National Cancer Institute®
Last Modified: October 1, 2002
UI - 12241722
AU - White RE; Abnet CC; Mungatana CK; Dawsey SM
TI - Oesophageal cancer: a common malignancy in young people of Bomet District, Kenya.
SO - Lancet 2002 Aug 10;360(9331):462-3
AD - Tenwek Hospital, PO Box 39, Bomet, Kenya. firstname.lastname@example.org
Oesophageal cancer is a common cancer with uneven geographical distribution. We reviewed all malignancies diagnosed at Tenwek Hospital (Bomet District, Kenya) between 1989 and 1998. Oesophageal cancer was the most common malignancy; 274 cases accounted for 19% of 1459 malignancies diagnosed, and for a steady rise in total cancer cases during this period. A striking feature of our study was the presence of a subset of very young patients. 26 (11%) patients were aged 30 years or less at diagnosis, and the youngest patient was 14 years old. This area of West Kenya seems to be a high-risk region for oesophageal cancer.
UI - 12324572
AU - Shibata Y; Haruki N; Kuwabara Y; Nishiwaki T; Kato J; Shinoda N; Sato A;
TI - Kimura M; Koyama H; Toyama T; Ishiguro H; Kudo J; Terashita Y; Konishi S; Fujii Y Expression of PTTG (pituitary tumor transforming gene) in esophageal cancer.
SO - Jpn J Clin Oncol 2002 Jul;32(7):233-7
AD - Department of Surgery II, Nagoya City University Medical School, Nagoya, Japan.
BACKGROUND: Recently, a vertebrate securin [pituitary tumor transforming gene (PTTG) in humans] has been identified that inhibits sister chromatid separation and is involved in malignant transformation and tumorigenesis. Abundance of this protein would disrupt cell division, generate chromosomal instability and thereby increase cell susceptibility to acquisition of further mutations during subsequent division. Esophageal cancer is a disease with poor prognosis with early local invasion and lymph node metastasis. It is important to identify factors that influence the aggressiveness of esophageal cancer. METHODS: Expression of PTTG messenger ribonucleic acid (mRNA) was evaluated by real-time reverse transcription polymerase chain reaction in 48 esophageal cancer specimens and matched normal esophageal mucosa. The data were analyzed with reference to clinicopathological factors. RESULTS: Tumor tissue expressed a significantly higher level of PTTG1 mRNA than the corresponding normal tissue (P < 0.0001). PTTG1 mRNA expression was significantly higher in tumors with higher pathological stage (IV vs 0-III, P = 0.0442) or more extensive lymph node metastasis (pathological N factor; N4 vs N0-3, P = 0.003). The median survival for patients with high PTTG1 expression (8.5 months) was less than that for patients with low PTTG1 expression (14.0 months, P = 0.039). PTTG1 expression was one of the significant predictors of survival on univariate analysis (hazard ratio 2.225; 95% confidence interval 1.007-4.915). CONCLUSIONS: Detection of high PTTG1 expression in surgically excised esophagus tumor tissues might help to identify patients with aggressive disease who require adjuvant therapy and provide prognostic information.
UI - 12324573
AU - Terashita Y; Sasaki H; Haruki N; Nishiwaki T; Ishiguro H; Shibata Y;
TI - Kudo J; Konishi S; Kato J; Koyama H; Kimura M; Sato A; Shinoda N; Kuwabara Y; Fujii Y Decreased peroxisome proliferator-activated receptor gamma gene expression is correlated with poor prognosis in patients with esophageal cancer.
SO - Jpn J Clin Oncol 2002 Jul;32(7):238-43
AD - Department of Surgery II, Nagoya City University Medical School, Nagoya, Japan.
BACKGROUND: Peroxisome proliferator-activated receptor gamma (PPAR gamma) induces apoptosis by ligand stimulation in various tumor cell lines. In esophageal cancer cell lines, PPAR gamma activation also has suppressed the proliferation. METHODS: In 55 primary esophageal squamous cell carcinomas (ESCCs) we examined the correlation between the expression of PPAR gamma mRNA with prognosis of esophageal cancer patients. The expression of PPAR gamma mRNA was quantified by real-time reverse transcription polymerase chain reaction using LightCycler. Immunohistochemistry was used to study the expression of PPAR gamma protein. RESULTS: The expression of PPAR gamma mRNA was significantly decreased in esophageal cancer cells compared with normal esophageal mucosa (P = 0.0084). Among the clinical factors, PPAR gamma mRNA expression was lower in the tumors with extensive lymph node metastasis (n4) than those with less extensive lymph node metastasis (n0-3) (P = 0.0059). Patients with low PPAR gamma mRNA expression had significantly shorter postoperative survival time than those with high PPAR gamma mRNA expression (P = 0.0191). In immunohistochemistry, PPAR gamma protein was expressed in the nuclei of cells in some cases and expressed in the nuclei and cytoplasm in others. The expression of PPAR gamma protein is decreased in esophageal cancer tissue compared with normal esophageal squamous epithelium. However, we could not deduce the apparent relation for the expression between PPAR gamma mRNA and PPAR gamma proteins in immunohistochemistry (P = 0.284). CONCLUSIONS: In esophageal cancer tissues, the expression of PPAR gamma was decreased compared with normal esophageal epithelium. The mRNA expression level of PPAR gamma may be a marker of prognosis after operation in esophageal cancer patients.
