Oncological results and morbidity following intended curative resection and free jejunal graft reconstruction of cervical esophageal cancer: a retrospective Danish consecutive cohort study

2021 ◽  
Author(s):  
Sune Brinck Erichsen ◽  
Josefine Slater ◽  
Birgitte Jul Kiil ◽  
Torben Ingemann Petersen ◽  
Niels Katballe ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
University Hospital ◽  
Treatment Modalities ◽  
First Line ◽  
Cervical Esophageal Cancer ◽  
Jejunal Graft ◽  
Free Jejunal Graft ◽  
Oncological Results

Summary Background The role of surgery in treatment of locally advanced cervical esophageal cancer (CEC) remains debated. In the European and American treatment guidelines, definitive chemoradiotherapy (dCRT) is preferred over surgery, while in the Danish guidelines, the two treatment modalities are equally recommended. Surgical treatment of CEC is centralized at our center in Denmark. We present our outcomes following neoadjuvant chemoradiotherapy (nCRT) when possible and resection as first-line therapy for CEC and compare with recent published dCRT results. Method We retrospectively reviewed the medical charts of patients treated for cervical esophageal cancer at Aarhus University Hospital from 2001–2018 with nCRT when possible and pharyngolaryngectomy followed by reconstruction with a free jejunal graft. Results Forty consecutive patients were included. About, 45% received nCRT. The median survival was 21 months. The overall, disease-specific and disease-free 5-year survival was 43.6%, 53.2%, and 47.4%, respectively. The rate of microscopically radical resection was 85%. The recurrence rate was 47% and 81% of recurrences were locoregional. The in-hospital and 30-day mortality rate was 0%. Major complications occurred in 27.9%. Anastomotic leakage, graft failure, fistulas and strictures occurred in 10%, 7.5%, 30%, and 30%, respectively. Conclusion Our treatment offers equal oncological results compared to the best internationally published results for dCRT for CEC. Results vary considerably between dCRT studies. Morbidity appears more pronounced following surgery. Future studies are warranted to investigate the Danish national outcomes following dCRT as first-line treatment for curable locally advanced CEC.

scholarly journals Neoadjuvant Chemoradiotherapy and Larynx-Preserving Surgery for Cervical Esophageal Cancer

2020 ◽  
Vol 9 (2) ◽  
pp. 387
Author(s):  
Kun-Yao Dai ◽  
Yu-Chao Yu ◽  
Yi-Shing Leu ◽  
Chih-Wen Chi ◽  
Mei-Lin Chan ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Surgical Margin ◽  
Complete Response ◽  
Relapse Free Survival ◽  
Cervical Esophageal Cancer ◽  
Free Survival ◽  
Larynx Preservation ◽  
Large Patient

Neoadjuvant concurrent chemoradiotherapy (CCRT) followed by surgery is widely used for treating locally advanced esophageal cancer in the thorax. This study evaluated the feasibility of neoadjuvant CCRT as a larynx preservation strategy for treating cervical esophageal squamous cell carcinoma (SCC) by a multidisciplinary team. Fifteen patients with cervical esophageal SCC who received neoadjuvant CCRT and radical surgery at our institution were reviewed. All patients received CCRT using the intensity-modulated radiation therapy with 48 Gy to gross tumor and 43.2 Gy to regional lymphatic basin in 24 fractions. Side effects, clinical tumor responses, pathological responses, and surgical margin status were analyzed. Pathological T down-staging was noted in seven patients (46.7%); pathological complete response was achieved in three patients (20%). Fourteen patients (93.3%) had larynx preservation; eight patients (53.3%) achieved negative surgical margins. The 2-year overall survival, local relapse-free survival, and regional relapse-free survival were 50.6%, 62.2%, and 47.5%, respectively. Neoadjuvant CCRT and larynx-sparing surgery are feasible and tolerable in patients with cervical esophageal SCC. Prospectively designed studies for large patient groups and long-term follow-up results are needed for validating this multimodality therapy.

scholarly journals First-line cisplatin plus bolus 5- Fluorouracil combination in patients with locally advanced and metastatic esophageal cancer(Izmir Oncology Group Study)

2015 ◽  
Vol 48 (1) ◽  
pp. 20-26
Author(s):  
Murat Akyol ◽  
Yüksel Küçükzeybek ◽  
Umut Varol ◽  
Ibrahim Yıldız ◽  
Suna Çokmert ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Locally Advanced ◽  
Oncology Group ◽  
First Line ◽  
Oncology Group Study

