Clinical T2-T3N0M0 Esophageal Cancer: The Risk of Node Positive Disease

Stiles, Brendon M.; Mirza, Fadi G.; Coppolino, Anthony; Port, Jeffrey L.; Lee, Paul C.; Paul, Subroto; Altorki, Nasser K.

doi:10.1016/j.athoracsur.2011.04.004

Cited by 85 publications

(75 citation statements)

References 17 publications

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“…While early-stage cT1a lesions are best managed by endoscopic mucosal resection and locally advanced tumors (cT3/4Nx) mainly receive neoadjuvant therapy followed by surgical resection, the therapeutic approach in patients with clinically staged cT2 tumors remains highly controversial [5,6,7,8,9]. Indeed, these proposed therapeutic trends emphasize that the pretherapeutic correct determination of the clinical T category is of great importance for the appropriate therapy decision.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, cT2 AEGs are not a common but a very interesting entity, of which available data about the optimal treatment strategy is very rare [5,6,7,8,9]. For example, Rice et al [5] evaluated the treatment algorithm for 61 cT2N0 esophageal cancer patients by determining errors in clinical staging and consequences of over- and undertreatment of incorrectly staged patients.…”

Section: Introductionmentioning

confidence: 99%

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Clinically Staged cT2 Adenocarcinomas of the Gastroesophageal Junction: Accuracy of Staging and Therapeutic Consequences

Vallböhmer

Sisic²,

Blank³

et al. 2014

Oncol Res Treat

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Background: Multimodality treatment options in locally advanced adenocarcinomas of the esophagogastric junction (AEGs) have been established in the last years. However, the therapeutic approach in patients with clinically staged cT2 tumors remains controversial. The most important determinant is the accuracy of clinical staging. We aimed to evaluate the association of clinical and histopathological staging in patients with cT2 tumors in respect of possible therapeutic consequences. Patients and Methods: Between 2001 and 2011, 71 patients with AEG tumors were clinically staged as cT2 (cN0 = 48 (68%); cN+ = 23 (32%)) and underwent surgical resection. Results: A primary tumor resection was performed in 59 (83%) patients while 12 (17%) patients received neoadjuvant therapy. Primarily resected patients showed the following pT/pN categories: pT1: 13 (22%), pT2: 35 (59%), pT3: 11 (19%), pN0: 23 (39%), whereas the clinical/histopathological pN category included 55% of the patients. Neoadjuvantly treated patients showed the following pT/pN categories: ypT0: 3 (25%), ypT1: 3 (25%), ypT2: 6 (50%), ypN0: 6 (50%). The overall survival of primarily resected patients compared with patients undergoing neoadjuvant therapy was not significantly different. Conclusions: The accuracy of clinical staging in patients with cT2 tumors of the gastroesophageal junction is poor. As in primarily resected patients, over- and understaging balance each other; correct pretherapeutic staging occurs in just about 60% of the patients. Moreover, our study suggests that a radical surgical resection with adequate lymphadenectomy seems to be appropriate for cT2N0 and even in cT2N+ tumors, since down-categorizing and prognosis are not improved for neoadjuvantly treated patients. However, the data have to be interpreted with caution because of the small patient numbers.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinically Staged cT2 Adenocarcinomas of the Gastroesophageal Junction: Accuracy of Staging and Therapeutic Consequences

Vallböhmer

Sisic²,

Blank³

et al. 2014

Oncol Res Treat

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“…The treatment of patients with T2,N0 esophageal cancer is more controversial, however, and a dearth of randomized trials exists to help determine the proper treatment for these patients. 10 One of the inherent complexities of treating patients with T2,N0 esophageal cancer is that the clinical staging is frequently inaccurate despite the use of PET and EUS. EUS plays a critical role in staging for esophageal cancers, and also has prognostic significance.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Early-Stage Esophageal Adenocarcinoma

Polish

Mulcahy

2013

J Natl Compr Canc Netw

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Although T2,N0,M0 esophageal adenocarcinoma is grouped with other locoregional disease by NCCN, no consensus exists about how it should be treated. One of the inherent complexities of treating T2,N0,M0 esophageal adenocarcinoma is the inaccuracy of the clinical staging. In addition, conflicting evidence exists about whether neoadjuvant therapy adds any benefit to esophagectomy. A 52-year-old patient recently seen at the Robert H. Lurie Comprehensive Cancer Center illustrates the complexity of these issues. (JNCCN 2013;11:640-644) NCCN: Continuing Education Accreditation StatementThis activity has been designated to meet the educational needs of physicians and nurses involved in the management of patients with cancer. There is no fee for this article. No commercial support was received for this article. The National Comprehensive Cancer Network (NCCN) is accredited by the ACCME to provide continuing medical education for physicians.NCCN designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.NCCN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center`s Commission on Accreditation.This activity is accredited for 1.0 contact hour. Accreditation as a provider refers to recognition of educational activities only; accredited status does not imply endorsement by NCCN or ANCC of any commercial products discussed/displayed in conjunction with the educational activity. Kristina M. Gregory, RN, MSN, OCN, is our nurse planner for this educational activity.All clinicians completing this activity will be issued a certificate of participation. To participate in this journal CE activity: 1) review the learning objectives and author disclosures; 2) study the education content; 3) take the post-test with a 70% minimum passing score and complete the evaluation at http://education.nccn.org/ node/22010; and 4) view/print certificate. Learning ObjectivesUpon completion of this activity, participants will be able to:• Ms. Harrold has disclosed that she has no relevant financial relationships. Kristina M. Gregory, RN, MSN, OCN, Vice President, Clinical Information OperationsMs. Gregory has disclosed that she has no relevant financial relationships.

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“…Several studies have shown non-trivial rates of unanticipated nodal disease in initial staging of both early and locally advanced cancers that are treated surgically: 24% in cT1, 39-55% in cT2, and 78% in cT3 (19,20). Post-treatment effects, such as ongoing inflammation in the esophageal wall, enlarged reactive lymph nodes, and radiation-induced alterations in the echogenicity of lymph nodes seem to further limit reliable restaging with these techniques alone.…”

Section: Endoscopy and Eusmentioning

confidence: 99%

Surveillance versus esophagectomy in esophageal cancer patients with a clinical complete response after induction chemoradiation

Semenkovich¹,

Meyers²

2018

Ann. Transl. Med.

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There currently exists an area of controversy in treatment of esophageal cancer for patients who have an apparent clinical complete response (cCR) after induction chemoradiation. A standard treatment is to offer these patients an esophagectomy, but increasingly there is interest from both the patient and provider for active surveillance with so-called "salvage" esophagectomies for local recurrence as an alternative treatment paradigm. In this article, we review the existing evidence that stakeholders should consider for clinical decision-making in this specific patient population, including: the accuracy of post-induction clinical restaging, the reliability of operative risk assessment, the feasibility and adherence to surveillance strategies, and the observed outcomes in these patients after salvage esophagectomy or continued active surveillance.We also briefly discuss quality of life and future directions for this field.

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Clinical T2-T3N0M0 Esophageal Cancer: The Risk of Node Positive Disease

Cited by 85 publications

References 17 publications

Clinically Staged cT2 Adenocarcinomas of the Gastroesophageal Junction: Accuracy of Staging and Therapeutic Consequences

Clinically Staged cT2 Adenocarcinomas of the Gastroesophageal Junction: Accuracy of Staging and Therapeutic Consequences

Treatment of Early-Stage Esophageal Adenocarcinoma

Surveillance versus esophagectomy in esophageal cancer patients with a clinical complete response after induction chemoradiation

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