UI - 12215149
AU - Wren SM; Stijns P; Srinivas S
TI - Positron emission tomography in the initial staging of esophageal cancer.
SO - Arch Surg 2002 Sep;137(9):1001-6; discussion 1006-7
AD - Department of Surgery, Palo Alto Veterans Hospital, 3801 Miranda Ave, Palo Alto, CA 94304, USA. email@example.com
OBJECTIVE: To assess the value of positron emission tomography (PET) compared with computed tomography (CT) in the initial staging of esophageal cancer. DESIGN: Case series. SETTING: Tertiary care veterans hospital. PATIENTS: Patients with newly diagnosed esophageal cancers scanning within 4 weeks were included in the study (n = 24). Only patients who underwent pathological or radiographic follow-up were included. MAIN OUTCOME MEASURES: The sensitivity, specificity, and negative and positive predictive values of CT and PET were determined based on a criterion standard of pathological staging in 16 patients (67%) and follow-up imaging in 8 patients (33%). RESULTS: For staging regional lymph node involvement, CT and PET scans showed no statistically significant difference in sensitivity (57% and 71%, respectively) and specificity (71% and 86%, respectively). For detection of metastatic disease, CT and PET showed no significant difference in sensitivity (83% and 67%, respectively) and specificity (75% and 92%, respectively). There was no significant difference in clinical decision making when the results of both tests were discordant. CONCLUSIONS: There was no significant difference between the 2 imaging modalities in the initial staging of esophageal cancer. The CT scan was a sensitive indicator of distant metastases, whereas PET was more specific. It is unclear what additional role PET scanning should have in the initial screening of patients.
UI - 12233170
AU - Wakefield C; Paterson-Brown S
TI - Diagnosis and treatment of oesophageal cancer.
SO - Practitioner 2002 Sep;246(1638):586-8, 591-2, 594
AD - Royal Hampshire County Hospital, Winchester.
UI - 11941947
AU - Dutkowski P; Hommel G; Bottger T; Schlick T; Junginger T
TI - How many lymph nodes are needed for an accurate pN classification in esophageal cancer? Evidence for a new threshold value.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):176-80
AD - Department of Surgery, University of Mainz, Langenbeckstr. 1, 55101 Mainz, Germany.
BACKGROUND/AIMS: The UICC recommends a number of at least six lymph nodes to be examined in the surgical therapy of esophageal cancer for a reliable pN classification. The aim of this study was to evaluate this threshold by means of the data from our patients. METHODOLOGY: Following curative resection (R0) of esophageal cancer the numbers of examined tumor-free and tumor-involved lymph nodes were compared. Different statistical models of logistic regression were fitted to the data and checked for plausibility (Hosmer Lemeshow test). The sensitivity of a correct pN classification was then calculated and correlated to the total number of examined lymph nodes. RESULTS: A maximum increase of the sensitivity in classifying pN occurred from 0 to 6 examined lymph nodes. Nevertheless an additional improvement of sensitivity was continuously shown up to 100 examined nodes. An over 90% sensitivity of a correct lymph node classification was reached when more than twelve nodes were examined. Thus the results demonstrate in the case of esophageal cancer, that the suggestion by the UICC to examine at least 6 nodes for defining pN appears too low and may not represent the clinical situation. A ninety percent confidence level of a correct lymph node classification can be expected above 12 examined nodes similarly to the current recommended threshold in colorectal carcinoma. CONCLUSIONS: We suggest a new threshold for the number of examined lymph nodes of at least 12 instead of 6 nodes for accurately defining the pN category in esophageal cancer.
UI - 11941948
AU - Ohwada S; Ogawa T; Kawate S; Koyama T; Yamada T; Yoshimura S; Sato Y;
TI - Tomizawa N; Ohya T; Morishita Y Omentoplasty versus no omentoplasty for cervical esophagogastrostomy following radical esophagectomy.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):181-4
AD - Second Department of Surgery, Gunma University Faculty of Medicine, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan. firstname.lastname@example.org
BACKGROUND/AIMS: Omentoplasty--wrapping the omentum around the alimentary tract anastomosis is thought to lower the rate of anastomotic leakage. We evaluated the role of omentoplasty to reinforce cervical esophagogastrostomy after radical esophagectomy. METHODOLOGY: We compared anastomotic leakage, stricture formation, and related deaths in 63 patients who underwent radical esophagectomy and cervical esophagogastrostomy, with (n = 48) or without (n = 15) omentoplasty, between 1995 and 1999. RESULTS: An esophageal anastomotic leakage was diagnosed in 1 of the 48 patients (2.1%) with omentoplasty versus 3 of the 15 patients (20.0%) without omentoplasty (P < 0.01). Anastomotic stricture occurred in 2 (4.2%) of the omentoplasty group and 1 (6.7%) of the no omentoplasty group (P < 0.01). Death within 1 month was zero in the omentoplasty group and one (6.7%) in the no-omentoplasty group, despite no differences in lethal anastomotic leakage. CONCLUSIONS: Omentoplasty of cervical esophagogastrostomy reduced anastomotic leakage. Although promising, these observations require confirmation with a randomized prospective study.
