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NCI CANCERLIT^® Search: Esophageal Neoplasms - July 2002

National Cancer Institute^®
Last Modified: July 1, 2002

Magnifying endoscopy, stereoscopic microscopy, and the microvascular architecture of superficial esophageal carcinoma.
Optimization of the diameter of a radial irradiation device for photodynamic therapy in the esophagus.
Esophageal intramural metastasis from adenocarcinoma of the gastroesophageal junction.
A phase I clinical trial of sequentially administered doxorubicin and topotecan in refractory solid tumors.
Significance of cyclin B1 expression as an independent prognostic indicator of patients with squamous cell carcinoma of the esophagus.
Prognostic significance of elevated cyclooxygenase 2 expression in patients with adenocarcinoma of the esophagus.
Occult lymph node metastases as a predictor of tumor relapse in patients with node-negative esophageal carcinoma.
[Barrett esophagus and inflammation of gastroesophageal junction]
[Malign complication of gastroesophageal reflux: adenocarcinoma of esophagus and gastric cardia]
Tea chemicals confirmed as cancer-busting compounds.
Oxaliplatin in combination with protracted-infusion fluorouracil and radiation: report of a clinical trial for patients with esophageal
Use of minimally invasive oesophagectomy for cancer of the oesophagus.
[Current status of nuclear medicine. Clinical application of FDG-PET for cancer diagnosis. Esophageal cancer]
Esophageal cancer. Facts, figures, and screening.
Multicentric occurrence of esophageal cancer after gastrectomy: a preliminary report.
Probabilities for a probabilistic network: a case study in oesophageal cancer.
Outcome for malignant tracheobronchial stenoses in esophageal cancer.
[Molecular alterations in esophageal cancer]
[Importance of the Barrett esophagus in the development of esophageal adenocarcinoma]
Upper endoscopy as a screening and surveillance tool in esophageal adenocarcinoma: a review of the evidence.
Small adenocarcinomas of the esophagogastric junction: association with intestinal metaplasia and dysplasia.
The approach to high grade dysplasia in Barrett's esophagus.
Artificial neural networks and gene filtering distinguish between global gene expression profiles of Barrett's esophagus and esophageal cancer.
Systematic review of endoscopic ultrasound in gastro-oesophageal cancer.
I've heard that chronic heartburn can lead to esophageal cancer. How commonly does heartburn progress to cancer, and can it be prevented?
[Clinical observation on effect of yiqi huoxue decoction in comprehensive treatment on advanced stage of esophageal cancer]
Carcinoma of esophagus: radiologic diagnosis and staging.
Gastroesophageal junction adenocarcinoma.
Spectrum of genetic changes in gastro-esophageal cancer cell lines determined by an integrated molecular cytogenetic approach.
Gene amplification and protein overexpression of c-erb-b2 in Barrett carcinoma and its precursor lesions.
Changing disease burden and management issues for esophageal cancer in the Asia-Pacific region.
Endoscopic mucosal resection for esophageal and gastric cancers.
Oesophageal cancer surgery.
[Current epidemiology of carcinoma of the esophagus and cardia in Germany]
[Analysis of telomerase activity in esophageal carcinoma using microdissection telomeric repeat amplification protocol assay]
Diagnosis and management of a mediastinal leak following radical oesophagectomy (Br J Surg 2001; 88: 1346-51).
Improved survival in both histologic types of oesophageal cancer in Sweden.
Chemoradiotherapy of esophageal cancer.
Paratracheal lymph node metastasis is associated with cervical lymph node metastasis in patients with thoracic esophageal squamous cell
Percutaneous endoscopic gastrostomy for nutrition in patients with oesophageal cancer.
A single-institution experience with concurrent capecitabine and radiation therapy in gastrointestinal malignancies.
Improving the consistency in cervical esophageal target volume definition by special training.
The expression of murine double minute 2 is a favorable prognostic marker in esophageal squamous cell carcinoma without p53 protein
Association of prediagnosis endoscopy with stage and survival in adenocarcinoma of the esophagus and gastric cardia.
All that glitters is not gold.
Outcomes of simultaneous resection of synchronous esophageal and extraesophageal carcinomas.
Prognostic value of cyclin B1 in patients with esophageal squamous cell carcinoma.
Expression of heat shock protein 70 in grossly resected esophageal squamous cell carcinoma.
Postesophagectomy morbidity, mortality, and length of hospital stay after preoperative chemoradiation therapy.
Clinical significance of micrometastasis in lung and esophageal cancer: a new paradigm in thoracic oncology.
Isolation and characterization of a novel gene, hRFI, preferentially expressed in esophageal cancer.

