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Treatment outcomes of low-radial-force self-expandable metal stent placement and palliative radiotherapy for unresectable advanced esophageal squamous cell carcinoma with dysphagia.

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Radiotherapy (RT) is preferred over stent placement for dysphagia in unresectable esophageal squamous cell carcinoma (ESCC); however, low-radial-force self-expandable metallic stents (SEMS) may offer safer and more effective palliation. We aimed to compare the outcomes of RT and low-radial-force SEMS in ESCC patients. This retrospective study included patients with unresectable ESCC and dysphagia who underwent palliative RT or low-radial-force SEMS placement between 2013 and 2023. Adverse events were compared, and treatment efficacy was assessed based on changes in Dysphagia Score (DS) and the duration of maintaining DS ≤ 1 among those who achieved it. The stent and RT groups comprised 34 and 45 patients, respectively. Treatment-related adverse events of Grade ≥ 2 and ≥ 3 occurred in 29.4% and 5.8% in the stent group and 34.9% and 6.7% in the RT group, respectively, with no significant differences. After adjustment for baseline DS, the stent group showed significantly greater improvement at 1 month (p < 0.001), whereas no differences were observed at 2 or 3 months. DS ≤ 1 was achieved in 76.5% with stent and 44.4% with RT (p = 0.006). Maintenance of DS ≤ 1 was shorter with stent group when additional SEMS placement was considered an event (p = 0.006), whereas no difference was observed when additional SEMS was allowed (p = 0.898). Low-radial-force SEMS is safe and effective for dysphagia in unresectable advanced ESCC, especially when early oral intake is needed, and can help prolong oral intake if additional SEMS is allowed.

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  • Research Article
  • Cite Count Icon 5
  • 10.1111/ases.12731
Safety of thoracoscopic esophagectomy after induction chemotherapy for locally advanced unresectable esophageal squamous cell carcinoma.
  • Jul 16, 2019
  • Asian Journal of Endoscopic Surgery
  • Yuji Akiyama + 13 more

Recent studies have reported that induction chemotherapy with docetaxel plus cisplatin and 5-fluorouracil (DCF) is an effective treatment for unresectable, locally advanced esophageal cancer. The aim of this study was to investigate the safety and feasibility of thoracoscopic esophagectomy (TE) after DCF for initially unresectable esophageal squamous cell carcinoma (ESCC). Twenty-three patients with initially unresectable T4 thoracic ESCC underwent TE after induction DCF. The neighboring organs with tumors were the tracheobronchus in nine patients, thoracic aorta in 13, and pericardium and diaphragm in three each (concurrent overlapping invasion occurred in five patients). The mean total operation time was 556.3 ± 107.2 minutes, and the mean time of the thoracic procedure was 258.9 ± 83.9 minutes. The mean total blood loss was 166.2 ± 117.8 mL, and the loss during the thoracic procedure was 33.5 ± 24.6 mL. All patients achieved complete R0 resection under TE. No conversions to open thoracotomy were performed. The postoperative morbidity rate was 34.8%. The postoperative hospital stay was 24.3 (range, 13-38) days. Five patients had recurrence: four had distant metastasis (lung, two; liver, three; and one with overlap), and one had mediastinal lymph node recurrence. No local recurrence was noted at the site of the primary T4 tumor. TE was safely performed in 23 patients after DCF therapy for locally advanced unresectable ESCC. Induction DCF, followed by TE, could be an alternative treatment for unresectable T4 ESCC.