UI - 11956617
AU - Kyriazanos ID; Tachibana M; Dhar DK; Shibakita M; Ono T; Kohno H;
TI - Nagasue N Expression and prognostic significance of S100A2 protein in squamous cell carcinoma of the esophagus.
SO - Oncol Rep 2002 May-Jun;9(3):503-10
AD - Shimane Medical University, Second Department of Surgery, Izumo, Shimane 693-8501, Japan. email@example.com
The purpose of this study was to evaluate the expression of S100A2 Ca2+-binding protein and its prognostic significance in the management of squamous cell carcinoma of the esophagus. Changes in cytosolic Ca2+ concentration control a wide range of cellular responses including cellular apoptosis. Intracellular S100 Ca2+-binding proteins are key molecules in transducing Ca2+ signaling. Among these, S100A2 has recently attracted major interest due to its stable expression in normal epithelia and down-regulation in some tumors. As a candidate tumor suppressor, expression of S100A2 has been proposed as a valuable prognostic marker in different tumors. We examined the clinical significance of S100A2 expression in 116 resected specimens of esophageal squamous cell carcinomas (ESCC) using immunohistochemistry. S100A2 was positive in 49 cases (42.2%) and its expression was significantly higher in large (p=0.01) and well differentiated tumors (p=0.013). Lymph node-positive tumors had a lower expression of S100A2 protein in comparison to the corresponding lymph node negative equivalents in each of the T stages, but the difference was statistically significant (p=0.041) only for the T1b tumors. S100A2 status became an independent predictor of patient survival (p=0.026) in lymph node-negative cases but not in node-positive cases. Evaluation of S100A2 protein expression may play an important role in the management of ESCC. The node-negative ESCC patients without S100A2 expression might be a high-risk group with poor survival and will need further attention to design appropriate adjuvant therapy.
UI - 12167574
AU - Chan AC; Lee DW; Griffith JF; Leung SF; Lam YH; Lam CC; Lau JY; Ng EK;
TI - Chung SC The clinical efficacy of neoadjuvant chemotherapy in squamous esophageal cancer: a prospective nonrandomized study of pulse and continuous-infusion regimens with Cisplatin and 5-Fluorouracil.
SO - Ann Surg Oncol 2002 Aug;9(7):617-24
AD - Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
BACKGROUND: We evaluated cisplatin and 5-fluorouracil as preoperative adjuvant chemotherapy for patients with locally advanced squamous esophageal cancer and compared two different infusion regimens. The outcomes were also compared with those of our historical control patients treated by surgery alone. METHODS: From 1991 to 1997, 83 consecutive esophageal cancer patients underwent surgical exploration after completion of two cycles of cisplatin and 5-fluorouracil chemotherapy regimens, either in pulse or in continuous infusion cycles. Outcomes were compared with those of 76 historical control patients. Both groups were comparable in demographic characteristics and tumor stages. The resection rates, operative morbidity, mortality, and survival rates were compared. RESULTS: Partial response was achieved in 50% of patients who received chemotherapy. There was no chemotherapy-related mortality. The resection, morbidity, and mortality rates and median survival between the surgery-alone group and the chemotherapy group were 71.1% vs. 82%, 51% vs. 55%, and 4% vs. 10.8%, 12.0 vs. 13.5 months, respectively (P >.05). There was also no statistically significant difference between the two regimens. CONCLUSIONS: Preoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil infusion, in pulse or continuous regimens, followed by surgery for squamous esophageal cancer patients had no added benefit in the overall survival.
UI - 12234996
AU - Lin L; Miller CT; Contreras JI; Prescott MS; Dagenais SL; Wu R; Yee J;
TI - Orringer MB; Misek DE; Hanash SM; Glover TW; Beer DG The hepatocyte nuclear factor 3 alpha gene, HNF3alpha (FOXA1), on chromosome band 14q13 is amplified and overexpressed in esophageal and lung adenocarcinomas.
SO - Cancer Res 2002 Sep 15;62(18):5273-9
AD - Section of General Thoracic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
Genomic amplification is observed in many, if not all, types of human malignancy and is one of the mechanisms for the activation of dominant-acting oncogenes in tumorigenesis. In the present study, three amplified restriction fragments were identified in an esophageal adenocarcinoma (P16) using the restriction landmark genome scanning two-dimensional gel technique. These fragments were cloned, sequenced, and mapped to chromosome band 14q13. Using the sequence tagged site-amplification mapping approach, we defined the core-amplified domain by screening 75 normal-tumor paired esophageal samples. The frequency of 14q13 amplification is 6.7% in esophageal tumors, and the amplicon spans >6 Mb in 1 tumor but is contained in a region <0.3 Mb in all of the remaining amplified tumors. Quantitative reverse transcription-PCR (RT-PCR) of 8 genes and expressed sequence tags located within the core-amplified domain revealed that the HNF3alpha (FOXA1)(4) gene, a forkhead gene family member, was overexpressed in all of the amplified esophageal tumors. HNF3alpha amplification was confirmed by Southern blot and interphase fluorescence in situ hybridization analyses, and the results of real-time RT-PCR were consistent with that of the regular quantitative RT-PCR. Increased immunohistochemical nuclear staining of the HNF3alpha protein was detected in all of the tumors containing 14q13 amplification. Affymetrix oligonucleotide microarrays of 86 lung adenocarcinomas demonstrated that expression of the HNF3alpha mRNA was elevated (> or =2.5-fold of mean expression in normal lung) in 37% (32 of 86) of the tumors analyzed. Gene amplification of HNF3alpha was detected in 2 of the 5 overexpressed lung tumors examined. This is the first report of HNF3alpha amplification, and overexpression in esophageal and lung adenocarcinomas. Amplification of HNF3alpha in esophageal and lung tumors may suggest a potential oncogenic role for this gene in tumorigenesis.
