National Cancer Institute®
Last Modified: May 1, 2002
UI - 11967675
AU - Incarbone R; Bonavina L; Saino G; Bona D; Peracchia A
TI - Outcome of esophageal adenocarcinoma detected during endoscopic biopsy surveillance for Barrett's esophagus.
SO - Surg Endosc 2002 Feb;16(2):263-6
AD - Department of Surgical Sciences, University of Milan, Ospedale Maggiore di Milano, IRCCS, Via F. Sforza 35, 20122 Milan, Italy.
BACKGROUND: In an attempt to reduce mortality from esophageal adenocarcinoma, it has been recommended to enroll patients with Barrett's esophagus in endoscopic surveillance programs in order to detect malignant degeneration at an early and possibly curable stage. The aim of this study was to assess the impact of endoscopic biopsy surveillance on outcome of Barrett's adenocarcinoma. METHODS: Between esophageal adenocarcinoma were referred to our department. Ninety-seven of these patients had Barrett's adenocarcinoma. In 12 (12.2%) patients, cancer was discovered during endoscopic surveillance for Barrett's metaplasia. RESULTS: The prevalence of gastroesophageal reflux disease in the Barrett's group was 38.8% versus 8% (p < 0.01) in non-Barrett's patients. In the surveyed group, there were 9 (75%) early stage tumors (Tis-1/N0) versus 9 (10.6%, p < 0.01) in the nonsurveyed patients. Three of 5 surveyed patients operated on for high-grade dysplasia proved to have invasive carcinoma in the esophagectomy specimen. All surveyed patients were alive at a median follow-up of 48 months; the median survival in the nonsurveyed group was 24 +/- 3 months (p < 0.01). CONCLUSION: Endoscopic surveillance of Barrett's esophagus provides early detection of malignant degeneration and a better long-term survival than in nonsurveyed patients.
UI - 11967708
AU - Norberto L; Urso E; Angriman I; Ranzato R; Erroi F; Marino S; Tosato S;
TI - Ruffolo C; D'Amico DF Yttrium-aluminum-garnet laser therapy of esophageal granular cell tumor.
SO - Surg Endosc 2002 Feb;16(2):361-2
AD - Department of Surgical and Gastroenterological Sciences, Surgical Endoscopy Unit, Clinica Chirurgica 1, University of Padua, Italy. firstname.lastname@example.org
BACKGROUND: Granular cell tumor (GCT) is a rare lesion. Approximately 4% to 6% of these tumors occur in the gastrointestinal tract, one-third of them affecting the esophagus. Almost all GCTs are benign lesions. Approximately 1% to 3% are malignant. Endoscopic ultrasonography (EUS) is a diagnostic support. The best treatment for esophageal GCT is not yet clear, whether surgical excision, periodic observation, endoscopic excision, or yttrium-aluminum-garnet (YAG) laser therapy. METHODS: From were observed. All the patients underwent EUS evaluation and endoscopic YAG laser therapy of the esophageal neoplasm. At each session, a biopsy at the tumor site was obtained. The treatment was continued until endoscopic and histologic evidence of the tumor disappeared. RESULTS: After the YAG laser therapy, no evidence of the tumor was found in any of the four patients with esophageal GCT. At this writing, the patients remain disease free after a mean follow-up period of 66 months. No complication has been observed. Only four sessions for each patient were necessary to eliminate the tumor. CONCLUSIONS: Therapy with YAG laser was effective in all four patients with esophageal GCT, and complete necrosis of the submucosal neoplastic cells was achieved. Endoscopic YAG laser therapy appears to be a good compromise between esophageal dissection and long-term observation without tumor excision. Esophageal laser therapy is safe if correctly used, and previous EUS evaluation increases treatment safety.
UI - 11764654
AU - Nutting CM; Bedford JL; Cosgrove VP; Tait DM; Dearnaley DP; Webb S
TI - Intensity-modulated radiotherapy reduces lung irradiation in patients with carcinoma of the oesophagus.
SO - Front Radiat Ther Oncol 2002;37():128-31
AD - Academic Department of Radiotherapy, Institute of Cancer Research, Royal Marsden NHS Trust, Sutton, UK. email@example.com
UI - 11910473
AU - Koliopanos A; Friess H; di Mola FF; Tang WH; Kubulus D; Brigstock D;
TI - Zimmermann A; Buchler MW Connective tissue growth factor gene expression alters tumor progression in esophageal cancer.
SO - World J Surg 2002 Apr;26(4):420-7
AD - Department of Visceral and Transplantation Surgery, University of Bern, Inselspital, CH-3010 Bern, Switzerland.
