Significance of multimodality therapy for esophageal cancer synchronously or metachronously associated with head and neck cancer.

Abstract

132 Background: Esophageal cancer is highly aggressive and until recently is associated with a poor prognosis. Another clinical problem of esophageal cancer is the frequent association of head and neck cancer. The therapy for esophageal cancer and head and neck cancer is difficult. Definitive chemoradiotherapy is frequently indicated, while invasive surgical resections have been aggressively performed for patients with esophageal cancer associated with head and neck cancer. Methods: The Japanese 202 patients underwent esophagectomy were divided into two groups according to the association of head and neck cancer. The clinicopathological factors and the method of operations were evaluated and statistically analyzed. Results: The double cancer group included 26 (12.9%) patients that had the cancer of esophagus and the head and neck either synchronously or metachronously, while the control group included 176 (87.1%) patients with esophageal cancer. Seventeen patients were operated synchronously in double cancer group. No statistically significant differences were recognized in other clinical backgrounds such as the gender, location of the tumor, etc. Several types of operations were performed for two groups, such as subtotal esophagectomy, total laryngo-pharyngo-esophagectomy, cervical esophagectomy and laryngo-pharyngectomy and free jejunal transfer.salvage esophagectomy, and two-staged operation after definitive chemoradiotherapy. Salvage esophagectomy was performed in five patients with either remnant or recurrent esophageal cancer after definitive chemoradiotherapy. The mortality as well as morbidity rate of the double cancer group was not significantly different from the control group. Furthermore, patients’ prognosis was similar in the two groups. Conclusions: Esophagectomy can be an effective treatment option by adopting techniques that appropriate for each cases, such as staged operations after definitive chemoradiotherapy, muscular flaps and microvascular anastomosis, even in patients with double cancers of the esophagus and the head and neck cancer.