UI - 12111259
AU - Tachibana M; Dhar DK; Kinugasa S; Yoshimura H; Fujii T; Shibakita M;
TI - Ohno S; Ueda S; Kohno H; Nagasue N Esophageal cancer patients surviving 6 years after esophagectomy.
SO - Langenbecks Arch Surg 2002 Jun;387(2):77-83
AD - Second Department of Surgery, Shimane Medical University, Enya-cho 89-1, Izumo 693-8501, Japan. firstname.lastname@example.org
BACKGROUND: Esophageal cancer is one of the most malignant tumors, with a dismal prognosis in spite of recent advances in early diagnosis and extended lymphadenectomy. These patients need to be stratified according to prognostic variables for precise identification of high-risk group. MATERIAL AND METHODS: Seventy-six patients with esophageal carcinoma were uniformly treated with curative intent between 1980 and 1992 with at least 6 years follow-up. Results and prognostic factors of long-term survival were analyzed by univariate and multivariate analyses. RESULTS: Thirty patients (39.5%) survived 6 years, and the remaining 46 patients died within 6 years: recurrent esophageal cancer in 27 and causes unrelated to esophageal cancer in 19. The 1-, 2-, 3-, and 6-year overall survival rates in all 76 patients were 77.6%, 57.9%, 53.9%, and 39.5%, respectively. The factors influencing survival rate verified by univariate analysis were Borrmann classification (0, 1 vs. 2, 3), size of tumor (< or =3.0 vs. >3.0 cm), depth of invasion (T1, 2 vs. T3, 4), pN category (pN0 vs. pN1), number of lymph node metastasis (< or =4vs. >4), metastatic lymph node ratio (< or =0.1 vs. >0.1), time of operation (< or =480 vs. >480 min), and amount of perioperative blood transfusion given (< or =2 vs. >2 U). Among the significant variables independent prognostic factors for survival determined by multivariate analysis were metastatic lymph node ratio and amount of blood transfusion. CONCLUSIONS: A significant number of patients can thus apparently be cured of esophageal carcinoma by extensive resection. Patients with many metastatic lymph nodes and much blood transfusion, on the other hand, should receive appropriate treatment against such esophageal carcinoma.
UI - 12242662
AU - Xia SH; Hu LP; Hu H; Ying WT; Xu X; Cai Y; Han YL; Chen BS; Wei F; Qian
TI - XH; Cai YY; Shen Y; Wu M; Wang MR Three isoforms of annexin I are preferentially expressed in normal esophageal epithelia but down-regulated in esophageal squamous cell carcinomas.
SO - Oncogene 2002 Sep 26;21(43):6641-8
AD - National Laboratory of Molecular Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, People's Republic of China.
The development and progression of human cancer are believed to be due to the alterations of multiple genes or/and their protein products. For identifying the proteins associated with esophageal cancer, we analysed the protein profiles of 24 pairs of esophageal squamous cell carcinomas/matched adjacent normal epithelia. Microdissection of routinely unstained frozen sections was performed to purify cancerous and epithelial cells. The protein expression profiles were obtained by two-dimensional electrophoresis. Selected proteins dysregulated in tumors were identified by MALDI-TOF-MS. Three isoforms of annexin I were detected in normal esophageal mucosa and down-regulated in esophageal squamous cell carcinomas. RT-PCR analysis showed annexin I mRNA levels were significantly reduced in 17 out of 24 carcinomas. Immunohistochemistry demonstrated that annexin I appeared strong positive in all normal epithelia layers except basal cells. In cancer tissues, decreased expression of annexin I was observed in 12 out of 16 well differentiated tumors, 16 out of 17 moderately differentiated tumors, and 3 out of 3 poorly differentiated tumors as compared with the corresponding normal esophageal epithelia. There was a significant correlation between annexin I expression and the status of tumor differentiation. Well differentiated tumors presented stronger immunohistochemical reaction than moderately and poorly differentiated tumors. These data suggested that there existed three different isoforms of annexin I in normal esophageal epithelia, which may be the results of post-translational modification. Down-expression of three annexin I isoforms was a frequent event in esophageal carcinogenesis.
UI - 12195146
AU - Hemminger LL; Wolfsen HC
TI - Photodynamic therapy for Barrett's esophagus and high grade dysplasia: results of a patient satisfaction survey.
SO - Gastroenterol Nurs 2002 Jul-Aug;25(4):139-41
AD - Esophageal Disease Group, Mayo Clinic, Jacksonville, Florida 32224, USA.
