Multimodality Management of Esophageal Cancer

Purwar, Pallavi; Bambarkar, Supriya; Jiwnani, Sabita; Karimundackal, George; Laskar, Sarbani Ghosh; Pramesh, C.S.

doi:10.1007/s12262-014-1163-x

Cited by 4 publications

(3 citation statements)

References 47 publications

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“…According to the 2014 Chinese cancer registry annual report, the incidence of esophageal carcinoma was 22.87 per 10 million, ranking fifth; the annual mortality rate was 17.35 per 10 million, ranking forth [2]. With surgery alone, the 5-year survival rate for T2-T3N0 disease is < 30-40%, and it declines to < 25% with nodal involvement [3]. Despite substantial advances in the multidisciplinary therapy for locally advanced resectable esophageal cancer, prognosis remains poor.…”

Section: Introductionmentioning

confidence: 99%

Phase II study of neoadjuvant therapy with nab-paclitaxel and cisplatin followed by surgery in patients with locally advanced esophageal squamous cell carcinoma

et al. 2016

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BackgroundWe carried out a phase II study to evaluate the efficiency and safety of the combination of nanoparticle albumin bound-paclitaxel (nab-paclitaxel) and cisplatin as preoperative chemotherapy for locally advanced esophageal squamous cell carcinoma (ESCC)ResultsFrom Oct 2011 to Dec 2012, 35 patients were enrolled and received neoadjuvant chemotherapy. Thirty patients underwent surgery and achieved a 100% R0 resection. Pathological complete response (pCR) rate was 13.3% and near pCR rate was 6.7%. Down-staging was achieved in 19 patients. With median follow-up of 37.8 months, 16 patients were still alive. One-, 2- and 3- year overall survival (OS) rate was 90.0%, 70.0% and 43.3%, respectively. This treatment resulted in a median disease-free survival (DFS) of 34.7 months and a median OS of 37.8 months. Median DFS and OS of down-staged patients were significantly longer than those of non-downstaged patients. The grade 4 toxicities during neoadjuvant chemotherapy were limited to neutropenia (2.9%) and vomiting (2.9%).MethodsPatients with locally advanced ESCC (stage IIA to IIIC) and performance status 0-1 were enrolled and received two cycles of nab-paclitaxel (100 mg/m2) on day 1, 8, 22 and 29, and cisplatin (75 mg/m2) on day 1 and 22, followed by resection. Two cycles of adjuvant chemotherapy with the same regimen were given. Postoperative radiotherapy was permitted and decided by radiation therapist.ConclusionWeekly nab-paclitaxel with three-weekly cisplatin seems effective and safe as a neoadjuvant chemotherapy strategy for locally advanced ESCC. Down-staged patients have favorable outcome.ClinicalTrials.gov IdentifierNCT01258192

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Section: Introductionmentioning

confidence: 99%

Phase II study of neoadjuvant therapy with nab-paclitaxel and cisplatin followed by surgery in patients with locally advanced esophageal squamous cell carcinoma

et al. 2016

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“…Surgical resection has become a mainstay of EC therapy with a goal of achieving negative surgical margins (4). The addition of neoadjuvant chemoradiation (NCR) has demonstrated a decrease in pathological node positive status, decreased positive surgical margins, and lesser rate of recurrence (5,6).…”

Section: Introductionmentioning

confidence: 99%

“…In addition to neoadjuvant therapy, adjuvant therapy for EC continues to be investigated but controversial (4,9,10). One study did demonstrate a survival benefit in node positive patients who received adjuvant therapy and using multivariate analysis they demonstrated that adjuvant therapy is an independent prognostic factor in survival for node positive patients (9).…”

Section: Introductionmentioning

confidence: 99%

Clinical fate of T0N1 esophageal cancer: results from the National Cancer Database

Takahashi

Shridhar

Huston

et al. 2018

J. Gastrointest. Oncol.

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The long-term survival for patients with locally advanced esophageal cancer (EC) remains poor despite improvements in multi-modality care. Neoadjuvant chemoradiation (NCR) followed by surgical resection remains pivotal in the management of patients with EC. However, the outcome of patients whose primary tumor exhibits a complete response with residual regional nodal disease (T0N1) remains unclear as well as the role for adjuvant therapy. Utilizing the National Cancer Database we identified patients with EC who underwent NCR followed by esophagectomy who had subsequent pathology of T0N1. Baseline univariate comparisons of patient characteristics were made for continuous variables using both the Mann-Whitney U and Kruskal Wallis tests as appropriate. Pearson's Chi-square test was used to compare categorical variables. Unadjusted survival analyses were performed using the Kaplan-Meier method comparing survival curves with the log-rank test. All statistical tests were two-sided and α (type I) error <0.05 was considered statistically significant. We identified 7,116 patients diagnosed with EC; 6,235 (87.6%) adenocarcinoma (AC), 881 (12.4%) squamous cell carcinoma (SCC) with a median age of 62 [21-88] years. There were 6,031 (84.8%) males and 1,085 (15.2%) females. R0 resections were achieved in 6,668 (93.7%) patients and this correlated to improved median survival 39.5 (R0) and 20.1 (R1) months respectively, P<0.001. The median nodes harvested were 13 [0-83] with a mean positive LN's of 1.4±2.9. Pathologic complete response (pCR) was achieved in 1,334 (18.7%), partial response (pPR) 2,812 (39.5%) and non-response (pNR) 2,970 (41.7%). There were 230 (3.2%) patients deemed as pathologic T0N1. The median survival of patients with pCR was 61.7 months compared to 32.1 months in the T0N1 patients P<0.001. T0N1 patients did not demonstrate an improved survival over T1/2 patients who had a median survival of 30.5 months, P=0.79. However, T0N1 did reveal an improved survival over T3/4 patients who had a median survival of 24.6 months, P=0.02. Adjuvant chemotherapy in T0N1 did not provide a benefit in survival, median survival adjuvant versus no adjuvant 30.8 vs. 32.1 months respectively, P=0.08. Multivariate analysis in T0N1 patients demonstrated only number of LN's positive, and histology SCC vs.

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Timing After Neoadjuvant Therapy Predicts Mortality in Patients Undergoing Esophagectomy: a Propensity Score–Matched Analysis

Maramara,

Shridhar,

Blinn

et al. 2023

Journal of Gastrointestinal Surgery

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Multimodality Management of Esophageal Cancer

Cited by 4 publications

References 47 publications

Phase II study of neoadjuvant therapy with nab-paclitaxel and cisplatin followed by surgery in patients with locally advanced esophageal squamous cell carcinoma

Phase II study of neoadjuvant therapy with nab-paclitaxel and cisplatin followed by surgery in patients with locally advanced esophageal squamous cell carcinoma

Clinical fate of T0N1 esophageal cancer: results from the National Cancer Database

Timing After Neoadjuvant Therapy Predicts Mortality in Patients Undergoing Esophagectomy: a Propensity Score–Matched Analysis

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