The ability of cancer cells to initiate specific fibroblast reactions may subsequently determine tumor evolution. In the present study we examined the coordinated expression of transforming growth factor-beta-1 (TGF-beta1), its signaling receptors, and its downstream mediator-connective tissue growth factor (CTGF)--and their impact on tumor progression and fibrogenesis in esophageal carcinomas. Messenger ribonucleic acid (mRNA) expression of TGF-beta1, CTGF, TGF-beta receptor subtype I ALK5 (TbetaR-IALK5), and TGF-beta receptor type II (TbetaR-II) was studied by Northern blot analysis in esophageal cancer and the normal esophagus. By means of immunohistochemistry and Western blot analysis, the respective proteins were localized in the tissue samples and the protein content was quantitated. Northern blot analysis revealed 3-fold and 4-fold increases (p < 0.05) in TGF-beta1 and CTGF mRNA levels, respectively, in esophageal cancer in comparison with normal controls, whereas TbetaR-I mRNA levels were significantly decreased and TbetaR-II mRNA levels were unchanged in the cancer samples. Immunostaining revealed results similar to those seen on the RNA level. TGF-beta1 and CTGF immunoreactivity were increased, TbetaR-II was unchanged, and TbetaR-IALK5 immunoreactivity was decreased. CTGF immunoreactivity was mainly present in the stroma surrounding the cancer cells but was also present in the cancer cells. The degree of fibrosis was different in squamous and adenocarcinomas and was significantly related to CTGF mRNA expression levels. The presence of CTGF in squamous cell carcinomas was associated with longer survival, whereas in adenocarcinomas it influenced survival negatively. The findings indicate that TGF-beta signaling is disturbed in esophageal cancer. CTGF, a downstream effector of TGF-beta action, differentially influences the composition of tumor microenvironment and distinct cell-matrix interactions in the two histological types of esophageal carcinoma, resulting in differences in tumor progression and patient survival.
UI - 11819737
AU - Wang SJ; Wen DG; Zhang J; Man X; Liu H
TI - Intensify standardized therapy for esophageal and stomach cancer in tumor hospitals.
SO - World J Gastroenterol 2001 Feb;7(1):80-2
AD - Hebei Tumor Hospital, 5 Jiankanglu, Shijiazhuang 050011, Hebei Province, China.
UI - 11916346
AU - Conio M; Filiberti R; Blanchi S; Giacosa A
TI - Carditis, intestinal metaplasia and adenocarcinoma of oesophagogastric junction.
SO - Eur J Cancer Prev 2001 Dec;10(6):483-7
AD - Department of Gastroenterology and Clinical Nutrition, National Cancer Research Institute, Genova, Italy.
Barrett's oesophagus is a precancerous condition in which the normal squamous epithelium is replaced by intestinal metaplasia (IM). IM can then progress through increasingly severe dysplasia to oesophageal adenocarcinoma (EAC). In the gastric cardia the normal gastric mucosa, when inflamed (carditis), can be replaced by IM and can then progress to gastric adenocarcinoma (GAC). The same histopathological sequence can take place on either side of the oesophagogastric junction. Since the location of that junction can be uncertain this can result in confused diagnosis between EAC and GAC. In this review, the diagnostic criteria, incidence and risk factors for Barrett's oesophagus and carditis are discussed, together with the factors determining the risk of progression to adenocarcinoma of the oesophagus or cardia. The risk factors include familial/genetic, environmental and dietary characteristics. Finally, these risk factors are discussed within the context of cancer prevention.
UI - 11884045
AU - Kyriazanos ID; Tachibana M; Yoshimura H; Kinugasa S; Dhar DK; Nagasue N
TI - Impact of splenectomy on the early outcome after oesophagectomy for squamous cell carcinoma of the oesophagus.
SO - Eur J Surg Oncol 2002 Mar;28(2):113-9
AD - Second Department of Surgery, Shimane Medical University, Izumo, 693 8501, Japan. firstname.lastname@example.org
AIM: Operative procedures for oesophageal malignancies are becoming more extensive and may result in fatal complications. Splenectomy compromises the immune system and can lead to increased susceptibility to infections. The aim of the present study was to report the early outcome of patients who underwent oesophagectomy and simultaneous splenectomy due to oesophageal squamous cell carcinoma (SCC). METHODS: Pre-operative risks and post-operative morbidity and mortality in 135 patients who had undergone extensive oesophagectomy without simultaneous splenectomy for SCC of the thoracic oesophagus were compared with those of 14 patients who had undergone oesophagectomy associated with splenectomy. RESULTS: Post-operative pneumonia, intra-abdominal abscess, post-operative sepsis and anastonotic leakage were significantly increased when splenectomy was added to the original operation. The incidence of in-hospital death was significantly higher among splenectomized than non-splenectomized patients (35.7% vs 8.1%, P<0.01). Pulmonary complications and leakage were the main causes of death. Multivariate analysis recognized splenectomy as an independent prognostic factor for in-hospital death following transthoracic oesophagectomy for SCC. CONCLUSION: The addition of splenectomy to transthoracic oesophagectomy for oesophageal carcinoma can be a fatal combination. Preservation of the spleen should be the primary intention. In circumstances that necessitate splenectomy precautions should be taken to prevent post-operative infectious complications. Copyright Harcourt Publishers Limited.
UI - 11937011
AU - Ilson DH
TI - New developments in the treatment of esophageal cancer.