There are few data available describing the experience of patients who have undergone photodynamic therapy with porfimer sodium for Barrett's esophagus. We describe the results of a satisfaction survey reported by 16 of 18 patients (11 men, 5 women; median age 75 years; median response at 27 months after treatment) treated with photodynamic therapy for Barrett's esophagus with high-grade dysplasia. Treatments were performed on an outpatient basis although two patients required clinic visits for intravenous fluids. Subjects reported their most significant post-treatment problem was odynophagia or dysphagia (75%), which was best treated with a hydrocodone bitartrate and acetaminophen elixir (75%). Cutaneous photosensitivity persisted for a median of six weeks; two patients had phototoxic reactions requiring clinic evaluation and treatment. All but two patients reported swallowing problems lasting a median of four weeks, and weight loss (median 6.8 kg). All patients indicated they would again choose photodynamic therapy if they were faced with a similar choice of endoscopic treatment versus surgery for Barrett's esophagus with high-grade dysplasia. These results indicate a generally high level of satisfaction in patients who have been treated with porfimer sodium photodynamic therapy for Barrett's esophagus with high-grade dysplasia.
UI - 12237911
AU - Eloubeidi MA; Desmond R; Arguedas MR; Reed CE; Wilcox CM
TI - Prognostic factors for the survival of patients with esophageal carcinoma in the U.S.: the importance of tumor length and lymph node status.
SO - Cancer 2002 Oct 1;95(7):1434-43
AD - Department of Medicine, Division of Gastroenterology and Hepatology, The University of Alabama at Birmingham, Birmingham, Alabama 35294, USA. email@example.com
BACKGROUND: The current TNM classification system does not consider tumor length or the number of lymph nodes in the staging and classification scheme for patients with esophageal carcinoma. Using data from the National Cancer Institute SEER Program, the authors explored the effect of tumor length and number of positive lymph nodes on survival in patients with esophageal carcinoma. METHODS: Patients with esophageal adenocarcinoma or squamous cell carcinoma were subgrouped according to historic stage with localized, regional, or distant disease. Demographic factors (age at diagnosis, race, and gender) and tumor characteristics (morphology, histologic grade, tumor length, primary site, depth of invasion, number of positive lymph nodes, proportion of positive lymph nodes dissected, and distant metastatic sites) were examined. RESULTS: Overall factors that were associated with an increased mortality risk included increasing age at diagnosis, black race versus white race, histologic grade, primary tumor site in the lower esophagus and abdomen versus upper regions, and increasing depth of invasion. Among patients with regional disease, the number of positive lymph nodes (>/= 5 vs. < 5) was related to an increasing risk (hazard ratio [HR], 1.29; 95% confidence interval [95%CI], 1.06-1.56). The proportion of positive lymph nodes compared with the number of lymph nodes dissected conferred an increased risk (HR, 1.63; 95%CI, 1.26-2.11). Among patients with distant disease, sites other than distant lymph nodes implied an increased mortality risk (HR, 1.37; 95%CI, 1.37-1.65). Tumor length was an independent predictor of mortality when controlling for depth of invasion in patients with localized disease (HR, 1.15; 95%CI, 1.08-1.21). CONCLUSIONS: Tumor length, the number of involved lymph nodes, and the ratio of positive lymph nodes are important prognostic factors for survival in patients with esophageal carcinoma. A revised TNM classification system for patients with esophageal carcinoma might consider adding tumor length and number of positive lymph nodes as two important prognostic factors. Copyright 2002 American Cancer Society.DOI 10.1002/cncr.10868
UI - 12354600
AU - Kato H; Kuwano H; Nakajima M; Miyazaki T; Yoshikawa M; Masuda N; Fukuchi
TI - M; Manda R; Tsukada K; Oriuchi N; Endo K Usefulness of positron emission tomography for assessing the response of neoadjuvant chemoradiotherapy in patients with esophageal cancer.
SO - Am J Surg 2002 Sep;184(3):279-83
AD - Department of Surgery I, Gunma University Faculty of Medicine, 3-39-22, Showa-machi, Maebashi 371-8511, Japan. firstname.lastname@example.org
BACKGROUND: In this study, we retrospectively assessed the performance of 18-F-fluorodeoxyglucose positron emission tomography (FDG-PET) compared with computed tomography (CT) and esophagography for assessing the response of advanced esophageal squamous cell carcinoma (SCC) to neoadjuvant chemoradiotherapy. METHODS: We studied 10 patients with thoracic esophageal SCC who received neoadjuvant chemoradiotherapy followed by surgery. Tumor response was assessed by CT, endoscopy, esophagography and FDG-PET before and after neoadjuvant treatment. RESULTS: Assessment of the rate of decrease in standardized uptake value (SUV) revealed a partial response (more than 50% decrease) in 5 (50%) of the patients, and assessment of length decrease of FDG uptake showed a partial response in 9 (90%) of the patients. Comparison of the histological response and the rate of decrease of various parameters revealed significant associations between histological response and tumor length (P <0.05), SUV after neoadjuvant therapy (P <0.05), and reduction in the extent of FDG uptake (P <0.01). However histological response was not significantly correlated with the rate of reduction of SUV, for both CT and esophagography. CONCLUSIONS: FDG-PET may be of considerable value for predicting the pathologic response of esophageal SCC to neoadjuvant therapy. Despite assessment of SUV before neoadjuvant therapy, low FDG uptake after therapy and reduction in the extent of FDG uptake may provide a reliable assessment of the response to therapy.
UI - 1467597
AU - Ganem G; Raoul Y; Goudier MJ; Dubray B; Colin P; Extra JM; Hennequin C;
TI - Michel-Langlet P; Vignoud J; Bardet E [Esophageal cancer: did combined treatments improve prognosis?]