1
UI - 11972267
AU - Kumagai Y; Inoue H; Nagai K; Kawano T; Iwai T
TI - Magnifying endoscopy, stereoscopic microscopy, and the microvascular architecture of superficial esophageal carcinoma.
SO - Endoscopy 2002 May;34(5):369-75
AD - First Department of Surgery, Tokyo Medical and Dental University School of Medicine, Japan. kuma.srg-k@komagome-hospital.bunkyo.tokyo.jp
BACKGROUND AND STUDY AIMS: In this study we clarify the microvascular architecture of superficial esophageal carcinoma as observed by ultra-high magnification endoscopy and stereoscopic microscopy with Microfil injection. PATIENTS AND METHODS: We observed two surgically resected specimens of superficial esophageal cancer under stereoscopic microscopy with Microfil injection. In addition, in the histological investigation, we measured the caliber of the vessels at the surface of the tumor. We carried out ultra-high magnification before treatment in 82 patients with superficial esophageal neoplasms. We classified the depth of tumor penetration of superficial esophageal carcinoma into four categories: m1 to m3 (mucosal cancer) and sm (submucosal cancer). RESULTS: By observing the normal esophageal mucosa under a stereoscopic microscope and an ultra-high magnification endoscope, we were able to visualize the intrapapillary capillary loops (IPCL). In cancer lesions, we observed characteristic changes in the superficial microvascular architecture according to the depth of tumor invasion. In m1 invasion, there was dilatation of the IPCL; in m2 invasion, there was dilatation and elongation of the IPCL; in m3, there was a mixed appearance of the IPCL and tumor vessels; and in sm invasion, complete replacement by tumor vessels. On the basis of the above criteria, ultra-high magnification endoscopic observation before treatment showed a rate of agreement between histological depth of invasion and magnified appearance of 60/72 cases (83.3 %) for which satisfactory pictures were obtained. The histological investigation showed the caliber of the IPCL of the m1 cancer lesions (12.9 +/- 3.9 microm) to be significantly greater than that of the normal esophageal mucosa (6.9 +/- 1.5 microm) (P < 0.0001). CONCLUSIONS: Observation of the microvascular architecture of superficial esophageal carcinoma is useful in the diagnosis of the depth of invasion.

2
UI - 11972275
AU - Stepinac T; Grosjean P; Woodtli A; Monnier P; van den Bergh H; Wagnieres
TI - G Optimization of the diameter of a radial irradiation device for photodynamic therapy in the esophagus.
SO - Endoscopy 2002 May;34(5):411-5
AD - Institute of Environmental Engineering, Swiss Federal Institute of Technology, Lausanne, Switzerland.
BACKGROUND AND STUDY AIMS: Photodynamic therapy (PDT) is a local therapeutic technique based on the photosensitization of lesions using a dye prior to light-induced tissue destruction. PDT of intraepithelial neoplasia in Barrett's esophagus, or of early squamous-cell carcinoma of the esophagus, requires light application devices that allow homogeneous and well-defined illumination of the tissue surface. Such devices must be large enough to induce complete unfolding of the esophagus in spite of esophageal motility and elasticity. The aim of this study was therefore to determine the optimal diameter of a cylindrical illumination device for PDT in this organ. PATIENTS AND METHODS: The study included nine patients (aged 49-72 years) who underwent panendoscopy. Flexible transparent hollow tubes with diameters ranging from 13 to 19 mm were successively introduced into the esophagus, and the esophageal wall was viewed from the inside through the tube using a flexible small-diameter endoscope. The number of folds was counted. Observations of the upper, middle, and lower thirds of the esophagus were recorded. The radial location of the folds was also recorded, and defined as follows: anterior wall (up), posterior wall (down), side walls (right, left). RESULTS: No significant difference in the number of folds between the lower and middle parts of the esophagus was noticed. However, the upper third had significantly fewer folds (about 30 %) than the other two parts. For diameters above 17 mm, this difference was less dramatic. The number of such folds was shown to decrease with the increasing diameter of the device. CONCLUSIONS: It appears that 18 mm or more is the optimal diameter for a fixed-geometry cylindrical photodynamic therapy irradiating device for the patient category considered in this study. It was also observed that most folds were located on the side walls of the esophagus.

3
UI - 11972277
AU - Szanto I; Voros A; Nagy P; Gonda G; Gamal EM; Altorjay A; Banai J; Kiss
TI - J Esophageal intramural metastasis from adenocarcinoma of the gastroesophageal junction.
SO - Endoscopy 2002 May;34(5):418-20
AD - Department of Surgery, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary. szantoimre@freemail.hu
Among a total of 143 patients examined for diagnosis of adenocarcinoma of the cardia, intramural esophageal metastases were verified in six patients (4.19 %). In each case the diagnosis was confirmed by histological examination. The histological structure of the primary tumors and metastases was the same. Metastases were detected by endoscopic ultrasound examination in three cases. All the cardia tumors proved to be well advanced. As well as endoscopic identification of the primary tumor, thorough examination of the proximal part of the esophagus is of great importance.

4
UI - 11895897
AU - Seiden MV; Ng SW; Supko JG; Ryan DP; Clark JW; Lynch T; Huang KC;
TI - Kwiatkowski D; Skarin A; Eder JP Jr A phase I clinical trial of sequentially administered doxorubicin and topotecan in refractory solid tumors.
SO - Clin Cancer Res 2002 Mar;8(3):691-7
AD - Department of Medicine, Massachusetts General Hospital, Boston 02114, USA. mseiden@partners.org
PURPOSE: To determine whether agents that target topoisomerase I and II could be administered sequentially. DESIGN: A Phase I study was conducted to evaluate sequential treatment with bolus IV doxorubicin followed 48 h later by topotecan given as a 30-min i.v. infusion on 3 consecutive days, with additional cycles of therapy repeated every 3 weeks. Characteristics of the 22 patients entered into the study were: 13 male and 9 female; median age, 49.5 (range 33-66) years; Eastern Cooperative Oncology Group performance status, 0-1; and normal cardiac, hematological, hepatic, and renal function. All patients had received prior therapy (median >or=2 prior regimens). RESULTS: The maximum tolerated dose of the combination was 25 mg/m(2) doxorubicin and 5.25 mg/m(2) topotecan (1.75 mg/m(2)/day x 3). Neutropenia was the dose-limiting toxicity. Attempts to further escalate the dose using 5 microg/kg granulocyte colony-stimulating factor proved unsuccessful because of thrombocytopenia. Among the 17 patients who were evaluable for response, 6 had a partial response, and 4 showed evidence of disease stabilization. The partial responses occurred in patients with small cell lung cancer (3 of 7), non-small cell lung cancer (1 of 6), esophageal adenocarcinoma (1 of 2), and ovarian carcinoma (1 of 1), and it lasted for 3-6 months. Administration of doxorubicin 2 days before topotecan did not alter topotecan pharmacokinetics. Changes in topoisomerase mRNA levels were observed during chemotherapy. CONCLUSIONS: The sequential combination of doxorubicin followed by topotecan is highly active in several chemotherapy refractory long, ovary, and esophageal cancers. Despite significant neutropenia, toxicity is manageable and well tolerated. Phase II trials to further evaluate the efficacy of this promising combination regimen against non-Hodgkin's lymphoma and lung cancer have been initiated.