SO - Curr Oncol Rep 2002 May;4(3):213-21
AD - Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10011, USA. email@example.com
Esophageal cancer is a rare but highly virulent malignancy in the United States and Western Europe, and adenocarcinoma of the esophagus has had the most rapid rate of increase of any solid tumor malignancy. Combined chemoradiotherapy is the standard of care in the nonsurgical management of esophageal cancer. Trials of preoperative chemotherapy followed by surgery have not shown a consistent benefit. Preoperative chemoradiotherapy followed by surgery continues to be actively studied in the surgical management of locally advanced esophageal cancer. Pathologic complete responses are seen in 20% to 40% of patients, with 5-year survival achieved in 30% to 35%. Newer agents, such as the taxanes and irinotecan, have been evaluated in combined chemoradiotherapy trials. These trials have shown promising antitumor activity and therapy tolerance, depending on the dose and schedule of therapy administered. Increasing the dose of radiotherapy, or adding a brachytherapy boost to chemoradiotherapy, has not improved the outcome of treatment in clinical trials. The advent of newer targeted therapies, including agents directed against growth factor receptor pathways, tumor angiogenesis, and tumor invasion and metastasis, is leading to a new generation of clinical trials combining these agents with conventional cytotoxic chemotherapy and radiation.
UI - 11930636
AU - Wang T; Zhang W; Liu Y
TI - [Clinical significance of the novel tumor marker CYFRA21-1 in patients with esophageal cancer]
SO - Zhonghua Yi Xue Za Zhi 2001 Nov 25;81(22):1390-1
AD - Department of Thoracic Surgery, Peking Union Hospital, Peking Union Medical Collage, Beijing 100730, China.
OBJECTIVE: To study the clinical significance of the novel tumor marker--CYFRA21-1 in patients with esophageal cancer. METHODS: The CYFRA21-1 level in serum of 84 patients with a definite diagnosis of esophageal cancer was examined 10 days before and after operation by ELISA. A 3 years' follow-up was conducted to the survival of patients. RESULTS: (1) The CYFRA21-1 level was > 3.3 ng/ml in 72.6% of the patients (61/84). (2) The serum CYFRA21-1 level decreased significantly after operation in patients at stage III or with high differentiation (P < 0.05). (3) The difference between pre- and post-operative serum CYFRA21-1 levels was statistically significant in patients who had undegone radical operation, and was not in patients who had undergone palliative operation. (4) In addition to stage (P < 0.05) and type of operation (P < 0.05), the difference of CYFRA21-1 level before and after operationwas closely related to the prognosis (P < 0.05). CONCLUSION: CYFRA21-1 is a useful marker in diagnosis and prediction of prognosis of esophageal cancer.
UI - 11859713
AU - Xing D; Song N; Tan W
TI - [Detection of malondialdehyde-DNA adduct level by 32P-postlabeling assay in normal human esophageal epithelium and esophageal squamous cell carcinoma]
SO - Zhonghua Zhong Liu Za Zhi 2001 Nov;23(6):473-6
AD - Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
OBJECTIVE: To study whether the main malondialdehyde-DNA adduct (M1-dG) produced by lipid peroxidation is involved in the carcinogenesis of esophagus. METHODS: DNA samples were isolated from normal esophageal epithelium (n = 32) obtained by biopsy and esophageal squamous cell carcinoma specimens (n = 30) obtained by surgery. All tissue samples came from individuals living in Linxian, Henan, a high-risk area of esophageal cancer. Contents of M1-dG adducts were detected by 32P-postlabeling method. RESULTS: M1-dG adducts were detectable both in the normal and cancerous tissue samples. However, normal esophageal epithelial tissues exhibited significantly lower levels of M1-dG adducts (median 3.4, range 1.7/10(8)-55.4/10(8) nucleotides) than those found in esophageal cancer tissues (median 14.1, range 1.4/10(8)-59.0/10(8) nucleotides, P < 0.0001). The adduct levels were neither associated with gender, age, tobacco smoking status or genetic polymorphism in the CYP2E1, an enzyme participating in the oxidation of ethanol to form reactive free radicals. CONCLUSIONS: Our findings provide evidence that DNA damage, resulted from lipid peroxidation, can accumulate in the normal human esophageal tissue and reach relatively high level in cancer tissue which suggests that M1-dG adducts may be involved in the initiation and progression of cancer with its mutagenic and carcinogenic effects.
UI - 11914632
AU - Hoang MP; Hobbs CM; Sobin LH; Albores-Saavedra J
TI - Carcinoid tumor of the esophagus: a clinicopathologic study of four cases.
SO - Am J Surg Pathol 2002 Apr;26(4):517-22
AD - Division of Anatomic Pathology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9073, USA.