  • Research Article
  • 10.1200/jco.2024.42.16_suppl.e16022
Polymeric micellar paclitaxel plus cisplatin combined with tislelizumab as the first-line treatment of advanced unresectable esophageal squamous cell carcinoma: A phase II study.
  • Jun 1, 2024
  • Journal of Clinical Oncology
  • Guochun Cao + 3 more

e16022 Background: Immunotherapy combined with chemotherapy has become the standard first-line treatment for advanced and metastatic esophageal squamous cell carcinoma (ESCC). However, the prophylactic use of hormones, a routine preconditioning regimen of paclitaxel, may weaken the immune response. Polymeric micellar paclitaxel is a new formulation of paclitaxel without polyoxyethylene castor oil solvent, which do not need for pretreatment with anti-allergy drugs before administration. We aimed to evaluate the efficacy and safety of polymeric micellar paclitaxel (pm-Pac) plus cisplatin combined with tislelizumab for unresectable advanced ESCC. Methods: This is a single-center, single-arm, prospective phase II clinical trial. Stage IV ESCC patients diagnosed histologically or cytologically without systemic treatment are eligible for this study. Polymeric micellar paclitaxel plus cisplatin combined with tislelizumab was treated for 2 cycles. After imaging evaluation, if there was no disease progression, an additional two cycles of treatment were completed, followed by maintenance treatment with tislelizumab for one year. At day 1 of each therapy cycle, patients were given pm-Pac 230 mg/m2 followed by cisplatin 70 mg/m2 combined with tislelizumab 200 mg via intravenous infusion, every three weeks. This trial planned to include 30 patients. The primary endpoint was objective response rate (ORR) determined by the independent review committee. And the secondary endpoints included overall survival, progression-free survival evaluated based on the Response Evaluation Criteria in Solid Tumors (version 1.1), as well as the incidence and severity of adverse events. Results: From September 2022 to January 2024, 31 patients were included in the trial. Median age was 65 years, 29 (93.5%) patients were male. Median follow-up was 13.1 months, 2 patient achieved complete response (CR), 19 of them showed partial response (PR), 8 stable disease (SD), illustrating an ORR of 67.7% and a DCR of 93.5%. Median PFS was 7.3 months. The most common AEs were neutropenia (90.3%), nausea(83.8%) and thrombocytopenia (25.8%). No grade 3 or higher immune-related AE was observed, and there were no treatment-related deaths. Conclusions: The pm-Pac plus cisplatin combined with tislelizumab as first-line treatment of unresectable advanced ESCC showed effective without new safety signal. This combination therapy may have great efficacy, but multi-center randomized trials with larger sample size are warranted in further.

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  • Cite Count Icon 5
  • 10.3389/fonc.2024.1370353
Comparison of immunochemotherapy and chemotherapy alone in conversion therapy for locally advanced unresectable esophageal squamous cell carcinoma.
  • Jun 24, 2024
  • Frontiers in oncology
  • Zhiyun Xu + 7 more

The clinical value of preoperative immunochemotherapy and simple chemotherapy induction regimen in the conversion therapy of locally advanced unresectable esophageal squamous cell carcinoma (ESCC) is still unclear. Retrospective analysis was conducted on patients with unresectable cT4b stage ESCC who underwent conversion surgery in our hospital from January 2020 to December 2022. According to the preoperative induction treatment plan, they were divided into induction immunochemotherapy group (iICT group) and induction chemotherapy group (iCT group). The conversion surgery rate, R0 resection rate, radiological and pathological tumor responses, safety, and short-term survival outcomes were analyzed. The results showed that a total of 199 patients with cT4b locally advanced unresectable ESCC who underwent preoperative induction therapy were included in this study. Among them, there were 64 cases (32.2%) in the iICT group, 135 cases (67.8%) in the iCT group. There was a statistically significant difference in objective response rate (73.5% vs 48.9%) and conversion surgery rate (81.3% vs 66.7%), between the iICT and iCT groups (P=0.001 and P=0.019). Among the two groups of patients who underwent surgery, there were statistically significant differences in R0 resection rate (94.2% vs 82.2%) and pathological complete remission rate (23.1% vs 6.7%) between the iICT and iCT groups (P=0.043 and P=0.004). And there was no statistically significant difference in the incidence of grade 3 and above between two groups (P=0.928). The 2-year EFS of the iICT group and iCT group were 76.4% and 42.4%, respectively, with statistically significant differences (P=0.006). Compared with simple chemotherapy, the combination of PD-1 inhibitors and chemotherapy can achieve better conversion surgery rate, tumor response and event-free survival in the conversion therapy of locally advanced unresectable ESCC.