SO - Bull Cancer 1992;79(8):735-50
AD - Centre d'oncoradiotherapie et d'hematologie Victor-Hugo, Le Mans, France.
Prognosis of esophageal cancer is very poor. Five-year survival does not exceed 20% after radical surgery, the best available treatment. Unfortunately, only 40% of the patients are amenable to surgery because of poor general status and/or locoregional extension. Adjuvant treatment did not yield survival improvement. Preoperative radiotherapy (three randomized trials) or postoperative radiotherapy (one randomized trial) showed only a decrease of regional relapses, perhaps only for the nodes negative patients. Neoadjuvant chemotherapy obtains some interesting response rate (20-60%), but there has been no evidence yet for survival improvement. Recently, promising results were presented after combination of radiotherapy and chemotherapy. In this paper, we review the present status of combined treatment for esophageal cancer. Our multicentric group (OSOF) is now completing a phase II trial, that should soon form the basis for a phase III prospective study.
UI - 8173179
AU - Bosset JF; Gignoux M; Elias D; Triboulet JP; Mantion G; Rougier P
TI - [Comment apropos of the article "Esophageal cancer: did combined treatment improve prognosis?" by G. Ganem et al]
SO - Bull Cancer 1993 Mar;80(3):261-4
UI - 11235580
AU - Zhong X; Yuan D; Yang L
TI - [A clinical analysis of combination treatment with brachytherapy and external radiation, plus chemotherapy for the treatment of esophageal cancer]
SO - Zhonghua Zhong Liu Za Zhi 2000 Nov;22(6):519-21
AD - Huizhou Central People's Hospital, Guangdong 516001, China.
OBJECTIVE: To analyse the value of various combinations of treatment for esophageal cancer. METHODS: One hundred twenty cases of esophageal cancer were randomly divided into four groups, 30 cases in each group. Group I was treated with external radiation (RT) alone; group II, with RT plus brachytherapy; group III with RT plus chemotherapy, and group IV with RT plus brachytherapy and chemotherapy. RT with 60Co was given 2 Gy daily, 5 times a week, with a total dose of 60-74 Gy. Brachytherapy was given 6-8 Gy once weekly with a total dose of 18-24 Gy. Chemotherapy with carboplatin was given 100 mg/day, five days a week at first and fifth week. RESULTS: The 1, 2, 3-year survival rate in group II, III and IV was higher than that in group I (P < 0.05). The 3-year survival rate of group I-IV patients was 13.3%, 36.7%, 40.0%, 46.7%, respectively. More patients died of cancer recurrence and progression in group I than in any of the other 3 groups of patients (P < 0.05). However, the frequency of distant metastasis was not significantly different. CONCLUSION: The combination treatment with external radiation, brachytherapy and chemotherapy can improve the local control of tumor growth and the survival rate in esophageal cancer patients.
UI - 11489794
AU - Hu YC; Lam KY; Law S; Wong J; Srivastava G
TI - Identification of differentially expressed genes in esophageal squamous cell carcinoma (ESCC) by cDNA expression array: overexpression of Fra-1, Neogenin, Id-1, and CDC25B genes in ESCC.
SO - Clin Cancer Res 2001 Aug;7(8):2213-21
AD - Department of Pathology, Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam Road, Hong Kong.
PURPOSE: This study aims to identify differentially expressed genes in esophageal squamous cell carcinoma (ESCC) through the use of a membrane-based cDNA array. EXPERIMENTAL DESIGN: Two newly established human ESCC cell lines (HKESC-1 and HKESC-2) and one corresponding to a morphologically normal, esophageal epithelium tissue specimen, prospectively collected from the HKESC-2-related patient, were screened in parallel using a cDNA expression array containing gene-specific fragments for 588 human genes spotted onto nylon membranes. RESULTS: The results of cDNA expression array showed that 53 genes were up-regulated 2-fold or higher and 8 genes were down-regulated 2-fold or higher in both ESCC cell lines at the mRNA level. Semiquantitative RT-PCR analysis of a subset of these differentially expressed genes gave results consistent with cDNA array findings. Four of the differentially expressed genes that belong to the categories of oncogenes/tumor suppressor genes (Fra-1 and Neogenin) and cell cycle-related genes (Id-1 and CDC25B) were studied more extensively for their protein expression by immunohistochemistry. The two ESCC cell lines and their corresponding primary tissues, 61 primary ESCC resected specimens and 16 matching, morphologically normal, esophageal epithelium tissues were analyzed. The immunostaining results showed that Fra-1, Neogenin, Id-1, and CDC25B were overexpressed in both ESCC cell lines and their corresponding primary tumors at the protein level, validating the microarray findings. The results of the clinical specimens showed that the Fra-1 gene was overexpressed in ESCC compared with normal esophageal epithelium in 53 of 61 cases (87%), Neogenin in 57 of 61 cases (93%), Id-1 in 57 of 61 cases (93%), and CDC25B in 48 of 61 cases (79%). Furthermore, the expression of Fra-1, Neogenin, and Id-1 in ESCC correlated with tumor differentiation. CONCLUSIONS: Overall, this study demonstrates that multiple genes are differentially expressed in ESCC and provides the first evidence that oncogenes Fra-1 and Neogenin and cell cycle-related genes Id-1 and CDC25B are overexpressed in ESCC.