Several case reports have emphasized that esophageal carcinoid tumors are associated with a poor prognosis. To expand our knowledge about the pathology and biologic behavior of these rare tumors, we reviewed the clinicopathologic and immunohistochemical findings of four cases of primary esophageal carcinoid. The age of the patients ranged from 48 to 82 years (mean 63 years; median 61 years). The lower segment of the esophagus was involved in two cases and the mid segment was involved in one case. The sizes of the tumors ranged from 0.3 cm to 3.5 cm. Two tumors were confined to the lamina propria and two invaded into the muscular wall. Two tumors appeared polypoid, whereas the remaining two were incidental findings and associated with adenocarcinoma arising in a background of Barrett esophagus. The adenocarcinoma was superficially invasive in one case, whereas it penetrated the muscular wall in the other. All four carcinoid tumors were immunoreactive with chromogranin and synaptophysin. There was focal expression of serotonin in two cases, glucagon in one case, and pancreatic polypeptide in one case. Endocrine cell hyperplasia was noted in both the Barrett esophagus and the invasive adenocarcinoma. One patient died secondary to postoperative pneumonia. Three patients are alive and disease free at 1, 6, and 23 years status post therapy. None of the patients had metastatic disease. These findings show that esophageal carcinoids are associated with a favorable prognosis. They arise in two settings: (1) a single large polypoid tumor or (2) an incidental finding and in association with adenocarcinoma arising in the background of Barrett esophagus. The presence of endocrine cell hyperplasia in the Barrett mucosa and the adenocarcinoma supports the hypothesis that these lesions arise from a common stem cell.
UI - 11965462
AU - Decker P; Lippler J; Decker D; Hirner A
TI - Use of the Polyflex stent in the palliative therapy of esophageal carcinoma: results in 14 cases and review of the literature.
SO - Surg Endosc 2001 Dec;15(12):1444-7
AD - Department of Surgery, Rheinische Friedrich Wilhelm University Bonn, Sigmund Freud Strasse 25, 53105 Bonn,Germany.
BACKGROUND: Several prospective randomized trials have shown that self-expanding stents have advantages over conventional plastic tubes. Nevertheless, the optimal stent has not yet been developed. The Polyflex stent is a completely new model that represents an improvement over the old metal stents. We have used this stent in a prospective study and herein our present preliminary results. METHODS: In 14 patients with nonresectable esophageal carcinoma, the Polyflex stent was implanted to reduce dysphagia. The grade of dysphagia, the complications following intervention, and the patients' total survival time were documented prospectively every 4 weeks. RESULTS: The implantation of the stent was successful in all cases. The grade of the dysphagia was reduced from 3.0 to 0.5 after stent implantation. One patient died during the hospital stay from a non-stent-induced complication. Stent dislocation occurred once, and tumor overgrowth at the stent margins was observed twice. The mean survival time was 6.2 months, and the reintervention rate was 21.3%. CONCLUSION: The new Polyflex stent, which is based on a completely new design, can be implanted without any difficulty and has had very good short- and long-term results. Therefore, it is a worthy alternative to the metal stents in current use.
UI - 11943125
AU - Urschel JD; Vasan H; Blewett CJ
TI - A meta-analysis of randomized controlled trials that compared neoadjuvant chemotherapy and surgery to surgery alone for resectable esophageal cancer.
SO - Am J Surg 2002 Mar;183(3):274-9
AD - Department of Surgery, McMaster University, Hamilton, Ontario, Canada. firstname.lastname@example.org
BACKGROUND: Esophagectomy is often considered the standard treatment for resectable esophageal cancer but the rate of cure is low. Combining neoadjuvant chemotherapy with surgery has theoretical appeal and some clinical evidence suggests a benefit. We performed a meta-analysis of randomized controlled trials (RCTs) that compared neoadjuvant chemotherapy and surgery with surgery alone for esophageal cancer. METHODS: Medline and manual searches were done to identify all published RCTs that compared neoadjuvant chemotherapy and surgery to surgery alone for esophageal cancer. The selection process was inclusive; no trials were excluded. Trial validity assessment was done and a trial quality score was assigned. Outcomes assessed by meta-analysis included 1-, 2-, and 3-year survival, rate of resection, rate of complete resection, operative mortality, anastomotic leaks, postoperative pulmonary complications, all treatment mortality, local-regional cancer recurrence, distant cancer recurrence, and all cancer recurrence. A random-effects model was used and odds ratio was the principal measure of effect. Systematic quantitative review was done for outcomes unique to the neoadjuvant chemotherapy treatment group (clinical response, pathological complete response, and chemotherapy mortality). RESULTS: Eleven RCTs, which included 1,976 patients, were selected with quality scores ranging from 1 to 3 (5-point Jadad scale). Odds ratio (95% confidence interval [CI]; P value), expressed as chemotherapy and surgery versus surgery alone (treatment versus control; values <1 favor chemotherapy-surgery arm), was 1.00 (0.76, 1.30; P = 0.98) for 1-year survival, 0.88 (0.62, 1.24; P = 0.45) for 2-year survival, 0.77 (0.37, 1.59; P = 0.48) for 3-year survival, 1.71 (1.22, 2.40; P = 0.002) for rate of resection, 0.71 (0.58, 0.87; P = 0.001) for rate of complete resection, 0.94 (0.66, 1.35; P = 0.76) for operative mortality, 1.08 (0.45, 2.60; P = 0.87) for anastomotic leaks, 1.31 (0.77, 2.23; P = 0.32) for postoperative pulmonary complications, 1.36 (0.83, 2.25; P = 0.22) for all treatment mortality, 0.71 (0.36, 1.42; P = 0.33) for local-regional cancer recurrence, 0.79 (0.57, 1.10; P = 0.16) for distant cancer recurrence, and 0.63 (0.28, 1.41; P = 0.26) for all cancer recurrence. A clinical response to chemotherapy was observed in 31% of patients and 5% had a complete pathological response. Chemotherapy mortality (before surgery) was 1.6%. CONCLUSIONS: Compared with surgery alone, neoadjuvant chemotherapy and surgery is associated with a lower rate of esophageal resection but a higher rate of complete (R0) resection. It does not increase treatment related mortality. This meta-analysis did not demonstrate a survival benefit for the combination of neoadjuvant chemotherapy and surgery.
