400 OUTCOME OF PATIENTS THAT DO NOT UNDERGO RESECTION AFTER NEOADJUVANT TREATMENT FOR CANCER OF THE ESOPHAGUS.

Patients with locally advanced esophageal cancer usually receive neoadjuvant treatment prior to surgery. A proportion of patients will not receive their surgery due to disease progression. Little is known about what happens to these patients and their prognosis. The aim of this study was to evaluate outcomes in patients that have received neoadjuvant treatment but not undergone esophagectomy. Methods A review of a contemporaneously maintained database of all patients that underwent neoadjuvant treatment for esophageal adenocarcinoma, or squamous cell carcinoma (SCC) but did not have a subsequent esophagectomy was carried out. Patients that were diagnosed with cancer between January 2009 and December 2018 were included. All patients underwent a standardised staging protocol, and were restaged on completion of their neoadjuvant treatment. Overall survival from the date of their initial staging CT and any subsequent treatments were recorded. Results Over the time period 927 patients received neoadjuvant treatment, and 107 did not progress to surgery. Of the 107, 106 received neoadjuvant chemotherapy and one chemoradiotherapy. 83 of the 107 were adenocarcinoma and 24 SCC. The median age of patients who had surgery was 66 compared to 67 for those that did not. Overall median survival for patients not having surgery was 328.5 days. 40 patients had subsequent oncological treatments. Median survival for patients who received no further treatment was 264 days, palliative chemotherapy 412 days palliative radiotherapy 418.5 days and any combination of the two was 390.5 days. Conclusion These results show median survival after disease progression during neoadjuvant treatment was over 10 months and this was extended with further oncological treatment with radiotherapy prolonging survival times the most to over 13 months. This information can help when counselling patients to potential treatment options.

Brain metastases in gastroesophageal cancers—an underestimated complication

Background Brain metastases represent a severe complication in many gastrointestinal malignancies especially those arising from the upper gastrointestinal tract, including cancer of the esophagus, gastroesophageal junction, and stomach (GEC). However, there is little knowledge about the onset or potential risk factors for brain metastases (BRMs) in upper gastrointestinal cancers resulting in a lack of screening guidelines for BRMs. Methods We analyzed 827 patients from our cancer registry suffering from gastroesophageal cancer (GEC) and treated at the University Medical Center Göttingen between January 2013 and December 2019 for the presence of BRMs. Results From 827 patients with GEC we found 54 patients with BRMs, resulting in an incidence of 6.5%. BRMs are more frequent in male patients (90.74% vs 9.26%, p = 0.0051) and in adenocarcinomas (90.74% vs 9.26%, p = 0.0117). Mean duration for the onset of BRMs from initial cancer diagnoses was 20.9 months in limited disease (curative approach) and 9.3 months in advanced disease (palliative approach) (p = 0.0026). However, early detection of BRMs is a prognostic factor since patients with successful resection of BRMs have a better prognosis compared to those with unresectable BRMs (5.93 vs 2.07 months, p = 0.0091). Conclusion In this single-center retrospective study, brain metastases (BRMs) occur with a high frequency (6.5%) in gastroesophageal cancer (GEC), significantly more often in male patients and adenocarcinomas. Since survival of these patients considerably correlates with successful BRMs resection, our observations propose further prospective trails to validate our hypothesis and ultimately the implementation of routine screening procedures to detect asymptomatic brain metastases.

Blood picture in esophageal cancer.

Master (Journ of Amer. Med. Ass., 1925, No. 10), examining the blood of 15 patients suffering from primary cancer of the esophagus, found in them either a normal blood composition, or even an increase in the number of red blood cells against the norm.