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Objective To systematically evaluate the efficacy and safety between neoadjuvant concurrent chemoradiotherapy followed by surgery and surgery alone in the treatment of resectable esophageal squamous cell carcinoma.Methods Literature review was performed from Embase,PubMed,Web of Science,Cochrane Library,CBM,Wanfang Data,CNKI and Chongqing VIP.The randomized controlled clinical trials of concurrent chemoradiotherapy followed by surgery versus surgery alone in the treatment of resectable esophageal squamous cell carcinoma were retrieved.The meta-analysis of survival data,R0 resection rate,incidences of postoperative complications and peritreatment mortality was conducted by using RevMan 5.3 software.Results A total of 1450 patients from 11 controlled clinical trials were included in this meta-analysis.The results of the meta-analysis showed that concurrent chemoradiotherapy followed by surgery group had significantly higher 2-and 5-year overall survival rate (RR=1.14,95％CI:1.05-1.23,P=0.00) and progression-free survival rate (RR=1.56,95％CI:1.05-2.32,P=0.03).R0 resection rate were also improved in concurrent chemoradiotherapy followed by surgery group (RR=1.10,95％CI:1.05-1.14,P=0.00).Compared with the surgery alone group,the incidence of arrhythmia in the concurrent chemoradiotherapy plus surgery group was.significantly higher (RR=2.45,95％CI:1.37-4.38,P=0.00).However,there was no significant difference in the overall incidence of postoperative complications (RR=1.12,95％CI:0.79-1.59,P=0.51) and incidence of peritreatment mortality (RR=1.78,95％CI:0.90-3.52,P=0.10) between two groups.Conclusions Neoadjuvant concurrent chemoradiotherapy followed by surgery improves the survival and R0 resection rate over surgery alone among patients with resectable esophageal squamous cell carcinoma,whereas it does not increase the risk of postoperative complications.Consequently,neoadjuvant concurrent chemoradiotherapy followed by surgery is an optimal treatment for patients with resectable esophageal squamous cell carcinoma.
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Objective@#To systematically evaluate the efficacy and safety between neoadjuvant concurrent chemoradiotherapy followed by surgery and surgery alone in the treatment of resectable esophageal squamous cell carcinoma.@*Methods@#Literature review was performed from Embase, PubMed, Web of Science, Cochrane Library, CBM, Wanfang Data, CNKI and Chongqing VIP. The randomized controlled clinical trials of concurrent chemoradiotherapy followed by surgery versus surgery alone in the treatment of resectable esophageal squamous cell carcinoma were retrieved. The meta-analysis of survival data, R0 resection rate, incidences of postoperative complications and peritreatment mortality was conducted by using RevMan 5.3 software.@*Results@#A total of 1450 patients from 11 controlled clinical trials were included in this meta-analysis. The results of the meta-analysis showed that concurrent chemoradiotherapy followed by surgery group had significantly higher 2-and 5-year overall survival rate (RR=1.14, 95%CI: 1.05-1.23, P=0.00) and progression-free survival rate (RR=1.56, 95%CI: 1.05-2.32, P=0.03). R0 resection rate were also improved in concurrent chemoradiotherapy followed by surgery group (RR=1.10, 95%CI: 1.05-1.14, P=0.00). Compared with the surgery alone group, the incidence of arrhythmia in the concurrent chemoradiotherapy plus surgery group was significantly higher (RR=2.45, 95%CI: 1.37-4.38, P=0.00). However, there was no significant difference in the overall incidence of postoperative complications (RR=1.12, 95%CI: 0.79-1.59, P=0.51) and incidence of peritreatment mortality (RR=1.78, 95%CI: 0.90-3.52, P=0.10) between two groups.@*Conclusions@#Neoadjuvant concurrent chemoradiotherapy followed by surgery improves the survival and R0 resection rate over surgery alone among patients with resectable esophageal squamous cell carcinoma, whereas it does not increase the risk of postoperative complications. Consequently, neoadjuvant concurrent chemoradiotherapy followed by surgery is an optimal treatment for patients with resectable esophageal squamous cell carcinoma.