5
UI - 11895914
AU - Nozoe T; Korenaga D; Kabashima A; Ohga T; Saeki H; Sugimachi K
TI - Significance of cyclin B1 expression as an independent prognostic indicator of patients with squamous cell carcinoma of the esophagus.
SO - Clin Cancer Res 2002 Mar;8(3):817-22
AD - Department of General Surgery, Fukuoka Dental College Hospital, Fukuoka, 814-0193 Japan. nozoet@surg2.med.kyushu-u.ac.jp
PURPOSE: Cyclin B1 plays an important role as a mitotic cyclin in the G(2)-M phase transition during the cell cycle. The aim of the present study was to elucidate the biological significance of cyclin B1 expression in squamous cell carcinoma (SCC) of the esophagus. EXPERIMENTAL DESIGN: We analyzed immunohistochemically the expression of cyclin B1 in the tumor specimens from 120 patients with SCC of the esophagus that had been treated with surgical treatment without any preoperative therapies. RESULTS: The positivity rate of cyclin B1 expression was 56.7% (68 of 120). One-, 3-, and 5-year survival rates in esophageal SCCs with cyclin B1 expression were 82.8, 61.6, and 50.7%, respectively, and they were significantly lower than those in esophageal SCCs without cyclin B1 expression (97.8, 85.5, and 78.6%, respectively; P = 0.005). Cyclin B1 expression was found to be an independent prognostic indicator in esophageal SCCs in a multivariate analysis. When immunostaining for cyclin B1 was classified as a nuclear dominant pattern and cytoplasmic dominant pattern, 1-, 3-, and 5-year survival rates in esophageal SCCs with nuclear dominant expression of cyclin B1 were 66.7, 47.9, and 28.7%, respectively, and they were significantly lower than those in esophageal SCCs with cytoplasmic dominant expression (92.5, 70.0, and 66.3%, respectively; P = 0.005). A multivariate analysis demonstrated that the nuclear dominant cyclin B1 expression was an independent prognosticator in patients with esophageal SCCs expressing cyclin B1. CONCLUSIONS: Our results demonstrate that cyclin B1 expression, especially nuclear dominant expression, can be significant as a prognostic indicator in esophageal SCCs.

6
UI - 12055587
AU - Buskens CJ; Van Rees BP; Sivula A; Reitsma JB; Haglund C; Bosma PJ;
TI - Offerhaus GJ; Van Lanschot JJ; Ristimaki A Prognostic significance of elevated cyclooxygenase 2 expression in patients with adenocarcinoma of the esophagus.
SO - Gastroenterology 2002 Jun;122(7):1800-7
AD - Department of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands.
BACKGROUND & AIMS: Use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a reduced risk of cancer in the digestive tract. Cyclooxygenase (COX) is the best-known target of NSAIDs, and expression of the COX-2 isoform is elevated in esophageal carcinomas but its clinical significance remains unclear. We examined COX-2 expression in esophageal adenocarcinomas and its relation to clinicopathologic parameters. METHODS: Tumor sections from 145 consecutive patients undergoing intentionally curative surgery for an adenocarcinoma arising from a Barrett's esophagus were immunohistochemically stained using a COX-2-specific anti-human monoclonal antibody. The specimens were scored based on the intensity and extent of COX-2 immunopositivity. RESULTS: COX-2 immunoreactivity was negative to weak in 21% (COX-2 low) and moderate to strong in 79% (COX-2 high) of the carcinomas. Patients with high COX-2 expression were more likely to develop distant metastases (P = 0.02) and local recurrences (P = 0.05), and survival was significantly reduced (P = 0.002, log-rank test) among patients with high COX-2 expression when compared with the COX-2 low group. Five-year survival rates were 35% (95% confidence interval [CI], 23-47) and 72% (95% CI, 53-90) in COX-2 high and COX-2 low categories, respectively. Furthermore, expression of COX-2 was recognized as an independent prognostic factor by multivariate analysis (relative risk, 3.5; 95% CI, 1.6-7.9). CONCLUSIONS: Elevated expression of COX-2 protein is associated with significantly reduced survival of patients undergoing surgery for esophageal adenocarcinoma. These findings support the effort to initiate clinical studies to investigate the effect of COX-2 inhibitors as a novel (adjuvant) chemotherapeutic modality for the treatment of adenocarcinoma arising from Barrett's esophagus.

