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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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Objective We aimed to analyze the clinical efficacy and treatment-related complications in patients with T4besophageal squamous cell carcinoma (SCC) who received concurrent CRT,and to explore the potential prognostic factors related to survival. Methods Between 2010 and 2015,143 patients with T4b esophageal SCC treated with CRT were analyzed, including 71% patients with trachea and/or bronchus invasion and 44% patients with aorta and/or large vessel invasion. The median radiation dose was 60 Gy ( range, 44-68 Gy ) with conventional fractionation, including 69 patients ( 48%) treated with three-dimensional conformal radiotherapy and 74 patients ( 52%) treated with intensity-modulated radiotherapy. All patients received concurrent platinum-based chemotherapy during radiotherapy. Kaplan-Meier method was used to analyze the survival,the log-rank test was used to examine group differences,and the Cox regression model was used for multivariate analysis. Results The median overall survival ( OS) time for the whole cohort was 12. 2 months. The 2-and 3-year OS rates were 34% and 29%,respectively. A total of 51 patients experienced ≥2 severe non-hematological complications,including 42 esophageal fistula,6 pneumonia,and 3 esophageal hemorrhage. Patients with severe complications showed significantly worse survival than those without complications (6. 9 months vs.20. 4 months,P＜0. 01).Multivariate analysis revealed that TNM stage and severe complications were independent prognostic factors for OS. Conclusions Patients with T4b esophageal SCC who received CRT showed satisfactory survival but with high risk of severe complications. Therefore,prevention and treatment of severe complications is the key to improve efficacy.
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Esophageal cancer is one of the most common gastrointestinal cancers, and chemoradiotherapy is an important part of the multidisciplinary treatment for this disease.In recent years,18Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET-CT) is widely used in esophageal cancer for delineation of gross tumor volume, local boost irradiation in the late stage of radiotherapy, and assessment of the pathologic remission rate after neoadjuvant chemoradiotherapy, response to definitive chemoradiotherapy, and prognosis.In this article, we review the application of FDG PET-CT in the chemoradiotherapy for esophageal cancer.
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Objective To evaluate the tolerance of preoperative neoadjuvant chemoradiotherapy (neoCRT) plus esophagectomy, as well as the short-term outcome, tumor resection rate, incidence of postoperative complications, and perioperative mortality, in patients with locally advanced esophageal cancer.Methods This study included 74 patients with thoracic esophageal cancer who were admitted to our hospital from May 2011 to June 2015.Chemotherapy and radiotherapy were performed concurrently.The chemotherapy consisted of vinorelbine (25 mg/m2 on days 1, 8, 22, and 29) and cisplatin (25 mg/m2 on days 1-4 and 22-25).The radiotherapy was conventionally fractionated with a total dose of 40 Gy (2.0 Gy/d).At 4-8 weeks after chemoradiotherapy, esophagectomy was performed (neoCRT+surgery group);definitive chemoradiotherapy (DCRT) was performed in the patients who refused surgery (DCRT group);follow-up was performed in the patients who refused any anti-cancer therapies after neoCRT (neoCRT group).Results Forty-four patients underwent neoCRT+surgery, with a radical resection (R0) rate of 100% and a pathological complete response (pCR) rate of 43%;17 patients received DCRT;13 patients received neoCRT alone.For the neoCRT+surgery group, DCRT group, and neoCRT group, the 2-year overall survival (OS) rates were 79%, 75%, and 17%, respectively, and the 2-year disease-free survival (DSF) rates were 75%, 55%, and 17%, respectively.There were significant differences in OS between the neoCRT group and the neoCRT+surgery group (P=0.000) and between the neoCRT group and the DCRT group (P=0.001), but no significant difference was observed between the neoCRT+surgery group and the DCRT group (P=0.415).There were significant differences in DFS between the neoCRT group and the neoCRT+surgery group (P=0.000) and between the neoCRT group and the DCRT group (P=0.002), but no significant difference was observed between the neoCRT+surgery group and the DCRT group (P=0.416).The rate of clinical response to preoperative neoCRT was 87% for all patients.Fifty-six patients (76%) developed grade ≥3 myelosuppression due to preoperative neoCRT.The incidence rates of postoperative pulmonary infection, anastomotic leakage, and anastomotic stenosis were 21%, 12%, and 7%, respectively, and the perioperative mortality rate was 2%.Conclusions For patients with locally advanced esophageal cancer, preoperative neoCRT plus surgery can increase the clinical response rate and pCR rate, reduce the tumor stage, and improve the survival, but chemoradiotherapy toxicities and perioperative complications cannot be ignored.
