EMR as salvage treatment for patients with locoregional failure of definitive chemoradiotherapy for esophageal cancer

Hattori, Santa; Muto, Manabu; Ohtsu, Atsushi; Boku, Narikazu; Manabe, Tetsuro; Doi, Toshihiko; Ishikura, Satoshi; Yoshida, Shigeaki

doi:10.1067/mge.2003.306

Cited by 72 publications

(43 citation statements)

References 17 publications

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“…In addition, gastroesophageal reflux disease is consistently associated with ACE [9]. Pathogenesis of this type of cancer leads from chronic reflux to esophagitis and metaplastic lesions in Barrett's esophagus (BE), which might result in the development of adenocarcinoma [11,12].…”

mentioning

confidence: 99%

The role of matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) in the development of esophageal cancer

Groblewska

Siewko

Mroczko

et al. 2012

Folia Histochem Cytobiol.

173

108

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Esophageal cancer (EC) is one of the most aggressive malignant tumors of the gastrointestinal tract. There are two distinct histological types of EC: esophageal squamous cell carcinoma and adenocarcinoma of the esophagus. Etiologic factors and the patterns of incidence of both subtypes are different. Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) play an important role in esophageal carcinogenesis. Gellatinases MMP-2 and MMP-9 are able to degrade collagen IV from basement membranes and extracellular matrix which is related to tumor progression, including invasion, metastasis, growth and angiogenesis. It has been shown that increased expression of MMPs plays a crucial role in the development of several human malignancies, including esophageal cancer. The activity of MMPs is regulated by their endogenous natural inhibitors (TIMPs). Among these, the roles of TIMP-1 and TIMP-2 in EC development, tumor progression and formation of metastases have been most extensively characterized and best recognized.

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mentioning

confidence: 99%

The role of matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) in the development of esophageal cancer

Groblewska

Siewko

Mroczko

et al. 2012

Folia Histochem Cytobiol.

173

108

View full text Add to dashboard Cite

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“…Endoscopic treatment is considered a potential alternative to surgical resection as it is less invasive, and the results are comparable with those of surgical resection [7][8][9]. Although both surgical resection and endoscopic treatment are potentially curative, they have different characteristics in terms of treatment indication, treatment process, and invasiveness.…”

Section: Introductionmentioning

confidence: 89%

Endoscopic classification of local recurrence after definitive chemoradiotherapy for esophageal squamous cell carcinoma

et al. 2009

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Background. It is unknown whether the endoscopic appearance of local recurrent squamous cell esophageal cancer treated with defi nitive chemoradiotherapy is predictive of the subsequent clinical course. Methods. We conducted a retrospective review of 19 patients with local recurrence. Local recurrence was classifi ed into three types as seen by endoscopy. Of 19 local recurrences, 9 lesions were classifi ed into superfi cial type, 7 lesions into submucosal tumor type, and 3 lesions into ulcerative type. The association between the endoscopic appearance of T1 local recurrence (rT1) and its clinical course was then evaluated. Results. Of 19 local recurrences, 13 were diagnosed as rT1 cancer. Three of nine patients with superfi cial-type recurrence were treated by surgical resection; the other six patients received endoscopic treatment. One of nine patients with a superfi cial-type recurrence died of abdominal lymph node recurrence. The other eight patients are alive without further recurrence. All four patients with rT1 submucosal tumor type recurrence received endoscopic treatment. After the diagnosis of local recurrence, lung or abdominal lymph node metastasis developed in three patients and two patients died of their disease. The median survival time for the submucosal tumor type was 26 months; median survival of the superfi cial type was not reached (P = 0.09).Conclusions. Superfi cial-type rT1 recurrence had a good prognosis with a low rate of nonlocal recurrence, whereas submucosal tumor type rT1 recurrence had a relatively high nonlocal recurrence rate and mortality.

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“…The outcomes of these patients treated with salvage EMR were not described in these abstracts. In this regard, although the effi cacy of salvage EMR for patients with baseline stage I disease has not yet been confi rmed, we have already reported its effi cacy in patients with baseline stage I-III diseases [17]. In this analysis, 16 patients were treated with salvage EMR among 93 consecutive patients treated with defi nitive chemoradiotherapy: 3 were treated for residual, 8 for local recurrent, and 5 for metachronous tumors in the esophagus.…”

Section: Combination Of Chemoradiotherapy and Emrmentioning

confidence: 96%

Nonsurgical treatments for submucosal esophageal squamous cell carcinomas

2007

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Esophageal cancer is a disease with a poor prognosis. As with superfi cial esophageal cancers, lymph node metastases are seen rarely if the tumors are limited to the epithelium or lamina propria, but when cancers invade the submucosa, there is a high incidence of lymph node involvement. Surgery with radical lymph node dissection is a standard treatment for treating submucosal esophageal cancers. However, it is usually associated with a reduced level of quality of life for the patients, who are often elderly and have various medical complications making them unfi t for aggressive surgery. According to these background indications, various nonsurgical treatments have been developed to preserve the esophagus and to achieve a less invasive cure for such patients. Defi nitive radiotherapy could be a treatment option for patients with superfi cial carcinomas, particularly for those with mucosal cancers with an unresectable width by endoscopic mucosal resection (EMR). Although there have been some retrospective analyses with a small number of patients, they could not draw defi nitive conclusions. Defi nitive chemoradiotherapy has become one of the treatment options for patients who desire nonsurgical treatment. It has shown similar survival rates with those seen for radical surgery in two retrospective analyses and one multicenter prospective phase II study. The combination of primary EMR and prophylactic chemoradiotherapy has also shown promising results with less invasiveness than surgery. These nonsurgical approaches are now under evaluation in two multi-institutional studies run by the Japan Clinical Oncology Group (JCOG), which will clarify the optimal treatment for this disease.

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EMR as salvage treatment for patients with locoregional failure of definitive chemoradiotherapy for esophageal cancer

Cited by 72 publications

References 17 publications

The role of matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) in the development of esophageal cancer

The role of matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) in the development of esophageal cancer

Endoscopic classification of local recurrence after definitive chemoradiotherapy for esophageal squamous cell carcinoma

Nonsurgical treatments for submucosal esophageal squamous cell carcinomas

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