7
UI - 12055589
AU - Vazquez-Sequeiros E; Wang L; Burgart L; Harmsen W; Zinsmeister A; Allen
TI - M; Jondal M; Wiersema M Occult lymph node metastases as a predictor of tumor relapse in patients with node-negative esophageal carcinoma.
SO - Gastroenterology 2002 Jun;122(7):1815-21
AD - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
BACKGROUND & AIMS: Esophageal carcinoma is an aggressive disease with a very poor prognosis. Early tumor relapse after surgical resection in patients with node-negative esophageal carcinoma suggests that occult metastases may have been missed at the original pathologic examination. The aim of this study was to determine the prevalence of immunohistochemically detected occult lymph node microscopic metastases in patients with pathologic N0 esophageal carcinoma and the impact of these occult metastases on relapse-free survival. METHODS: All patients (n = 124) with pathologic N0 esophageal carcinoma undergoing resection at our institution between January, 1994, and October, 1998, constituted the study population. Esophagectomy specimens were reevaluated by immunohistochemistry (monoclonal antibody against cytokeratin AE1/AE3). Clinical and pathologic features were summarized, and patient relapse-free survival was estimated. RESULTS: Among the total of 124 patients, occult lymph node microscopic metastases were identified by immunohistochemistry in 14 patients (11%) (T1 mucosa, 4%; T1 submucosa, 6%; T2, 22%; and T3, 14%). Patients were followed for a median of 3.2 years. Relapse-free survival was not significantly associated with the presence of occult lymph node microscopic metastases as detected by immunohistochemistry (P = 0.12). Advanced T stage (T3; P < 0.001) and lymphovascular invasion (P < 0.001) were found to be associated with tumor relapse. CONCLUSIONS: In the present study, occult lymph node microscopic metastases in pathologic N0 esophageal carcinoma patients were less frequent than previously reported. T stage and lymphovascular invasion were significantly associated with relapse-free survival, although a significant association with occult lymph node metastases was not detected.

8
UI - 12001646
AU - Voutilainen M; Farkkila M; Sipponen P
TI - [Barrett esophagus and inflammation of gastroesophageal junction]
SO - Duodecim 2000;116(17):1899-905
AD - Keski-Suomen keskussairaala, sisatautien poliklinikka 40620 Jyvaskyla.

9
UI - 12001647
AU - Sihvo E; Salo J
TI - [Malign complication of gastroesophageal reflux: adenocarcinoma of esophagus and gastric cardia]
SO - Duodecim 2000;116(17):1907-11
AD - HUS:n kirurgian klinikka Haartmaninkatu 4, 00029 HUS.

10
UI - 12067792
AU - Morris K
TI - Tea chemicals confirmed as cancer-busting compounds.
SO - Lancet Oncol 2002 May;3(5):262

11
UI - 12065561
AU - Khushalani NI; Leichman CG; Proulx G; Nava H; Bodnar L; Klippenstein D;
TI - Litwin A; Smith J; Nava E; Pendyala L; Smith P; Greco W; Berdzik J; Douglass H; Leichman L Oxaliplatin in combination with protracted-infusion fluorouracil and radiation: report of a clinical trial for patients with esophageal cancer.
SO - J Clin Oncol 2002 Jun 15;20(12):2844-50
AD - Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA.
PURPOSE: To identify a dose and schedule of oxaliplatin (OXP) to be safely administered in combination with protracted-infusion (PI) fluorouracil (5-FU) and external-beam radiation therapy (XRT) for patients with primary esophageal carcinoma (EC). PATIENTS AND METHODS: Eligibility included therapeutically naive EC patients with clinical disease stages II, III, or IV. Initial doses and schedules for cycle 1 consisted of OXP 85 mg/m(2) on days 1, 15, and 29; PI 5-FU 180 mg/m(2) for 24 hours for 35 days; and XRT 1.8 Gy in 28 fractions starting on day 8. At completion of cycle 1, eligible patients could undergo an operation or begin cycle 2 without XRT. Postoperative patients were eligible for cycle 2. Stage IV patients were allowed three cycles in the absence of disease progression. OXP and 5-FU increases were based on dose-limiting toxicity (DLT) encountered in cohorts of three consecutive patients. RESULTS: Thirty-eight eligible patients received therapy: 22 noninvasively staged as IV and 16 noninvasively staged as II and III. Thirty-six patients completed cycle 1, 29 patients started cycle 2, and 24 patients completed cycle 2. The combined-modality therapy was well tolerated, but DLT prevented OXP and 5-FU escalation. No grade 4 hematologic toxicity was noted. Eleven grade 3 and two grade 4 clinical toxicities were noted in eight patients. After cycle 1, 29 patients (81%) had no cancer in the esophageal mucosa. Thirteen patients underwent an operation with intent to resect the esophagus; five patients (38%) exhibited pathologic complete responses. CONCLUSION: OXP 85 mg/m(2) on days 1, 15, and 29 administered with PI 5-FU and XRT is safe, tolerable, and seems effective against primary EC. The role of OXP in multimodality regimens against EC deserves further evaluation.

12
UI - 12067683
AU - Law S; Wong J
TI - Use of minimally invasive oesophagectomy for cancer of the oesophagus.
SO - Lancet Oncol 2002 Apr;3(4):215-22
AD - Division of Oesophageal Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
Minimally invasive surgery has had a great effect on all branches of surgery, although its use for oesophageal cancer is controversial because of the technical complexity of the techniques involved and its uncertain benefits. We review the minimally invasive techniques that have been used for oesophagectomy. The methods are certainly feasible and can be done safely in experienced centres, but postoperative morbidity and mortality rates are not substantially reduced by the procedure. There are also concerns regarding the adequacy of tumour clearance. Further evaluation of the role of minimally invasive techniques in oesophageal cancer would require larger scale studies, preferably randomised controlled trials, in experienced centres. However, given that survival rates have not changed, proving that minimally invasive techniques are more effective than conventional methods of oesophagectomy, will be a difficult task.