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Objective To analyze the outcomes and prognostic factors in patients with esophageal cancer after concurrent chemoradiotherapy.Methods A total of 135 patients with esophageal squamous cell carcinoma were enrolled in the clinical study from January 2008 to June 2015.The patients were treated with two-dimensional radiotherapy (56 patients) or three-dimensional radiotherapy (79 patients).The radiotherapy was delivered at a total dose of 60-64 Gy (1.8-2.0 Gy per fraction).The concurrent chemotherapy regimen consisted of fluorouracil plus cisplatin or paclitaxel plus cisplatin and was performed on days 1 and day 29 of radiotherapy.The Kaplan-Meier method was used to calculate overall survival (OS)and progression-free survival (PFS) rates,the log-rank test was used for survival difference analysis and univariate prognostic analysis,and the Cox model was used for multivariate prognostic analysis.Results The 1-,3-,and 5-year sample sizes were 96,31,16,respectively.The 1-,3-,and 5-year OS rates were 74.0％,39.0％,and 28.6％,respectively;the median OS time was 25 months.The 1-,3-,and 5-year PFS rates were 57.3％,27.3％,and 16.6％,respectively;the median PFS time was 15 months.The univariate analysis indicated that clinical stage,radiotherapy method,and M stage were prognostic factors for OS and PFS (P =0.006,0.000,and 0.032;P=0.017,0.004,and O.000).The multivariate analysis showed that clinical stage and radiotherapy method were independent prognostic factors for OS and PFS (P=0.006 and 0.000;P =0.033 and 0.023).Conclusions For non-surgical treatment of patients with esophageal cancer,concurrent chemoradiotherapy is a preferred strategy and has proven to be effective and tolerable.
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Objective To study the short-term curative effects and side effects of the three-dimensional conformal radiotherapy combined with chemotherapy in advanced esophageal cancer in Xinjiang provenience.Methods One hundred and twelve cases were divided into Kazak and Han nationality group according to the different nations.Chemotherapy was DF regime:5-Fu 1000 ms/m2+DDP 20 mg/m2,d1-4,21 days as a cycle,total 4-6 cycles.For both groups,3DCRT was carried out by conventional fractionation with total dose of 60-66 Gy/30-33frin 6-7w.Results The following-up rate was 100%.The number of pailents followed up at two years wero 23 and 27 in Kazak and Han nationality group,respectively.The immediate effective rates(CR(complete remission)+PR(partial remission))were 77%(34/44)and 85%(58/68)in ban and kazak group,respectively(X2=4.89,P=0.180).The 1-and 2-year survival rate were 75%,59%and 52%,40%(X2=1.71,P=0.191)in Kazak and Han group,respectively.The 3-4grade radioesophagitis were 5%(2/44)and 7%(5/68)in kazak group and han group,respectively(X2=1.66,P=0.435).The 3-4 grade radiopneumonia were 2%(1/44)and 1%(1/68)in kazak group and ban group,respectively(X2=0.99,P=0.608).The 3-4 grade haematolosical toxicity were9%(4/44) and 29%(20/68 in kazak and in han group,respectively(X2=6.57,P=0.037).Conclusions There was no significant difference in short-term curative effects between patients from han and kazak nationality with advanced carcinoma of esophagus who received the three-dimensional conformal radiotherapy combined with chemotherapy.but Kazak people showed better tolerance.