Role of endoscopy and nutritional support in advanced esophageal cancer

2015 ◽  
pp. 265-276
Author(s):  
Manol Jovani ◽  
Andrea Anderloni ◽  
Alessandro Repici
Keyword(s):  
Esophageal Cancer ◽  
Nutritional Support ◽  
Advanced Esophageal Cancer

scholarly journals CNA profiling of single CTCs in locally advanced esophageal cancer patients during therapy highlights unexplored molecular pathways.

2021 ◽  
Author(s):  
Giulia Gallerani ◽  
Tania Rossi ◽  
Martina Valgiusti ◽  
Davide Angeli ◽  
Pietro Fici ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Gene Regulation ◽  
Immune System ◽  
Innate Immune System ◽  
Locally Advanced ◽  
Epigenetic Modifications ◽  
Innate Immune ◽  
Advanced Esophageal Cancer ◽  
Locally Advanced Esophageal Cancer

Abstract Locally advanced esophageal cancer (EC) is an aggressive disease with a dismal prognosis. The role of circulating tumor cells (CTC) in the EC metastatic process is still an unaddressed question. Here we monitored the evolution of CTCs spread in 11 patients affected by locally advanced EC who were undergoing neoadjuvant chemo-radio therapy followed by surgery. We developed an ad hoc assay named ‘Grab-all’ assay using DEPArray system. Longitudinal monitoring allowed the identification of CTCs expressing epithelial, mesenchymal or mixed phenotype markers, in at least one time-point per patient. Through single cell copy number aberration (CNA) analysis, we revealed that individual CTCs from relapsed patients displayed higher degree of genomic imbalance compared to disease-free patients' ones. Post-neoadjuvant therapy CTCs show genomic aberrations previously reported in EC, namely 23/23 amplifications and 13/19 deletions. Notably the phenomenon was not restricted to the group of relapsed patients. In-depth analysis showed that networks enrichment in all time-points CTCs were inherent to innate immune system. At variance, transcription/gene regulation, post-transcriptional and epigenetic modifications were uniquely affected in CTCs of relapsed patients. Collectively, our data add clues to the comprehension of the role of CTCs in EC aggressiveness: chromosomal aberrations on genes related to innate immune system behave as relevant to the onset of CTC-status, whilst pathways of transcription / gene regulation, post-transcriptional and epigenetic modifications seem linked to patients’ outcome.

scholarly journals Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting

2012 ◽  
Vol 49 (3) ◽  
pp. 227-231 ◽  
Author(s):  
Ana Grilo ◽  
Carla Adriana Santos ◽  
Jorge Fonseca
Keyword(s):  
Body Mass Index ◽  
Esophageal Cancer ◽  
Body Mass ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Nutritional Support ◽  
Oral Intake ◽  
Upper Esophageal Sphincter ◽  
Advanced Esophageal Cancer ◽  
Endoscopic Gastrostomy ◽  
Esophageal Stenting

CONTEXT: Esophageal cancer is often diagnosed at an advanced stage and has a poor prognosis. Most patients with advanced esophageal cancer have significant dysphagia that contributes to weight loss and malnutrition. Esophageal stenting is a widespread palliation approach, but unsuitable for cancers near the upper esophageal sphincter, were stents are poorly tolerated. Generally, guidelines do not support endoscopic gastrostomy in this clinical setting, but it may be the best option for nutritional support. OBJECTIVE: Retrospective evaluation of patients with dysphagia caused advanced esophageal cancer, no expectation of resuming oral intake and with percutaneous endoscopic gastrostomy for comfort palliative nutrition. METHOD: We selected adult patients with unresecable esophageal cancer histological confirmed, in whom stenting was impossible due to proximal location, and chemotherapy or radiotherapy were palliative, using gastrostomy for enteral nutrition. Clinical and nutritional data were evaluated, including success of gastrostomy, procedure complications and survival after percutaneous endoscopic gastrostomy, and evolution of body mass index, albumin, transferrin and cholesterol. RESULTS: Seventeen males with stage III or IV squamous cell carcinoma fulfilled the inclusion criteria. Mean age was 60.9 years. Most of the patients had toxic habits. All underwent palliative chemotherapy or radiotherapy. Gastrostomy was successfully performed in all, but nine required prior dilatation. Most had the gastrostomy within 2 months after diagnosis. There was a buried bumper syndrome treated with tube replacement and four minor complications. There were no cases of implantation metastases or procedure related mortality. Two patients were lost and 12 died. Mean survival of deceased patients was 5.9 months. Three patients are alive 6, 14 and 17 months after the gastrostomy procedure, still increasing the mean survival. Mean body mass index and laboratory parameters were roughly stable 1 and 3 months after the gastrostomy procedure. CONCLUSIONS: In patients with advanced upper esophageal cancer where only palliative treatment is possible, nutritional support is easily achieved with percutaneous endoscopic gastrostomy, allowing patients to be at homes, surviving a significant period of time. Percutaneous endoscopic gastrostomy feeding should be considered as standard definitive nutritional palliation in patients with upper esophageal cancer, unsuitable for esophageal stenting.

Does Paclitaxel Improve the Chemoradiotherapy of Locoregionally Advanced Esophageal Cancer? A Nonrandomized Comparison With Fluorouracil-Based Therapy

2000 ◽  
Vol 18 (10) ◽  
pp. 2032-2039 ◽  
Author(s):  
David J. Adelstein ◽  
Thomas W. Rice ◽  
Lisa A. Rybicki ◽  
Marjorie A. Larto ◽  
Jay Ciezki ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Phase Ii Trial ◽  
Survival Function ◽  
Residual Tumor ◽  
Advanced Esophageal Cancer ◽  
Distant Metastatic Disease ◽  
Standard Management ◽  
Paclitaxel Group ◽  
Accelerated Fractionation

PURPOSE: A phase II trial of accelerated fractionation radiation with concurrent cisplatin and paclitaxel chemotherapy was performed to investigate the role of the paclitaxel, when substituted for fluorouracil (5-FU), in the chemoradiotherapy of esophageal cancer.PATIENTS AND METHODS: Patients with an esophageal ultrasound stage of T3or N1or M1(nodal) esophageal cancer were treated with two courses of a cisplatin infusion (20 mg/m2/d for 4 days) and paclitaxel (175 mg/m2over 24 hours) concurrent with a split course of accelerated fractionation radiation (1.5 Gy bid to a total dose of 45 Gy). Surgical resection was performed 4 to 6 weeks later followed by a single identical postoperative course of chemoradiotherapy (24 Gy) in patients with significant residual tumor at surgery. Toxicity and results of this treatment were retrospectively compared with our previous 5-FU and cisplatin chemoradiotherapy experience.RESULTS: Between September 1995 and July 1997, 40 patients were entered onto this study. Although dysphagia proved worse in our 5-FU–treated patients, profound leukopenia and a need for unplanned hospitalization were significantly more common in the paclitaxel group. Thirty-seven patients (93%) proved resectable for cure. The 3-year projected overall survival is 30%, locoregional control is 81%, and distant metastatic disease control is 44%. When compared with a similarly staged cohort of 5-FU–treated patients, there was no advantage for any survival function studied.CONCLUSION: This paclitaxel-based treatment regimen for locoregionally advanced esophageal cancer produced increased toxicity with no improvement in results when compared with our previous 5-FU experience. Paclitaxel-based treatments must be carefully and prospectively studied before their incorporation into the standard management of esophageal cancer.

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