13
UI - 12073632
AU - Noboru O
TI - [Current status of nuclear medicine. Clinical application of FDG-PET for cancer diagnosis. Esophageal cancer]
SO - Nippon Igaku Hoshasen Gakkai Zasshi 2002 May;62(6):265-9
AD - Department of Nuclear Medicine, Gunma University School of Medicine.
Positron emission tomography (PET) with [18F]-fluorodeoxyglucose (FDG) is a tool for the imaging and evaluation of glucose metabolism. This technique has recently become available in more than thirty hospitals and has been approved under Japan's national health insurance program. FDG uptake correlates with glucose utilization in tissue and is widely used for evaluating malignant tumors as well as brain function and myocardial viability. FDG-PET is useful for the diagnosis of lung cancer, colon cancer, esophageal cancer, malignant lymphoma, malignant melanoma, head and neck cancer, myocardial viability, and epileptic focus. A brief summary of the application and utility of FDG-PET for esophageal carcinoma is described in this article. Because of its limited spatial resolution, FDG-PET is not able to evaluate the invasiveness of primary tumors and small lesions. However, the uptake of FDG correlates with the aggressiveness of the tumor and the prognosis of patients with esophageal carcinoma. The sensitivity, specificity, and accuracy of lymph node staging is higher than that with CT. FDG-PET has the advantage of being able to detect distant metastases on a single occasion. Evaluation of the response to therapy and of recurrence is also possible by means of FDG-PET. There is some normal uptake and physiological distribution of FDG in many organs. Physiological status has an effect on the uptake of FDG in normal organs, and, consequently, on lesion uptake. Understanding of these characteristics makes this procedure a useful diagnostic modality for the management of patients with esophageal carcinoma.

14
UI - 11837211
AU - Glenn TF
TI - Esophageal cancer. Facts, figures, and screening.
SO - Gastroenterol Nurs 2001 Nov-Dec;24(6):271-3; quiz 274-5
AD - Medical University of South Carolina, Digestive Disease Center, 96 Jonathan Lucas Street, 210 CSB, Charleston, SC 29425, USA. glennt@MUSC.edu
Over the last 25 years, the incidence of adenocarcinoma of the esophagus has increased 350%, faster than any other malignancy in the western world. This increase is largely due to gastroesophageal reflux disease and Barrett's esophagus. While the current incidence of esophageal cancer is relatively low in comparison to other cancers in the United States, this may rapidly change. A cost-effective screening technique is needed for populations at risk for adenocarcinoma of the esophagus. Using unsedated esophagoscopy, gastroenterology nurses may be in the best position to coordinate and perform esophageal cancer screening for the U.S. population. This article provides an overview of esophageal cancer, including types, etiology, symptoms, and diagnosis. In addition to an overview of esophageal cancer, this article provides a look at non-physician, unsedated esophagoscopy as a future direction for esophageal cancer screening.

15
UI - 11510600
AU - Kitabayashi K; Nakano Y; Saito H; Ueno KI; Kita I; Takashima S; Kurose
TI - N; Nojima T Multicentric occurrence of esophageal cancer after gastrectomy: a preliminary report.
SO - Surg Today 2001;31(8):670-4
AD - Department of Surgery II, Kanazawa Medical University, Ishikawa, Japan.
The effect of gastrectomy on the subsequent development of esophageal cancer was investigated, focusing on its multicentric occurrence. We retrospectively evaluated 28 patients who underwent subtotal esophagectomy for intrathoracic esophageal cancer between 1985 and 1999. They were divided into two groups according to whether or not they had previously undergone a gastrectomy: group 1, comprising 7 patients who had undergone gastrectomy and group 2, comprising 21 patients who had not. Clinical profiles of the patients were obtained from the medical records and the whole resected esophagus was histopathologically examined. The interval between gastrectomy and esophagectomy in group 1 was significantly shorter in the patients who had undergone gastrectomy for gastric cancer than in those who had undergone gastrectomy for a peptic ulcer, and also in the patients for whom anastomosis had been performed by Billroth I compared with Billroth II. The patients in group 1 were significantly younger than those in group 2. The multiple occurrence of esophageal cancer was found in 4 of 5 patients (80%) in group 1, and in 2 of 18 patients (11%) in group 2, with significantly higher frequency being seen in group 1. More than two coexisting cancer lesions apart from the primary tumor were detected in all four patients. Histological examination of all the coexisting cancer lesions showed well-differentiated squamous cell carcinoma confined within the superficial mucosal layer. No significant differences were noted in the location of the coexisting lesions between the oral and anal side of the primary tumors. Squamous dysplasia was randomly observed, especially around the cancer lesions. These findings suggest that gastrectomy precipitated subsequent chronic gastroesophageal reflux which in turn induced the development of squamous dysplasia and carcinoma at multiple locations in the esophagus.

16
UI - 12031603
AU - van der Gaag LC; Renooij S; Witteman CL; Aleman BM; Taal BG
TI - Probabilities for a probabilistic network: a case study in oesophageal cancer.
SO - Artif Intell Med 2002 Jun;25(2):123-48
AD - Institute of Information and Computing Sciences, Utrecht University, P.O. Box 80.089, 3508 TB, Utrecht, The Netherlands. linda@cs.uu.nl
With the help of two experts in gastrointestinal oncology from The Netherlands Cancer Institute, Antoni van Leeuwenhoekhuis, a decision-support system is being developed for patient-specific therapy selection for oesophageal cancer. The kernel of the system is a probabilistic network that describes the presentation characteristics of cancer of the oesophagus and the pathophysiological processes of invasion and metastasis. While the construction of the graphical structure of the network was relatively straightforward, probability elicitation with existing methods proved to be a major obstacle. To overcome this obstacle, we designed a new method for eliciting probabilities from experts that combines the ideas of transcribing probabilities as fragments of text and of using a scale with both numerical and verbal anchors for marking assessments. In this paper, we report experiences with our method in eliciting the probabilities required for the oesophagus network. The method allowed us to elicit many probabilities in reasonable time. To gain some insight in the quality of the probabilities obtained, we conducted a preliminary evaluation study of our network, using data from real patients. We found that for 85% of the patients, the network predicted the correct cancer stage.

