Trimodal therapy in squamous cell carcinoma of the esophagus

Abstract

Patients with ESCC (squamous cell carcinoma of the esophagus) are most commonly diagnosed with locally advanced tumor stages. Early metastatic disease and late diagnosis are common reasons responsible for this tumor's poor clinical outcome. The prognosis of esophageal cancer is very poor because patients usually do not have symptoms in early disease stages. Squamous cell carcinoma of the esophagus frequently complicates patients with multiple co-morbidities and these patients often require interdisciplinary diagnosis and treatment procedures. At present time, neoadjuvant radiation therapy and chemotherapy followed by surgery are regarded as the international standard of care. Meta-analyses have confirmed that this approach provides the patient with better local tumor control and an increased overall survival rate. It is recommended that patients with positive tumor response to neoadjuvant therapy and who are poor surgical candidates should consider definitive radiochemotherapy without surgery as a treatment option. In future, EGFR antibodies may also be administered to patients during therapy to improve the current treatment effectiveness. Positron-emission tomography proves to be an early response-imaging tool used to evaluate the effect of the neoadjuvant therapy and could be used as a predictive factor for the survival rate in ESCC. The percentage proportions of residual tumor cells in the histopathological analyses represent a gold standard for evaluating the response rate to radiochemotherapy. In the future, early response evaluation and molecular biological tests could be important diagnostic tools in influencing the treatment decisions of ESCC patients.

Combination of checkpoint inhibitors with radiotherapy in esophageal squamous cell carcinoma treatment: A novel strategy (Review)

“…At present, RT remains the main treatment for ESCC. RT results in a significant reduction in local tumor growth and simultaneously relieves dysphagia (22,23). The use of ionizing radiation on local tumor cells leads to direct or indirect DNA damage and induces a series of molecular events associated with cell death (24).…”

Twist2 is NFkB-responsive when p120-catenin is inactivated and EGFR is overexpressed in esophageal keratinocytes

“…As the most common subtype of esophageal cancer worldwide, ESCC invades and metastasizes rapidly, but typically remains asymptomatic until it impinges on the esophageal lumen and causes dysphagia 1 , 2 . As a result, ESCC is often diagnosed at a late stage, causing poor quality of life and mortality in the vast majority of patients 1 – 3 . Yet despite its dire nature, ESCC is still an understudied disease and little progress has been made on understanding the molecular pathways and mechanisms at play that make ESCC so devastating.…”