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Both endoscopic resection and surgery are the common treatment modes for early esophageal cancer. Compared with radical surgery, endoscopic resection has the advantages of less trauma, quicker recovery, lower cost, less complications, the preservation of the normal anatomy, the physiological function of the esophagus, and higher postoperative quality of life. For patients with a high risk of lymph node metastasis, endoscopic resection alone can lead to inadequate treatment, which need adjuvant therapies. Currently, the common adjuvant therapies consist of adjuvant radiochemotherapy and adjuvant radiochemotherapy combined with surgery. How to combine endoscopic resection with adjuvant therapy to bring maximal benefits to patients has become the hot topic in the field of clinical researches. In this article, the current research status, progress and challenges in the combination of endoscopic resection and adjuvant therapy for the treatment of high-risk patients were reviewed.
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In China, radical esophagectomy remains the main strategy for resectable esophageal cancer. However, the high locoregional recurrence rate and hematogenous metastasis rate are the main causes of surgical failure. Therefore, whether postoperative adjuvant therapy can become one of the important means for esophageal cancer remains controversial. In this article, the research progress on the postoperative recurrent pattern and adjuvant therapy for esophageal carcinoma was reviewed to provide references for clinicians.
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Esophageal cancer is one of the common tumors in China. Esophageal perforation is a common complication of esophageal carcinoma. Currently, there is no consensus on the treatment of esophageal perforation of esophageal carcinoma at home and abroad. Twenty-seven articles were selected from PubMed, CNKI and Wanfang database between 1997 to December 2017. The mechanism of esophageal perforation and clinical characteristics in these 27 articles were analyzed. Surgery can improve the survival rate, but the risk of perioperative complications may be increased. Concurrent chemoradiotherapy with nutritional support can significantly improve the survival rate.
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Esophageal cancer is one of the common tumors in China.Esophageal perforation is a common complication of esophageal carcinoma.Currently,there is no consensus on the treatment of esophageal perforation of esophageal carcinoma at home and abroad.Twenty-seven articles were selected from PubMed,CNKI and Wanfang database between 1997 to December 2017.The mechanism of esophageal perforation and clinical characteristics in these 27 articles were analyzed.Surgery can improve the survival rate,but the risk of perioperative complications may be increased.Concurrent chemoradiotherapy with nutritional support can significantly improve the survival rate.
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Along with the intensification of the aging trend,the proportion of elderly patients suffering from esophageal cancer has been ever increased.Radiotherapy plays a pivotal role in the treatment of esophageal cancer in the elderly patients considering their relatively poor tolerance of surgery and high risk of postoperative complications.In this review,the development in the comprehensive treatment of esophageal cancer in the elderly was summarized.
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Objective To retrospectively analyze the factors of postoperative recurrence of stage pT1-3NoM0 esophageal squamous cell carcinoma.Methods A total of 488 patients who underwent two-field R0 esophagectomy,pathologically classified as stage pT1-3N0M0,without adjuvant radiotherapy and/or chemotherapy before or after surgery and postoperative survival time ≥ 3 months were enrolled in this study.Multivariate analysis was performed by using Cox model.Results At the end of follow-up,the overall recurrence rate was 36.9％(180/488);the local recurrence rate was 21.5％ (105/488),the distant metastasis rate was 6.8％ (33/488) and the local recurrence rate complicated with the distant metastasis rate was 8.6％ (42/488).Cox multivariate analysis demonstrated that tumor site and pT staging were the factors affecting the overall/local recurrence rate and distant metastasis.The recurrence rate in patients with the upper esophageal squamous cell carcinoma and stage pT3 was the highest,followed by those with the middle esophageal squamous cell carcinoma or stage pT2 and the lowest recurrence rate was observed in patients with the lower esophageal squamous cell carcinoma or stage pT1.Conclusions Tumor site and pT staging are the pivotal factors for postoperative recurrence of stage pT1-3 NoM0 esophageal squamous cell carcinoma after two-field R0 esophagectomy,which contributes to offer guidance to the selection of indications for postoperative adjuvant radiotherapy.
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60?Gy is able to effect a good loco-regional control as well as a good result.