Long-term outcome of definitive radiotherapy for cervical esophageal squamous cell carcinoma

Sakanaka, Katsuyuki; Ishida, Yuichi; Fujii, Kimio; Itasaka, Satoshi; Miyamoto, Shin’ichi; Horimatsu, Takahiro; Muto, Manabu; Mizowaki, Takashi

doi:10.1186/s13014-018-0957-6

Cited by 23 publications

(14 citation statements)

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“…Chemoradiotherapy for clinical T4 esophageal cancer provides long survival [5,6]. Successful tumor shrinkage by chemoradiotherapy for lung cancer reportedly resolves the mediastinal shift and atelectasis by reducing tumor-associated airway obstruction with a geometrical change in the tumor location [7].…”

Section: Discussionmentioning

confidence: 99%

Adaptive radiotherapy in locally advanced esophageal cancer with atelectasis: a case report

2020

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Background: To the best of our knowledge, no study has reported mediastinal shift accompanied with obstructive atelectasis due to bulky primary esophageal tumor components treated with adaptive radiotherapy and concurrent chemotherapy. Case presentation: Here we report the case of a 65-year-old male patient diagnosed with locally advanced thoracic esophageal squamous cell cancer, clinical T4bN1M0, stage IVA. Bronchoscopy and computed tomography (CT) revealed an almost complete obstruction of the lumen of the left bronchus due to compression by bulky primary esophageal tumor components. On admission, the patient presented with dyspnea and decreased arterial oxygen saturation. Chest radiography and CT on admission revealed mediastinal shift with left atelectasis, as opposed to findings from the chest radiography performed 26 days before admission. Because of the patient's overall good condition, we recommended definitive chemoradiotherapy instead of palliative bronchial stent placement. After obtaining the patient's consent, chemoradiotherapy was initiated on the following day and it comprised three-dimensional conformal radiotherapy with 60 Gy in 30 fractions with concurrent administration of cisplatin and 5-fluorouracil. During chemoradiotherapy, tumor location was monitored with cone-beam CT and chest radiography. Chemoradiotherapy on day 8 revealed no evidence of the mediastinal shift. CT simulation was reperformed to adjust the radiotherapy fields to account for geometrical changes induced by the absence of the mediastinal shift. Subsequently, the mediastinal shift and bronchial obstruction did not recur during the course of chemoradiotherapy. The patient completed the planned radiotherapy with concurrent and adjuvant chemotherapy, and no non-hematological grade ≥ 3 adverse events were observed. Complete response was confirmed 7 months after initiating chemoradiotherapy. Currently, no disease recurrence, dysphagia, or respiratory symptoms have been reported at 13 months after initiating chemoradiotherapy. Conclusions: In this study, a bulky primary esophageal tumor caused mediastinal shift due to ipsilateral bronchial obstruction. The close follow-up for monitoring resolution of the mediastinal shift during the course of chemoradiotherapy enabled adequate dose delivery to targets, thus reflecting the geometrical changes induced by the absence of the mediastinal shift. Adaptive radiotherapy technique was crucial for favorable patient outcomes in this challenging clinical situation.

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Section: Discussionmentioning

confidence: 99%

Adaptive radiotherapy in locally advanced esophageal cancer with atelectasis: a case report

2020

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“…Für Letztere gibt es als Option bei Therapieversagen oder lokalem Rezidiv die sogenannte "Salvage"-Ösophagektomie [1]. Die hohen Ansprechraten der Neoadjuvanz nach Radiochemotherapie im Cross-Trial [2] und der alleinigen kurativ intendierten Strahlentherapie [3] bei Patienten mit hohem chirurgischen Risiko eröffnen die Möglichkeit für die Evaluierung einer "watchand-wait-Strategie" auch für diese Indikation [4]. Wesentlich für die Überlegungen ist die perioperative Mortalität nach Ösophagusresektion gegenüber einer strukturierten Nachsorge.…”

