ASO Author Reflections: Intensified Neoadjuvant Chemoradiotherapy Followed by Esophagectomy in Esophageal Cancer
Conclusions: After NAC for locally advanced esophageal cancer, the shallow residual tumor pattern was most common, but approximately 40% of specimens showed no tumor cells in the mucosal layer. Deep and diffuse remnant patterns were associated with high risks of pleural dissemination and distant metastasis.
Esophageal cancer (EC) carries a poor prognosis with median five-year survival rate of 15% –25% . It is the eighth most common cancer diagnosed worldwide, with incidence increasing [1–3]. Locally advanced esophageal carcinoma (cT1-4N1M0/T4N0M0) is optimally treated with multimodality therapy including chemotherapy, radiotherapy, and surgery [4,5]. In surgical candidates, evidence s uggests that trimodality therapy including neoadjuvant CRT followed by esophagectomy improves overall survival [5–9].
Discussion: A tertiary referral center referred 125 individuals to physiotherapy who were eligible for the study; we finally included 93 individuals for statistical analysis. Multiple backward regression analysis showed that gender (95% confidence interval [CI], 2.05-33.82), weight (95% CI, 0.39-1.02), age (95% CI, −0.91 to −0.04), left handgrip strength (95% CI, 0.14-1.44), and inspiratory muscle strength (95% CI, 0.08-0.38) were all independently associated with muscle surface area at L3. All these variables together explained 66% of the variability (R2) in muscle surface area at L3 (P
ConclusionsLaparoscopic transhiatal esophagectomy has an important role in current esophageal cancer treatment and can be performed with curative intent in patients with distal esophageal tumors. In addition to the well-known advantages of laparoscopy, the increased mediastinal visibility and a modern focus on oncologic principles seem to have a positive impact on cancer survival compared to the open transhiatal approach.
ConclusionsNeoadjuvant radiotherapy with 46 Gy and concomitant chemotherapy with paclitaxel and carboplatin for the treatment of locally advanced esophageal carcinoma is safe and effective. The results of this modified radiotherapy protocol are encouraging and should be considered in future patient treatment and study designs.
This study aimed to evaluate the individual and combined value of 18F-fluorodeoxyglucose positron emission tomography with integrated computed tomography (18F-FDG PET/CT) and diffusion-weighted magnetic resonance imaging (DW-MRI) during and after nCRT to predict pathologic response in esophageal cancer patients.
AbstractBackgroundDespite wide acknowledgement of the importance of sarcopenia and prognostic markers such as the neutrophil-to-lymphocyte ratio, the impact on cancer patient survival of the timing of sarcopenia ’s emergence and its severity is not well understood, nor is the association between sarcopenia and prognostic markers. The aim of this study, therefore, was to investigate the effect of the severity and timing of changes in the psoas muscle index (PMI) on survival of advanced esophageal squamous cell carcinoma (ESCC) patients receiving neoadjuvant chemoradiotherapy (NACRT) plus esophagectomy and the associat...
Publication date: Available online 14 December 2019Source: The Annals of Thoracic SurgeryAuthor(s): Zachary D. Horne, Rodney E. Wegner, Athanasios Colonias, Benny Weksler, Scott M. Glaser, Ronny Kalash, Sushil BeriwalAbstractBackgroundNeoadjuvant chemoradiation followed by esophagectomy is a standard of care for locally advanced esophageal cancers. The CROSS trial reported a 30-day mortality rate of 6%. We sought to evaluate 30- and 90-day mortality in similar patients in the United States and identify predictors of higher mortality rates.MethodsThe National Cancer Database was used to identify patients with cT3-4/N+ esoph...
ConclusionsHigh preoperative serum IL-6 levels are associated with a poor response to chemotherapy or chemoradiotherapy and poor prognosis after esophagectomy. Preoperative serum IL-6 levels may be a useful independent prognostic marker for esophageal cancer patients.
ConclusionsThe presence of LPAS in esophageal cancer surgery makes it difficult to dissect the left RLN nodes. We could safely perform curative esophagectomy for an ESCC patient with LPAS using the cervicothoracoscopic approach.