UI - 11943134
AU - Nakabayashi T; Mochiki E; Garcia M; Haga N; Kato H; Suzuki T; Asao T;
TI - Kuwano H Gastropyloric motor activity and the effects of erythromycin given orally after esophagectomy.
SO - Am J Surg 2002 Mar;183(3):317-23
AD - First Department of Surgery, Faculty of Medicine, Gunma University, 3-39-15, Showa-machi, 371-8511, Maebashi, Japan.
BACKGROUND: The motor activity of the gastric tube as an esophageal replacement after esophagectomy is poorly understood. The aims of the present study were to examine the gastropyloric motility of the gastric tube and the effects of erythromycin given orally. METHODS: Interdigestive gastropyloric motility was recorded by manometry with a sleeve sensor in 23 esophagectomized patients. The 23 patients were classified into 3-, 12-, and 24-month groups according to postoperative follow-up time. Radiopaque markers were used in 8 patients to assess gastric emptying. The effects of erythromycin were studied after the patients received 600 mg during fasting and 1 g postprandially. RESULTS: Compared with the 3-month group, the 12-month group and the 24-month group showed significantly increased pyloric and antral motility, respectively. During a fast, erythromycin induced phase III in 44.4% of the patients with more than 12 months of follow-up. In contrast to the normal subjects, esophagectomized patients showed delayed gastric emptying at 3 and 4 hours. However, erythromycin significantly accelerated gastric emptying at 1, 2, 3, and 4 hours. CONCLUSIONS: The motor activity of the gastric tube returns towards normal in a progression over time from the pylorus cephalad. Erythromycin given orally might be used as a prokinetic agent in patients after esophagectomy.
UI - 11953125
AU - Li C; Wu M; Liang Y; Xu L; Cai W
TI - [Analysis of telomerase activity in esophageal carcinoma using microdissection telomeric repeat amplification protocol assay]
SO - Zhonghua Yi Xue Za Zhi 2002 Jan 10;82(1):39-42
AD - Department of Pathology, Shantou University Medical College, Shantou, Guangdong 515031, China.
OBJECTIVE: To investigate the changes of telomerase activities in atypical hyperplasia of esophageal mucosal epithelium and esophageal squamous cell carcinoma (SCC) and to study the association of telomerase activity with differentiation, invasiveness, and lymphatic metastasis of cancer. METHODS: The telomerase activities of esophageal SCC tissues, adjacent tissue with dysplasia, and normal mucosal epithelium from surgical edge of 45 cases were detected by microdissection-TRAP (Telomeric Repeat Amplification Protocol)-silver assay. RESULTS: The telomerase activity rates were 79.3% (23/29) in atypical displastic epithelium, 82.2% (37/45) in SCC tissue, and only 5% (2/40) in normal epithelium. The difference of telpmerase activity between dysplastic and normal esophageal epithelia was highly significant (P < 0.01). In the same cancer tissue the differences of telomerase activity among cancer nests to different degrees of defferentiation and to different depths were not significant (P > 0.05). The positive rate of telomerase activity was significantly higher in cases with lymphatic metastasis than in cases without lymphatic metastasis (P < 0.05). CONCLUSION: The telomerase activities is increased in esophageal SCC tissue and adjacent atypical dysplastic tissue. The telomerase activity in SCC tissue is related to lymphatic metastasis but not related to cancer differentiation.
UI - 11993218
AU - Tsurumaru M
TI - [Current and future problems of treatments for esophageal carcinoma]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):323-4
AD - First Department of Surgery, Juntendo University School of Medicine, Tokyo, Japan.
UI - 11993219
AU - Tamura K; Yoshikawa K; Tsujii H; Murata H
TI - [Diagnosis of esophageal cancer using positron emission tomography]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):325-30
AD - National Institute of Radiological Sciences, Research Center Hospital for Charged Particle Therapy, Clinical Diagnosis Section, Chiba, Japan.