Multimodality treatment for esophageal cancer in Turkey: A single center experience.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15507-e15507
Author(s):  
Umut Demirci ◽  
Fatma Bugdayci Basal ◽  
Ferit Aslan ◽  
Erkan Erdur ◽  
Ayse Demirci ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Tnm Classification ◽  
Locally Advanced ◽  
Survival Rates ◽  
Neoadjuvant Chemoradiotherapy ◽  
Multimodality Treatment ◽  
Single Center Experience ◽  
Stage 4 ◽  
Stage 1 ◽  
Upper Third

e15507 Background: Esophagus cancer is an important cause of cancer-related deaths in Turkey as well as in the world. In our study, clinicopathological features and survival results of patients treated for esophageal cancer were presented. Methods: This study retrospectively reviewed esophageal squamous cell carcinoma (SCC) and adenocarcinoma (ADC) patients who were admitted to our center, between 2012 and 2016. Results: A total of 82 patients (56 males) with a median age of 56 years were evaluated. Seventy-one (87%) patients were diagnosed with SCC, 10 (12%) with ADC, 1 with adenosquamous carcinoma. All ADC patients were HER2 negative. The localization of tumors; lower third (55%), middle third (27%) and upper third (18%) of the esophagus. Prior to surgery, neoadjuvant chemoradiotherapy (CRT) was administered in 21 patients (26%); 10 of them receiving carboplatin and paclitaxel (CP), and 11 receiving cisplatin and 5-FU (CF). TNM classification of operated patients were as follows; Stage 1 (n = 5), stage 2 (n = 10), stage 3 (n = 8) and stage 4 (n = 1). Adjuvant chemotherapy (CF) was administered in the other 6 (7%) patients. Definitive CRT was given in 36 patients (44%), with CF being administered in 32 patients, and CP therapy in 4 patients. There were 19 patients (23%) with metastatic diagnosis and 13 of whom were treated with CF, and 4 with docetaxel-cisplatin-5FU combination. With median follow up of 21 months, median overall survival (OS) and time to progression (TTP) were 24 and 17 months, respectively. The median OS and TTP of patients with metastatic disease were 14 and th 9 months, respectively. The median OS and TTP of the patients who underwent surgery were 45 and 34 months, respectively. Conclusions: Our findings in this study regarding the rate of histology, the percentages of patients with metastatic vs. locally advanced disease, and survival rates were similar to the literature.

scholarly journals Effect of extending the original eligibility criteria for the “CROSS” neoadjuvant chemoradiotherapy on toxicity and survival in esophageal cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 187-187
Author(s):  
Jan-Binne Hulshoff ◽  
Ellen C. de Heer ◽  
Daphne H. Klerk ◽  
Derk Jan De Groot ◽  
John Theodorus Plukker ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cox Regression ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Postoperative Mortality ◽  
Hematologic Toxicity ◽  
Eligibility Criteria ◽  
Cox Regression Analysis ◽  
Group I ◽  
The Cross

187 Background: Patients with curable esophageal cancer (EC) which proceed beyond the original CROSS eligibility criteria are also treated with neoadjuvant chemoradiotherapy (nCRT). This study assessed the effect of extending the CROSS eligibility criteria for nCRT on treatment related toxicity and overall survival (OS) in EC. Methods: Included were 161 patients with locally advanced EC (T1N1-3/T2-4aN0-3/M0), treated with the CROSS schedule followed by esophagectomy. Group 1 (N = 90) consisted of patients which met the CROSS criteria and patients in group 2 (N = 71) met the extended eligibility criteria, i.e. including a tumor length of > 8 cm (N = 23), > 10% weight loss (N = 35), > 2 – 4 cm extension in the stomach (N = 21), celiac lymph node metastasis (N = 13), and/or age > 75 years (N = 2). We assessed the differences in hematologic toxicity (≥ grade 3) and 90-day postoperative mortality. Moreover, we assessed the prognostic value on OS with multivariate Cox regression analysis. Results: No difference was found in hematologic toxicity and 90-day mortality. The OS differed significantly (P = 0.003), with a median of 37.3 (95% CI 10.56 – 64.0) and 17.2 (95% CI 13.8 – 20.6) months in group I and II, respectively. Pathological N-stage (P = 0.024), ypT-stage (P = 0.044), and group II (P = 0.006) were independent prognostic factors for OS. Conclusions: Extension of the CROSS study eligibility criteria for nCRT did not affect hematologic toxicity and postoperative mortality, but was prognostic for OS.

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