UI - 12119515
AU - Urschel JD; Blewett CJ; Young JE; Miller JD; Bennett WF
TI - Pyloric drainage (pyloroplasty) or no drainage in gastric reconstruction after esophagectomy: a meta-analysis of randomized controlled trials.
SO - Dig Surg 2002;19(3):160-4
AD - Department of Surgery, McMaster University, Hamilton, Ont., Canada. email@example.com
BACKGROUND/AIM: A gastric conduit is usually used to reconstruct the foregut after esophagectomy for cancer. The gastric emptying may be impaired after this operation, so some esophageal surgeons routinely add a pyloric drainage procedure (pyloroplasty or pyloromyotomy). We performed a meta-analysis of randomized controlled trials (RCTs) to determine the effect of pyloric drainage on patient outcomes. METHODS: Medline and manual searches were done (completed independently and in duplicate) to identify all published RCTs that addressed the issue of pyloric drainage procedures during gastric conduit reconstruction of the esophagus. The selection process was inclusive; no trials were excluded. Trial validity assessment was done, and a trial quality score was assigned. Early outcomes assessed by meta-analysis included operative mortality, esophagogastric anastomotic leaks, pulmonary morbidity, pyloric drainage complications, fatal pulmonary aspiration, and gastric outlet obstruction. A random-effects model was used, and the relative risk was the principal measure of effect. Systematic semiquantitative review was used for late outcomes such as gastric emptying, bile reflux, nutritional status, and obstructive foregut symptoms. RESULTS: Nine RCTs, that included a total of 553 patients, were selected, with quality scores ranging from 1 to 4 (5-point Jadad scale). Selection and validity agreement was strong. The relative risk (95% CI; p value), expressed as pyloric drainage versus no drainage (treatment vs. control), was 0.92 (0.34, 2.44; p = 0.86) for operative mortality, 0.90 (0.47, 1.76; p = 0.77) for esophagogastric anastomotic leaks, 0.69 (0.42, 1.14; p = 0.15) for pulmonary morbidity, 2.55 (0.34, 18.98; p = 0.36) for pyloric drainage complications, 0.25 (0.04, 1.60; p = 0.14) for fatal pulmonary aspiration, and 0.18 (0.03, 0.97; p = 0.046) for gastric outlet obstruction. Systematic semiquantitative review showed a nonsignificant trend favoring pyloric drainage for the late outcomes of gastric emptying, nutritional status, and obstructive foregut symptoms. For the late outcome of bile reflux, there was a nonsignificant trend favoring the no-drainage group. The scintographic gastric emptying time, expressed as a ratio (pyloric drainage/no drainage), was 0.53. CONCLUSIONS: Data synthesized from existing RCTs show that pyloric drainage procedures reduce the occurrence of early postoperative gastric outlet obstruction after esophagectomy with gastric reconstruction, but they have little effect on other early and late patient outcomes. Copyright 2002 S. Karger AG, Basel
UI - 12199447
AU - Ogendo SW
TI - Follow up of oesophageal cancer therapy at the Kenyatta National Hospital, Nairobi.
SO - East Afr Med J 2001 Dec;78(12):650-4
AD - Department of Surgery, College of Health Sciences, University of Nairobi.
OBJECTIVE: To determine the pattern of follow-up for oesophageal cancer patients following hospital discharge and reviewing followup results of the different treatment modalities with emphasis on oesophagectomies. DESIGN: A retrospective hospital based study covering the period January National Hospital, Nairobi. MAIN OUTCOME MEASURES: Determination and the comparison of the one, two and three-year followup rates for the different treatment modalities and their median follow-up period in addition to reviewing the common variables associated with follow-up. RESULTS: The median followup for patients managed by oesophagectomy was 9.5 months with a 43%, 22% and 10% one-, two- and three-year followup rates respectively. This compared to a median of two months and a 7% and 3% one-, and two- year followup rate for patients managed by intubation, and a 3-month median followup with a one- and two- year follow-up rate of 12% and 4% respectively for radiotherapy treated patients. Oesophagectomy patients had a better followup compared to intubations and radiotherapy (p<.00001). Oesophagectomy for stage T4 tumours had an apparently better follow-up compared to both stage T1-3 tumours and patients managed with intubations (p=.002 and .02 respectively).
UI - 12045791
AU - Menezes AM; Horta BL; Oliveira AL; Kaufmann RA; Duquia R; Diniz A; Motta
TI - LH; Centeno MS; Estanislau G; Gomes L [Attributed risk to smoking for lung cancer, laryngeal cancer and esophageal cancer]
SO - Rev Saude Publica 2002 Apr;36(2):129-34
AD - Departamento de Clinica Medica, Universidade Federal de Pelotas, Pelotas, RS, Brasil.