17
UI - 12073598
AU - Takamori S; Fujita H; Hayashi A; Mitsuoka M; Terazaki Y; Miwa K;
TI - Fukunaga M; Shirouzu K Outcome for malignant tracheobronchial stenoses in esophageal cancer.
SO - Jpn J Thorac Cardiovasc Surg 2002 Jun;50(6):231-4
AD - Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.
OBJECTIVE: Optimal tracheobronchial stenosis treatment in esophageal cancer remains a clinical challenge. METHODS: Subjects were 26 patients with tracheobronchial stenosis due to esophageal cancer treated by modalities such as expandable metallic stent emplacement, laser therapy, radiotherapy, and/or chemotherapy. We assessed patient outcome and modality efficacy, and determined prognostic factors for survival using multivariate analysis. RESULTS: Of the 26, 16 (61%) had improved respiration after treatment. Average posttreatment survival was 140 days (10-1550 days). Multivariate analysis indicated that a Karnofsky performance score of > or = 70% was the most significant prognostic factor, with chemotherapy and laser therapy also significant factors. CONCLUSIONS: Although individual modalities were effective in ameliorating respiratory symptoms, patients with good performance status survived the longest. After a tracheobronchial stenosis diagnosis in esophageal cancer patients, chemotherapy and laser therapy are recommended if the patient is in good general condition.

18
UI - 12094695
AU - Ozawa S; Kitagawa Y; Kitajima M
TI - [Molecular alterations in esophageal cancer]
SO - Nippon Geka Gakkai Zasshi 2002 Jun;103(6):457-62
AD - Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
The clinicopathological characteristics of esophageal cancer have gradually been clarified using molecular biologic methods developed over the past 20 years. For example, amplification of the c-erb B gene is a prognostic factor and predictive of lymph node involvement, while the amplification of the cyclin D1 gene is also a prognostic factor and predictive of distant organ metastasis. Alteration of the p16 gene is also a prognostic factor and predicts lymph node involvement. As telomerase activity is almost a unique phenomenon of cancer cells, highly sensitive detection of esophageal cancer cells in the peripheral blood can be performed. Recently, such new methods as comparative genomic hybridization analysis and cDNA microarray analysis have been used to determine meaningful genetic changes. For therapeutic purposes, although tailor-made therapy has been proposed for several years, the validity of these approaches should be confirmed in a well-designed clinical trial. As molecular targeted therapies, tyrosine kinase inhibitors of epidermal growth factor receptor (EGFR) and monoclonal antibodies against EGFR are being studied in clinical trials in Western countries. A clinical trial of p53 gene therapy against esophageal cancer is also promising.

19
UI - 12055729
AU - Pulanic R
TI - [Importance of the Barrett esophagus in the development of esophageal adenocarcinoma]
SO - Med Arh 2002;56(1 Suppl 1):7-9
AD - Referentni centar Ministarstva zdravstva Republike Hrvatske za intervencijsku gastroenterologiju, Zavod za gastroenterologiju, Interna klinika, KBC Zagreb, Hrvatska.
Arising of esophageal carcinoma, particularly adenocarcinoma of esophagus could be prevented. With correct nutrition, avoiding of substances which could lead to carcinogenesis patients could help himself in esophageal carcinoma prevention. Thats for, broad education of population on state level is needed. Duly discovering and treatment of reflux disease is a key factor in preventing of complications, especially Barretts esophagus which is premalignant lesion by itself. Program of long term endoscopic and histology follow up contribute in esophageal adenocarcinoma prevention or its early discovering in a stage of curability.

20
UI - 12094844
AU - Shaheen NJ; Provenzale D; Sandler RS
TI - Upper endoscopy as a screening and surveillance tool in esophageal adenocarcinoma: a review of the evidence.
SO - Am J Gastroenterol 2002 Jun;97(6):1319-27
AD - Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill 27599-7080, USA.
Esophageal adenocarcinoma is a rare cancer that is increasing rapidly in incidence. Because gastroesophageal reflux disease (GERD) is a risk factor for the development of this cancer, endoscopic screening of individuals with GERD symptoms and endoscopic surveillance of those who are found to have Barrett's esophagus (BE), the presumed precursor to adenocarcinoma, have been proposed. Although no direct data support endoscopic screening or surveillance, several lines of indirect evidence are available. We apply a set of criteria for the evaluation of screening programs to endoscopic screening of subjects with reflux and endoscopic surveillance of subjects with BE. A critical examination of the data supporting these practices shows that considerable gaps exist in our knowledge regarding endoscopy as a screening test in GERD, making us unable to support this practice based on current evidence. Although no controlled trials exist to substantiate the effectiveness of surveillance programs for subjects with BE, some stronger indirect evidence does support this practice. However, further studies are necessary to substantiate the effectiveness and cost-effectiveness of endoscopic surveillance in BE. Based on the currently available data, consideration should be given to expanding the intervals between endoscopic surveillance sessions.

22
UI - 12094886
AU - Case CL; Barkin JS
TI - The approach to high grade dysplasia in Barrett's esophagus.
SO - Am J Gastroenterol 2002 Jun;97(6):1559-60
AD - Division of Gastroenterology, University of Miami, School of Medicine/Mt Sinai Medical Center, Florida, USA.

