Enteral Access is not Required for Esophageal Cancer Patients Undergoing Neoadjuvant Therapy

Huerter, Mary E.; Charles, Eric J.; Downs, Emily A.; Hu, Yinin; Lau, Christine L.; Isbell, James M.; McMurry, Timothy L.; Kozower, Benjamin D.

doi:10.1016/j.athoracsur.2016.03.041

Cited by 17 publications

(15 citation statements)

References 32 publications

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“…Furthermore, the National Comprehensive Cancer Network and European Society for Medical Oncology guidelines recommend EC treatments implement enteral tubes for feeding (8,9). Recent studies have focused on the routine placement of EA and suggest it may not be a necessary part of neoadjuvant therapy (10)(11)(12)(13). CRT has the potential to reduce dysphagia symptoms.…”

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confidence: 99%

Efficacy of Enteral Access in Patients with Esophageal Squamous Cell Carcinoma Under Neoadjuvant Therapy

Huang

Wang

et al. 2018

Anticancer Res

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Background: Enteral feeding tubes used to manage the nutritional status of esophageal cancer were evaluated regarding their effectiveness in patients receiving neoadjuvant therapy. Patients and Methods: A retrospective study evaluating patients with esophageal squamous cell carcinoma undergoing neoadjuvant therapy between 2001 and 2014 was conducted at a medical center. Hospital patients' records for enteral access (EA) insertion and treatment outcomes were statistically analyzed. Results: Patients with EA at initial diagnosis had lower body mass index than the group without EA (p=0.012). Chemotherapy-related adverse events with grade 3-4 mucositis were significantly less frequent in the EA group (p=0.008), and grade 3-4 anemia was significantly more frequent (p=0.012). The 4-year mortality rate was 63.0% in the EA group and 67.7% in the group without EA (p noninferiority =0.035), which met the non-inferiority criterion with a non-inferiority margin of 10%. Conclusion: Patients with esophageal squamous cell carcinoma with malnutrition status undergoing neoadjuvant therapy with EA showed an improved outcome at maintaining nutritional status, reduced severity of mucositis and improved survival rate.

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confidence: 99%

Efficacy of Enteral Access in Patients with Esophageal Squamous Cell Carcinoma Under Neoadjuvant Therapy

Huang

Wang

et al. 2018

Anticancer Res

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“…162 Percutaneous Endoscopic Gastrostomy (PEG) is another procedure employed to ensure nutrition and prevent further weight loss during neoadjuvant treatment. 163 However, this is also considered more controversial, with a risk of damaging the future blood supply to the future gastric conduit, and thus contributing to anastomosis complications. In addition, a risk of tumor cell seeding with abdominal wall metastasis has also been reported.…”

Section: Palliation Of Dysphagia-a Bridge To Surgerymentioning

confidence: 99%

“…164 However, it has also been reported that PEG employment does not endanger the surgical resection, but concerns with high adverse effect rates up to 36% and major rates of 22% at placements. 163,165 In addition, the use of feeding jejunostomy is considered to enhance nutrition during neoadjuvant treatment, but it requires a transabdominal procedure under general anesthesia. Such a procedures also carries a risk of infection, displacement, obstruction or other surgical complications, with delay in starting neoadjuvant treatment 166 After surgery, a feeding jejunostomy is often used, through the postoperative phase and until patients have recovered and are able to cover their nutritional needs orally, with the support of a dietician.…”

Section: Palliation Of Dysphagia-a Bridge To Surgerymentioning

confidence: 99%

“…The recommendation from these authors was to only place PEGs in a selective group of patients and instead increase nutritional support during treatment. 163 However, it has also recently been reported in oncological settings that patients experience relief of dysphagia during neoadjuvant treatment, challenging the need for invasive procedures. 170,171 In HRQoL research a dysphagia scale is included in the oesophageal cancer-specific module and a few papers have reported that dysphagia during neoadjuvant treatment as well after termination of neoadjuvant therapy, dysphagia both improved and deteriorated.…”

Section: Palliation Of Dysphagia-a Bridge To Surgerymentioning

confidence: 99%

“…Moreover, earlier papers have reported that neoadjuvant treatment may significantly worsen nutritional parameters compared to patients undergoing resection upfront, 158,167,202 while other recently published papers report that with professional support during neoadjuvant treatment patients may keep weightstability and continue oral intake without stent or gastrostomy placement. 163,171 Stenting is also reported having a negative outcome impact on oncology. 159…”