Fluorodeoxyglucose positron emission tomography (FDG-PET) is more accurate than computed tomography (CT) for evaluating lymph node metastases and for N staging, but less accurate than combined CT and endoscopic ultrasonography (EUS). Lymph nodes located adjacent to the primary lesion tend to be false negatives. We consider that combined FDG-PET and EUS is the most accurate for the detection of lymph node metastasis in esophageal cancer. FDG-PET is also more accurate than CT for detecting distant metastases and improves the detection of stage IV disease compared with the conventional staging modalities. For the diagnosis of recurrence except for perianastomotic recurrence, FDG-PET provides additional information and is more sensitive than conventional work-ups. FDGPET is a valuable tool for the noninvasive assessment of tumor response after neoadjuvant therapy. 11C-methionine (MET) is another tracer for PET that can be used to assess the metabolism of amino acids, since MET accumulates in esophageal malignant tumors. Choline-PET is more accurate than FDG-PET for the detection of mediastinal lymph node metastases.
UI - 11993220
AU - Okuda I; Kokubo T; Hoshihara Y; Udagawa H
TI - [Imaging diagnosis of esophageal carcinoma by computed tomography and magnetic resonance imaging]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):331-6
AD - Department of Diagnostic Radiology, Toranomon Hospital, Tokyo, Japan.
The staging diagnosis of esophageal carcinoma is important to determine therapeutic modalities and to predict prognosis. The current status of imaging diagnosis of tumor invasion to the adjacent organs and lymph node metastasis is described. The diagnostic criteria used to determine tumor invasion to the adjacent or gans by computed tomography (CT) and magnetic resonance imaging(MRI) are displacement and compression deformity of the tracheobronchial tree and obliteration of the periaortic fat plane over more than 90 degrees of the aortic circumference. Detection of the fat plane between the esophagus and the aorta supported by density profile analyzing software on CT may enable the diagnosis of invasion. Cine-MRI imaging is also useful to obtain dynamic information on the tumor and aorta. Tumor invasion to the aortic wall can be excluded when a low-intensity stripe is recognized between the tumor and the aortic wall. Although the criterion for lymph node metastasis on CT is 10 mm or more in long transverse diameter, the diagnostic accuracy is poor. The accuracy improves when imaging patterns such as heterogeneous internal structures in the enhanced lymph nodes and/or hyperenhancement in the lymph nodes in the early phase by dynamic study are added to the diagnostic criteria. However, small metastatic lymph node remain undetected and it is difficult to diagnose negative lymph node metastasis properly on CT and MRI. It is important to have full knowledge of the advantages and limitations of each imaging modality and to obtain objective information form them.
UI - 11993221
AU - Yoshida M; Momma K
TI - [Endoscopic evaluation of the depth of invasion in cases of superficial esophageal cancer in determining indications for endoscopic mucosal resection]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):337-42
AD - Department of Surgery, Tokyo Metropolitan Komagome General Hospital, Tokyo, Japan.
Endoscopic mucosal resection (EMR) should be performed for the treatment of squamous cell carcinoma of the esophagus limited to the lamina propria mucosae (m1 and m2 cancers), because lymph node metastasis is rare in these cases. The lymph node metastasis rate is 6% when cancers reach the muscularis mucosa(m3) or slightly invade the submucosa (sm1). Lymph node metastasis is noted in 47% of esophageal cancers moderately or severely invading the submucosa(sm2 and sm3). Radical esophagectomy is recommended for sm2 and sm3 disease. Type 0-II cancers are candidates for EMR, because 86% remain within the mucosa, while 90% of type 0-I lesions and 96% of type 0-III lesions are submucosal cancers. Among type 0-II cancers, most type 0-IIb lesions are m1 cancer. Among type 0-IIa cancers, 96% are mucosal. Type 0-IIc lesions are frequent among superficial esophageal cancers and 19% reach the submucosa. Endoscopic diffrentiation of m1 and m2 cancers is reliable, since 96% of all m1 and m2 cancers were correctly diagnosed before treatment. In cases with type O-IIc lesions which is most frequent among superficial esophageal cancers, m1 cancer showed very slight depressions with a smooth surface and reddening. Sometimes fine granular changes are seen. They are also delineated as an unstained area by endoscopic toluidine blue-iodine double staining. They showed very slight depressions with a smooth surface and reddening. Sometimes fine granular changes are seen. They are also delineated as an unstained area by endoscopic toluidine blue-iodine double staining. Dark blue dots, spots, or reticular staining are frequently identified in m2 cancers. In cases with m3 or sm1 cancer, coarse granular changes, small nodular elevations, or slightly deeper depressed areas in the m1 and m2 lesions suggest sites of deeper invasion.
UI - 11993222
AU - Kajiyama Y; Tsurumaru M
TI - [Esophagectomy with lymph node dissection through right thoracotomy]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):343-7
AD - First Department of Surgery, Juntendo University School of Medicine, Tokyo, Japan.