OBJECTIVE: Lung, laryngeal and esophageal cancers have smoking as one of their main risk factors. The objective of this study was to evaluate the population attributed risk (PAR) of smoking for these forms of cancer. METHODS: The study was based in three case-control studies conducted in medium size cities in Brazil. Incident cases of lung cancer, laryngeal cancer and esophageal cancer seen at a hospital setting and diagnosed through biopsy were analyzed; controls were hospitalized patients with another diagnoses. Smoking was the exposure factor measured at three levels: non-smokers, former smokers and smokers, which were defined using a questionnaire applied by trained interviewers. For effect measure, odds ratio was used and the populational attributed risk for smoking was then calculated for a 95% CI. RESULTS: A total of 122 lung cancer cases and 244 controls, 50 cases of laryngeal cancer and 48 cases of esophageal cancer, and 96 controls for both of them were studied. The prevalence of smoking exposure was 34%, which is the overall prevalence of smoking in this city's adult population. Odds ratios (OR) for the PAR analysis were the adjusted OR for confounding variables from each study. Lung cancer PAR was 63% (95% IC, 0.58-0.68) for former smokers and 71% (95%IC, 0.65-0.77) for smokers. Larynx cancer PAR was 74% (95% IC, 0.70-0.78) and 86% (95%IC, 0.81-0.85) for former smokers and smokers, respectively. Esophageal cancer PAR was 54% (95%IC, 0.46-0.62) for smokers. CONCLUSION: Smoking is an avoidable risk factor and smoking cessation could be responsible for significant reductions in the incidence of these three forms of cancer.
UI - 12107384
AU - Drudi FM; Trippa F; Cascone F; Righi A; Iascone C; Ricci P; David V;
TI - Passariello R Esophagogram and CT vs endoscopic and surgical specimens in the diagnosis of esophageal carcinoma.
SO - Radiol Med (Torino) 2002 Apr;103(4):344-52
AD - Istituto di Radiologia, Universita degli Studi di Roma La Sapienza, Policlinico Umberto I, Rome, Italy. FrancescoM.Drudi@uniromal.it
PURPOSE: Aim of our study was to assess the accuracy of diagnostic imaging in establishing site, morphology and size of the neoplasm comparing surgical specimens or endoscopic examination with esophagograms and CT in patients with esophageal cancer. CT accuracy in defining TNM staging was also evaluated. MATERIAL AND METHODS: From 1993 to 2000 we examined 39 patients with esophageal cancer: 30 males (77%) and 9 females (23%), age range 41-85 years. All patients underwent esophagogram, digestive endoscopy, and chest and abdominal CT. In 22 patients who underwent surgery, we evaluated the correlation between diagnostic imaging and surgical specimens. Patients were divided into 3 groups on the basis of discrepancy between pathological and radiological measurements: =/<1 cm (considered as no discrepancy); 1 to 3 cm; > 3 cm. RESULTS: Esophagogram identified neoplasm in 38 patients out of 39, while CT identified neoplasm in all patients. Location and morphology of the neoplasm established at endoscopy were confirmed in all patients. Lesion length measured at esophagogram corresponded to length of surgical specimens in 13 of the 22 surgically treated patients (59%). In this group there was a dominance of polypoid and stenotic tumor forms. In the remaining 9 cases there was a dominance of ulcerative tumor forms. CT measurement corresponded in 7 patients (32%) with a dominance of polypoid and stenotic tumor forms. T staging performed with CT corresponded to surgical specimens in 12 patients (54%, T3-T4). N staging correlated in 19 patients (86%). CT identified distant metastases in 6 patients (27%). DISCUSSION AND CONCLUSIONS: Our study proves a high sensitivity of esophagogram and CT in the diagnosis of esophageal carcinoma. Esophagogram presented a higher accuracy in establishing tumor length (59% of cases, as compared to CT 32%). Tumor morphology influenced the accuracy of the esophagogram, and highest accuracy was obtained in polypoid and stenotic tumors. T staging performed with CT corresponded to surgical specimens in advanced stages (T3-T4), while accuracy was poorer in smaller superficial lesions (T1-T2) due to the inability of CT to differentiate the layers of the esophageal wall. N understaging in 14% of cases did not modify surgical management. CT presented a high sensitivity in the identification of loco-regional lymph nodes and identified distant metastases in 6 patients. In conclusion, these techniques are accurate and non-invasive and their role in establishing the correct management is therefore important.
UI - 12324764
AU - Heidecke CD; Weighardt H; Feith M; Fink U; Zimmermann F; Stein HJ;
TI - Siewert JR; Holzmann B Neoadjuvant treatment of esophageal cancer: Immunosuppression following combined radiochemotherapy.
SO - Surgery 2002 Sep;132(3):495-501
AD - Department of Surgery, Technische Universitat Munchen, Germany.
BACKGROUND: The biologic effects of neoadjuvant tumor therapies on the immune system of cancer patients are largely unknown. Immune deviations may be particularly detrimental if they occur in conjunction with postoperative immunosuppression. The effects of combined radiochemotherapy (RCTx) on T cell functions in patients with squamous cell carcinoma of the esophagus were investigated. METHODS: T cell proliferation was stimulated by incubation of peripheral blood mononuclear cells with bacterial superantigens or by exposure of enriched T cells to superantigens presented by B lymphoma cells. Cytokine production of enriched T cells was induced by cross-linking of CD3 and CD28 and the secretion of interleukin (IL)-2, IL-4, IL-10, and interferon-gamma was measured by enzyme-linked immunosorbent assay. T cell expression of human leukocyte antigen-DR (HLA-DR) molecules was determined by flow cytometry. RESULTS: T lymphocytes from patients having undergone RCTx exhibited a significantly reduced proliferative response following stimulation with 3 independent superantigens. Cytokine production of T cells and the antigen presenting capacity of p