Section: Paper IImentioning

confidence: 99%

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Effects of neoadjuvant chemoradiotherapy vs chemotherapy alone on the relief of dysphagia in esophageal cancer patients: secondary endpoint analysis in a randomized trial

Sunde

Johnsen

Jacobsen

et al. 2018

Diseases of the Esophagus

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Dysphagia is the most significant symptom in patients with esophageal cancer. There are different therapeutic interventions designed to relieve dysphagia, but few studies have addressed the effects of neoadjuvant therapy. The aim of this study is to compare the effects on dysphagia of neoadjuvant chemotherapy (nCT) versus neoadjuvant chemoradiotherapy (nCRT) and further to study the association between dysphagia response and histological response. Patient reported swallowing function was a secondary endpoint in the NeoRes trial, in which patients were randomized between neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy. Patients completed dysphagia questionnaires before the start and after neoadjuvant therapy, using the European Organization for Research and Treatment of Cancer (EORTC) esophageal cancer modules QLQ-OES24/OG25. Chirieac tumor regression grade (TRG) was used to assess the histological response. Out of 181 patients were randomized, of whom 87% completed the dysphagia questionnaires before and 73% after neoadjuvant treatment. Patient characteristics were similar between the treatment arms. Among patients reporting dysphagia at baseline, neoadjuvant therapy improved dysphagia in both arms. The mean dysphagia score after neoadjuvant treatment was significantly lower after nCT compared to after nCRT (P = 0.022). The reported dysphagia did not differ between those with a complete histological response (TRG 1) and those without any response at all (TRG 4) (P = 0. 583).

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Prognostic impact of shift to low visceral fat mass after neoadjuvant chemotherapy in patients with esophageal cancer

Onishi,

Tajika,

Tanaka

et al. 2024

Cancer Reports

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BackgroundBased on the JCOG1109 trial, it is suggested that the combination of docetaxel, cisplatin, and 5‐fluorouracil (DCF) could potentially become a standard neoadjuvant chemotherapy regimen, alongside the conventional 5‐fluorouracil and cisplatin (CF) therapy, for esophageal cancer. However, there are few reports on the impact of body composition changes associated with neoadjuvant chemotherapy on prognosis.AimOur study aimed to explore the effect of different neoadjuvant chemotherapy regimens on body composition during treatment and the impacts of body composition changes on their prognosis.Methods and resultsThis is a retrospective study of 215 patients with advanced thoracic esophageal cancer who had surgery after neoadjuvant chemotherapy from 2013 to 2019. Computed tomography scans were performed before and after neoadjuvant chemotherapy to assess body composition. Skeletal muscle mass index (SMI) was calculated by dividing total skeletal muscle mass at the 3rd lumbar level by the square of height, while visceral and subcutaneous fat masses were measured at the level of umbilicus. Patients in the lowest 25% of both sexes were classified into the low visceral fat and low subcutaneous fat groups, respectively. Of the patients enrolled, 178 were male and 37 were female. Among them, 91 had clinical Stage II disease, and 124 had clinical Stage III disease. Additionally, 146 patients received neoadjuvant chemotherapy CF, and 69 received neoadjuvant chemotherapy DCF. Comparing the DCF and CF groups, the DCF group consisted of significantly younger patients (p < .01), a higher proportion of males (p = .03), and a greater number of clinical Stage III cases (p < .01). However, although percent change in SMI and visceral fat mass was not significantly different between two regimens, percent change in subcutaneous fat mass was significant in the DCF group. The major prognostic factors for patients undergoing surgery after neoadjuvant chemotherapy for thoracic esophageal cancer were clinical Stage III, transition to low visceral fat, and response rating (SD/PD), while the specific neoadjuvant chemotherapy regimen did not significantly influence the outcomes.ConclusionThis study suggests that prevention of the shift to low visceral fat throughout the neoadjuvant chemotherapy process should improve patient outcomes.

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Enteral Access is not Required for Esophageal Cancer Patients Undergoing Neoadjuvant Therapy

Cited by 17 publications

References 32 publications

Efficacy of Enteral Access in Patients with Esophageal Squamous Cell Carcinoma Under Neoadjuvant Therapy

Efficacy of Enteral Access in Patients with Esophageal Squamous Cell Carcinoma Under Neoadjuvant Therapy

Effects of neoadjuvant chemoradiotherapy vs chemotherapy alone on the relief of dysphagia in esophageal cancer patients: secondary endpoint analysis in a randomized trial

Prognostic impact of shift to low visceral fat mass after neoadjuvant chemotherapy in patients with esophageal cancer

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