In esophageal cancer, the incidence of lymph node metastasis is much higher than that in gastric or colonic cancer. Lymph node metastasis is frequently found along the recurrent laryngeal nerve and around the gastric cardia. The accuracy rate of preoperative diagnosis of lymph node metastasis is up to 80%, in spite of vigorous diagnostic efforts. In Japan, "esophagectomy with 3-field lymph node dissection through a right thoracotomy" is the standard surgery for advanced esophageal cancer. However, based on the "Comprehensive Registry of Esophageal Cancer in Japan," this standard operation does not prevail nationwide. Although, it is difficult to obtain evidence showing the effects of lymph node dissection for ethical reasons, we must continue accurate lymph node dissection with the best surgical techniques to improve patient survival.
UI - 11993223
AU - Ide H; Narumiya K; Eguchi R; Nakamura T; Kobayashi A; Ota M
TI - [Radical surgery with mini-thoracolaparotomy for esophageal cancer]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):348-53
AD - Department of Surgery, Institute of Gastroentelorogy, Tokyo Women's Medical University, Tokyo, Japan.
In our institute, radical esophagectomy through mini-thoracolaparotomy has been performed as a less-invasive surgery for esophageal cancer since 1996. We describe the indications for and operative procedures of mini-thoracolaparotomy. Next we report the preliminary results of a prospective randomized trial that compared mini-thoracolaparotomy with conventional thoracolaparotomy in 30 patients without neoadjuvant therapy. There were no differences between the two groups in operative time, bleeding volume, and number of dissected lymph nodes. Thoracolaparotomy was effective in decreasing the quantity of morphinerequired in the ICU and shortening hospitalization after surgery. Thoracolaparotomy was effective in preventing a decrease in and early recovery of postoperative vital capacity. In clinical data on radical esophagectomy performed through a right thoracotomy and reconstruction with a stomach tube from 1996 to 2000, the 5-year survival rate of 63 patients in the thoracolaparotomy group (67.6%) did not differ from that of 124 patients in the conventional surgery group (49.9%).
UI - 11993224
AU - Osugi H; Takada N; Masashi; Takemura; Lee S; Ueno M; Tanaka Y; Fukuhara
TI - K; Kinoshita H [Thoracoscopic esophagectomy]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):354-8
AD - Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
The current roles of thoracoscopic esophagectomy in the treatment of cancer in Japan are described. Lymphadenectomy of the same quality as open surgery should be performed thoracoscopically to obtain good oncological outcomes. The indications for thoracoscopic esophagectomy are 1) no extensive pleural adhesions; 2) pulmonary function sufficient for single-lung ventilation; and 3) tumor not invading other organs. Hand-assisted or mini-thoracotomy facilitates the dissection of lymph nodes, especially on the left side of the trachea. However, for any type of procedure, a good en-face view is essential for safe and accurate lymphadenectomy. The magnifying effect of video, with the camera in close proximity, is important to maintain a proper dissecting plane. Although sufficient experience is necessary to master the learning curve, lymphadenectomy of the same quality as open surgery can be performed with mini-thoracotomy in a feasible time period. Thoracoscopic esophagectomy contributes to reducing postoperative pain and constrictive pulmonary dysfunction. It may be too soon to assert that the thoracoscopic approach can provide oncological outcomes comparable to those after open surgery because long-term follow up is not yet sufficient. Thoracoscopic esophagectomy, however, has the potential to improve the postoperative quality of life of patients with esophageal cancer.
UI - 11993225
AU - Ando N; Shih CH
TI - [Chemotherapy for the patients with esophageal cancer]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):359-63
AD - Department of Surgery, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Japan.
The combination of cisplatin and continuous-infusion 5-fluorouracil is the standard regimen for the treatment of both squamous cell carcinoma and adenocarcinoma. Paclitaxel has shown favorable results as a single agent or in combination with cisplatin. The efficacy of neoadjuvant chemotherapy in terms of survival benefit remains controversial despite large-scale, randomized, controlled trials comparing it with surgery alone. The disease-free survival benefit of postoperative adjuvant chemotherapy was recognized in a Japan Clinical Oncology Group randomized controlled trial in comparison with surgery alone.
UI - 11993226
AU - Masamichi N
TI - [Radiotherapy and chemotherapy for esophageal cancer]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):364-70
AD - Department of Radiology, National Sapporo Hospital (Hokkaido Cancer Center), Sapporo, Japan.
The nonsurgical gold standard treatment for esophageal cancer is radiotherapy, but chemoradiation therapy using anticancer agents concurrently is becoming standard management. With chemoradiation adverse responses in the acute stage may be enhanced in comparison with conventional radiation therapy alone, but improved treatment outcomes are reported. A consensus has nearly been reached on the standard radiation technique and dose, and a guideline changes, but drug type, timing, and optimum dosage in chemoradiation are unclear. Further future study is thus necessary. In this report, recent trends in radiotherapy and chemoradiation are outlined and future problems described.