23
UI - 12067993
AU - Xu Y; Selaru FM; Yin J; Zou TT; Shustova V; Mori Y; Sato F; Liu TC;
TI - Olaru A; Wang S; Kimos MC; Perry K; Desai K; Greenwald BD; Krasna MJ; Shibata D; Abraham JM; Meltzer SJ Artificial neural networks and gene filtering distinguish between global gene expression profiles of Barrett's esophagus and esophageal cancer.
SO - Cancer Res 2002 Jun 15;62(12):3493-7
AD - Department of Medicine, Division of Gastroenterology, Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore VA Hospital, 21201, USA.
cDNAmicroarrays, combined with bioinformatics analyses, are becomingincreasingly used in current medical research. Existing analytic methods,particularly those that are unsupervised, often have difficulty recognizing subtle differences among predefined subgroups. In contrast, supervised methods, such as Artificial Neural Networks (ANNs), are able to recognize subtly different biological entities. We applied ANNs in a proof-of-principle study of cDNA microarray data in esophageal cancer (CA) and premalignancy. cDNA microarrays, each containing 8064 clones, were hybridized to RNAs from 22 esophageal lesions, including 14 Barrett's esophagus (BA) metaplasias and 8 esophageal carcinomas (3 squamous cell carcinomas and 5 adenocarcinomas). Scanned cDNA microarray data were analyzed using the bioinformatics software Cluster/TreeView, Significance Analysis of Microarrays (SAM), and ANNs. Cluster analysis based on all 8064 clones on the microarrays was unable to correctly distinguish BA specimens from CA specimens. SAM then selected 160 differentially expressed genes between Barrett's and cancer. Cluster analysis based on this reduced set still misclassified 2 Barrett's as cancers. The ANN was trained on 12 samples and tested against the remaining 10 samples. Using the 160 selected genes, the ANN correctly diagnosed all 10 samples in the test set. Finally, the 160 genes selected by SAM may merit further study as biomarkers of neoplastic progression in the esophagus, as well as in elucidating pathological mechanisms underlying BA and CA.

24
UI - 10096035
AU - Harris KM; Kelly S; Berry E; Hutton J; Roderick P; Cullingworth J;
TI - Gathercole L; O'Connor PJ; Boyce JC; Smith MA Systematic review of endoscopic ultrasound in gastro-oesophageal cancer.
SO - Health Technol Assess 1998;2(18):i-iv, 1-134
AD - Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, UK.

25
UI - 12132405
AU - Johnson D
TI - I've heard that chronic heartburn can lead to esophageal cancer. How commonly does heartburn progress to cancer, and can it be prevented?
SO - Health News 2002 May;8(5):12
AD - Eastern Virginia School of Medicine, Norfolk, VA, USA.

26
UI - 11783170
AU - Wang B; Liu X; Fu X
TI - [Clinical observation on effect of yiqi huoxue decoction in comprehensive treatment on advanced stage of esophageal cancer]
SO - Zhongguo Zhong Xi Yi Jie He Za Zhi 1999 Oct;19(10):589-91
AD - 251 Hospital of PLA, Zhangjiakou, Hebei (075000).
OBJECTIVE: To observe the effect of Yiqi Huoxue (Replenishing Qi and activating blood circulation, YQHX) decoction in patients with advanced stage esophageal cancer treated with radiotherapy (RT) and intervention chemotherapy (ICT). METHODS: In comparing 31 patients who were treated with RT and ICT (Group A), and 31 patients treated with RT and ICT plus YQHX decoction (Group B). RESULTS: Immediate effective rate were 48.4% in Group A and 64.5% in Group B (P > 0.05). The function of bone marrow in Group B was obviously higher than that in Group A. The 1 year metastasis rate in Group A was higher than that in Group B, but the long-term survival rate of Group B was obviously higher than that in Group A (P < 0.05). CONCLUSION: YQHX decoction could reduce the inhibition of bone marrow caused by radiotherapy and intervention chemotherapy, lower the metastasis rate, prolong the long-term survival rate and improve the quality of life.

27
UI - 12044696
AU - Kumbasar B
TI - Carcinoma of esophagus: radiologic diagnosis and staging.
SO - Eur J Radiol 2002 Jun;42(3):170-80
AD - Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, 34390 Capa, Istanbul, Turkey. bkumbasar@hotmail.com
Esophageal carcinoma is an uncommon malignancy accounting for approximately 7% of gastrointestinal tract cancers and 1% of all cancers. Esophageal cancer still remains one of the most lethal of all cancers. Since a multimodality approach is presently used to treat esophageal cancer, early radiologic diagnosis and accurate tumor staging are essential to direct therapy toward cure or palliation. This article presents a review of radiologic diagnosis and staging of esophageal cancer.

