatment for carcinoma of the esophagus.
SO - Dis Esophagus 2001;14(3-4):202-7
AD - Department of Radiation Oncology, University of Texas Medical Branch at Galveston, Galveston, TX 77555-0711, USA. firstname.lastname@example.org
The purpose of the study was to investigate the difference in overall survival in patients with localized carcinoma of esophagus treated using chemo-radiation (bi-modality, BM) or chemo-radiation followed by surgery (tri-modality, TM). From 1981 to 1999, 65 patients were identified who had localized carcinoma of the esophagus treated with either concurrent chemo-radiation (BM, n=22) or concurrent chemo-radiation followed by surgery (TM, n=43) at the University of Texas Medical Branch at Galveston. All 65 patients received concurrent chemotherapy and external beam radiation. Radiation was delivered by linear accelerators (greater-than-or-equal 6 MV), except in one patient who had part of his treatment given by a Co-60 machine. Chemotherapy consisted of 5-fluorouracil and cisplatin plus minus vinblastine under different regimens. Median follow-up time was 10 months (range=1-195 months) for all patients. Of the 14 patients still alive, the median follow-up time was 32 months (range=2-192 months). No difference in overall survival was detected between the two treatment groups, BM vs. TM (P=0.394) despite a selection bias favoring the TM group. Five-year survival rates of the BM and TM groups were 17% and 18%, respectively; 10-year survival rates were 17% and 12%, respectively. The presence of significant past medical history (P=0.017) and a complete pathologic response in the TM