UI - 11993227
AU - Shimada H; Matsubara H; Ochiai T
TI - [Gene therapy for esophageal cancer]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):371-5
AD - Department of Academic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Esophageal cancer is a highly malignant disease in which progression is observed in most patients even at the first medical examination. Neoadjuvant cytoreduction treatments are frequently used for the purpose of tumor down-staging, increasing the resection rate, and possibly improving survival. Although combination therapy with radiation and anticancer agents is available, no satisfactory treatment regimen has yet been established due to the development of resistance. Based on the concepts of genetic alteration in carcinogenesis, cancer gene therapy has been developing rapidly. We previously reported the growth inhibitory effect of adenovirus-mediated wild-type p53 gene transfer into esophageal squamous carcinoma cell lines. After extensive preclinical study of p53 gene therapy in vitro and in vivo, we are conducting a phase I/II clinical trial. The target of this trial is patients with unresectable esophageal cancer resistant to chemoradiotherapy. As of December 1, 2001, 8 candidates had been admitted to our hospital. After extensive examination, 4 patients were enrolled in this trial. After giving informed consent, the first patient received injections of Ad5 CMV-p53 on December 19, 2000. No serious adverse events have occurred so far in these patients, and the trial has been conducted safely.
UI - 11993228
AU - Yamana H
TI - [Immunotherapy for esophageal carcinoma]
SO - Nippon Geka Gakkai Zasshi 2002 Apr;103(4):376-80
AD - Multidisciplinary Treatment Center, Kurume University School of Medicine, Kurume, Japan.
Recent progress in gene technology has clarified the existence of some cancer-rejection genes and peptides such as MAGE, MART, etc. Many clinical trials with cancer vaccines have been performed. Since the clinical efficacy of HLA class I-restricted peptide vaccines is still poor, many researchers are mainly administering dendritic cell therapies. However, there have been few clinicals trials of cancer-specific immunotherapy for esophageal carcinomas. We have performed cancer vaccine therapy with SART-1 peptide and locoregional adoptive immunotherapy with activated autologous lymphocytes for patients with advanced esophageal carcinoma in a phase I and a phase I/II trial, respectively. The clinical responses were poor in the vaccine trial because of the rapid growth of esophageal cancers and the requirement for more than 2 months to activate and increase killer T cells after in vivo vaccination, while locoregional adoptive immunotherapy was effective for the treatment of esophageal cancers even in advanced stages with organ metastases. Based on these results, we think that a combination immunotherapy with adoptive immunotherapy and vaccine therapy is needed for the treatment of advanced esophageal carcinomas.
UI - 11785709
AU - Naso P; Bonanno G; Aprile G; Trama G; Favara C; Greco S; Russo A
TI - EsophaCoil for palliation of dysphagia in unresectable oesophageal carcinoma: short- and long-term results.
SO - Dig Liver Dis 2001 Nov;33(8):653-8
AD - Department of Surgery, Policlinico Universitario di Catania, Italy.
BACKGROUND AND AIM: Few reports have shown that EsophaCoil is an effective and safe prosthesis for palliation of malignant oesophageal dysphagia. A single centre experience using this type of prosthesis is 42 consecutive patients, 41 with unresectable oesophageal cancer and one with oesophageal stenosis secondary to lung cancer, were treated with 44 EsophaCoils (2 patients received 2 stents). Tumours were located in lower third of oesophagus and/or gastric cardia in 22 cases, in middle third in 18 and in upper third in 2. Mean stricture length was 5.3 cm. Implantation was performed on hospitalized patients. RESULTS: EsophaCoil placement was successful all 44 times and was followed by complete expansion of the prostheses. There were no major procedure-related complications or deaths. Dysphagia score improved from mean of 2.9 to 1.3 within 24 hours of stent implantation. Median hospital stay was 2.7 days. Late complications occurred in 14 patients (34.2%): 3 migrations into stomach, 7 tissue overgrowth, 2 late perforations and 2 food impactions. Mean survival time was 4.2 months (range 1-10). CONCLUSIONS: In our experience, full expansion of EsophaCoil was achieved in all cases. This result, was associated with high incidence of retrosternal pain. Relief of dysphagia score was identical to that obtained with other types of Self-Expanding Metal Stent. Coil design prevented tumour ingrowth and allowed retrieval of three migrated stents. Mean survival time was similar to that reported in larger series using different types of Self-Expanding Metal Stent.
UI - 11809537
AU - Nakakubo Y; Hida Y; Miyamoto M; Hashida H; Oshikiri T; Kato K; Suzuoki
TI - M; Hiraoka K; Ito T; Morikawa T; Okushiba S; Kondo S; Katoh H The prognostic significance of RCAS1 expression in squamous cell carcinoma of the oesophagus.
SO - Cancer Lett 2002 Mar 8;177(1):101-5
AD - Hokkaido University Graduate School of Medicine, Division of Cancer Medicine, Cancer Medicine, Surgical Oncology, N-14, W-5, Sapporo 060-8648, Japan. email@example.com
Overexpression of RCAS1 (receptor-binding cancer antigen expressed on SiSo cells) protects cancer cells from immune attack and might be related to poor prognosis in several cancers. We investiga