28
UI - 12057146
AU - Swisher SG; Pisters PW; Komaki R; Lahoti S; Ajani JA
TI - Gastroesophageal junction adenocarcinoma.
SO - Curr Treat Options Oncol 2000 Dec;1(5):387-98
AD - Department of Thoracic and Cardiovascular Surgery, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 109, Houston, TX 77030, USA.
The incidence rate of adenocarcinoma of the esophagogastric junction (AEG) is increasing in association with the epidemiologic rise in distal esophageal adenocarcinoma and gastric cardial (AEG type III) tumors. The overall survival rate is poor in most patients with AEG because lymph node or visceral metastases are frequently present at the time patients become symptomatic. A few patients are identified early in the disease because of screening for gastroesophageal reflux and Barrett's esophagus. Early stage AEG (T1N0 or T2NO, carcinoma in situ, or severe dysplasia ) can in many instances be cured with surgery alone. Ablative treatments for early stage AEG, including endoscopic fulguration by cautery and laser or photodynamic therapy, are investigational at this time. Locoregionally advanced AEG (T3, T4, N1, or M1a ) without distant systemic metastases (M1b) has a poor overall survival rate with surgery alone or definitive chemotherapy and radiation therapy without surgery. Analysis of the use of multimodality treatment strategies for locoregionally advanced AEG types I and II have demonstrated improved survival rates in two small phase III trials with preoperative concurrent chemoradiotherapy followed by surgical resection. In contrast, three small phase III trials with preoperative concurrent or sequential chemoradiotherapy in patients with predominantly squamous cell carcinoma did not demonstrate any clear survival advantage. Additionally, a randomized phase III study evaluating preoperative chemotherapy without radiation therapy in esophageal cancer (predominantly adenocarcinoma) has demonstrated no survival benefit. In light of these results, additional large randomized phase III studies are needed to confirm the potential benefit of preoperative concurrent chemoradiotherapy. At the present time, preoperative chemoradiotherapy remains investigational. For locoregionally advanced gastric adenocarcinoma, including AEG type III, postoperative concurrent 5-fluorouracil (5-FU)-based chemoradiotherapy is associated with improved survival as demonstrated in a recently completed random assignment trial (INT 0116). As a result, surgery with postoperative chemoradiotherapy has recently become the standard of care for patients with AJCC stage II and III gastric adenocarcinoma (including patients with AEG type III). Metastatic AEG (M1b) should be treated with palliative chemotherapy (in good performance patients) or supportive care (poor performance) in asymptomatic patients. Radiation therapy and endoscopic stent placement (expandable wire mesh) can be used to palliate dysphagia in patients with M1b disease. The development of expandable stents and improved radiotherapy has obviated surgical bypass to palliate patients with symptomatic, metastatic AEG.

29
UI - 12072201
AU - Rosenberg C; Geelen E; IJszenga MJ; Pearson P; Tanke HJ; Dinjens WN; van
TI - Dekken H Spectrum of genetic changes in gastro-esophageal cancer cell lines determined by an integrated molecular cytogenetic approach.
SO - Cancer Genet Cytogenet 2002 May;135(1):35-41
AD - Laboratory of Cytochemistry and Cytometry, Department Molecular Cell Biology, Leiden University Medical Center (LUMC), Leiden, The Netherlands. c.rosenberg@lumc.nl
Adenocarcinomas arising around the gastro-esophageal junction (GEJ) are highly malignant, and their incidence has risen rapidly in the last decades. Cell lines are the basic in vitro system for functional and therapeutic studies in GEJ tumors, but only a small number of cell lines are currently available, and none of them has been fully karyotyped. We analyzed 5 GEJ tumor cell lines using a combination of 24-color fluorescence in situ hybridization (FISH), comparative genomic hybridization (CGH) and genomic microarrays. Using CGH we demonstrated that these cell lines present imbalances similar to those we had previously observed in primary GEJ tumors, namely gains on 1q, 7q, 8q, 17q, 19q, 20, and X, and losses on 3p, 4, 5q, 9p, 18q, and 21. Multicolor FISH karyotyping revealed multiple structural rearrangements involving chromosomes 1, 5, 6, 7, 8, 9, 13, 17, 18, and 22. Rearrangements of chromosome 8 involved 10 different chromosomes, while rearrangements of chromosome 17 involved 5. Different rearrangements resulted in imbalances of similar chromosome regions, suggesting that similar genomic imbalances are constitutively important but are achieved through different pathways. The use of a commercially available genomic array excluded TOP2A (17q), and MYBL2, PTPT1, CSE1L, and ZNF217 (20q) as candidate genes for frequently amplified areas on these chromosomes, and contributed to refining the limits of chromosome regions involved in genomic imbalances.

30
UI - 12109857
AU - Geddert H; Zeriouh M; Wolter M; Heise JW; Gabbert HE; Sarbia M
TI - Gene amplification and protein overexpression of c-erb-b2 in Barrett carcinoma and its precursor lesions.
SO - Am J Clin Pathol 2002 Jul;118(1):60-6
AD - Department of Pathology, University of Dusseldorf, Germany.
We examined 39 samples of metaplastic specialized epithelium (SE), 27 of low-grade dysplasia (LGD), 27 of high-grade dysplasia (HGD), and 46 of adenocarcinoma (CA) derived from Barrett esophagus for c-erb-b2 gene amplification using differential polymerase chain reaction and for overexpression of c-erb-b2 protein using immunohistochemical analysis. Amplification of the c-erb-b2 gene was as follows: SE, 0.0%; LGD, 0.0%; HGD, 11.1%; and CA, 13.6%; and protein overexpression was as follows: SE, 0.0%; LGD, 7.4%; HGD, 18.5%; and CA, 21.7%. In 8 (89%) of 9 samples, c-erb-b2 gene amplification correlated with protein overexpression. The reverse was true in 8 (47%) of 17 samples: c-erb-b2 protein overexpression was proved with simultaneous gene amplification. Amplification of c-erb-b2 is a late event in the carcinogenesis of Barrett esophagus. In contrast, protein overexpression appears more often and earlier Besides gene amplification, other mechanisms to induce protein overexpression must exist.

31
UI - 11982715
AU - Law S; Wong J
TI - Changing disease burden and management issues for esophageal cancer in the Asia-Pacific region.
SO - J Gastroenterol Hepatol 2002 Apr;17(4):374-81
AD - Division of Esophageal Surgery, Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong.
The changing epidemi

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