Section: öSophaguskarzinomunclassified

„Standard Changing News Onkologie“ in der Tumorchirurgie

Königsrainer

2018

Klinikarzt

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ZusammenfassungTumorerkrankungen stellen nach wir vor die zweithäufigste krankheitsbedingte Todesursache in der westlichen Welt dar. Trotz aller Fortschritte in der Diagnostik, der medikamentösen Tumortherapie aber auch in der chirurgischen Onkologie verlieren wir nach wie vor ca. 50 % der Patienten am Tumorleiden. Schonende Chirurgie durch minimal invasives Operieren auf der einen Seite erlaubt vielfach eine raschere Rekonvaleszenz bei gleicher onkologischer Qualität, und maximale Chirurgie bei metastasierten Erkrankungen auf der anderen Seite kann die Prognose auch im Stadium IV deutlich verbessern. Vermehrt kommen auch sogenannte „wait and see“-Strategien zum Einsatz. In diesem Übersichtsbeitrag werden Konzepte beim Ösophaguskarzinom, beim Magenkarzinom, bei Neuroendokrinen Tumoren (NET) und beim Pankreaskarzinom beschrieben. Zuletzt noch „Neues“ zur Peritonealkarzinose bei Darmtumoren vom ASCO 2018.

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“…Chemoradiotherapy plays an important role in the treatment of esophageal cancer. Chemoradiotherapy is conducted with curative, preoperative, salvage, and palliative intents [5,6]. The acute and late adverse events for chemoradiotherapy have been previously reported [3,6]; however, the reports on therapy-related AML after chemoradiotherapy for esophageal cancer are limited with only one report describing four patients with therapyrelated AML after chemoradiotherapy for esophageal cancer.…”

Section: Introductionmentioning

confidence: 99%

“…Chemoradiotherapy is conducted with curative, preoperative, salvage, and palliative intents [5,6]. The acute and late adverse events for chemoradiotherapy have been previously reported [3,6]; however, the reports on therapy-related AML after chemoradiotherapy for esophageal cancer are limited with only one report describing four patients with therapyrelated AML after chemoradiotherapy for esophageal cancer. Overt AML from myelodysplastic syndrome was reported in two of four patients, and its onset after chemoradiotherapy was 19-41 months [7].…”

Section: Introductionmentioning

confidence: 99%

Therapy-Related Acute Myeloid Leukemia 2 Months after Chemoradiotherapy for Esophageal Cancer: A Case Report

et al. 2020

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Therapy-related acute myeloid leukemia (AML) is a rare but potentially fatal adverse event caused by chemotherapy or radiotherapy. Herein we report a patient diagnosed with therapyrelated AML 2 months after chemoradiotherapy for esophageal cancer. A 61-year-old man with dysphagia was diagnosed with locally advanced esophageal cancer with para-aortic lymph node metastasis. Laboratory blood test did not reveal any abnormality except mild macrocytic anemia. To alleviate dysphagia due to malignant esophageal stenosis, the patient underwent concurrent chemoradiotherapy of 60 Gy in 30 fractions with cisplatin and 5-fluorouracil at a local area in thoracic esophagus. Dysphagia alleviated during chemoradiotherapy; however, pancytopenia did not recover after the completion of chemoradiotherapy, and general fatigue with fever developed 13 weeks after the last day of chemoradiotherapy. To rule out hematological malignancy, bone marrow biopsy was performed. The bone marrow smear and flow cytometry analysis indicated the development of AML. Chromosomal test revealed a complex karyotype, suggesting that AML was associated with myelodysplastic syndrome. The patient died 1 month after the diagnosis of therapy-related AML. Thus, the findings indicate that therapy-related AML may develop during the acute phase of chemoradiotherapy and bone marrow biopsy is necessary when prolonged pancytopenia exists after chemoradiotherapy.

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Long-term outcome of definitive radiotherapy for cervical esophageal squamous cell carcinoma

Cited by 23 publications

References 30 publications

Adaptive radiotherapy in locally advanced esophageal cancer with atelectasis: a case report

Adaptive radiotherapy in locally advanced esophageal cancer with atelectasis: a case report

„Standard Changing News Onkologie“ in der Tumorchirurgie

Therapy-Related Acute Myeloid Leukemia 2 Months after Chemoradiotherapy for Esophageal Cancer: A Case Report

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