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  • Supplementary Content
  • Cite Count Icon 25
  • 10.3390/cancers13010051
Progress in Multimodal Treatment for Advanced Esophageal Squamous Cell Carcinoma: Results of Multi-Institutional Trials Conducted in Japan
  • Dec 27, 2020
  • Cancers
  • Kazuo Koyanagi + 7 more

Simple SummaryIn Japan, the therapeutic strategies for esophageal squamous cell carcinoma (ESCC) are based on the results of multi-institutional trials conducted by the Japan Esophageal Oncology Group (JEOG), a subgroup of the Japan Clinical Oncology Group (JCOG). Since there are several differences in the factors influencing the treatment approach for esophageal cancer between Eastern and Western countries, the therapeutic strategies adopted in Asian countries, especially Japan, are often different from those in Western countries. Because a transthoracic esophagectomy with three-field lymph node dissection has been performed as a standard surgical procedure for advanced thoracic ESCC in Japan, multimodal treatment for ESCC has been developed to improve the surgical outcomes after this relatively invasive surgical procedure. In this review, we describe the history and current status of therapeutic strategies for ESCC in Japan with a focus on the results of clinical trials conducted by the JEOG.In Japan, the therapeutic strategies adopted for esophageal carcinoma are based on the results of multi-institutional trials conducted by the Japan Esophageal Oncology Group (JEOG), a subgroup of the Japan Clinical Oncology Group (JCOG). Owing to the differences in the proportion of patients with squamous cell carcinoma among all patients with esophageal carcinoma, chemotherapeutic drugs available, and surgical procedures employed, the therapeutic strategies adopted in Asian countries, especially Japan, are often different from those in Western countries. The emphasis in respect of postoperative adjuvant therapy for patients with advanced esophageal squamous cell carcinoma (ESCC) shifted from postoperative radiotherapy in the 1980s to postoperative chemotherapy in the 1990s. In the 2000s, the optimal timing of administration of perioperative adjuvant chemotherapy returned from the postoperative adjuvant setting to the preoperative neoadjuvant setting. Recently, the JEOG commenced a three-arm randomized controlled trial of neoadjuvant therapies (cisplatin + 5-fluorouracil (CF) vs. CF + docetaxel (DCF) vs. CF + radiation therapy (41.4 Gy) (CRT)) for localized advanced ESCC, and patient recruitment has been completed. Salvage and conversion surgeries for ESCC have been developed in Japan, and the JEOG has conducted phase I/II trials to confirm the feasibility and safety of such aggressive surgeries. At present, the JEOG is conducting several trials for patients with resectable and unresectable ESCC, according to the tumor stage. Herein, we present a review of the JEOG trials conducted for advanced ESCC.

  • Research Article
  • Cite Count Icon 16
  • 10.1111/cas.15262
Treatment patterns and survival in advanced unresectable esophageal squamous cell cancer: A population-based study.
  • Jan 25, 2022
  • Cancer science
  • Marieke Pape + 7 more

Data on treatment and survival of patients with advanced unresectable esophageal squamous cell carcinoma (ESCC) from Western populations are limited. Here we describe treatment and survival in patients with advanced unresectable ESCC: patients with cT4b disease without metastases (cT4b), metastases limited to the supraclavicular lymph nodes (SCLNM) or distant metastatic ESCC at the population level. All patients with unresectable (cT4b) or synchronous metastatic ESCC at primary diagnosis (2015‐2018) or patients with metachronous metastases after primary non‐metastatic diagnosis in 2015‐2016 were selected from the Netherlands Cancer Registry. Fifteen percent of patients had cT4b disease (n = 146), 12% SCLNM (n = 118) and 72% distant metastases (n = 681). Median overall survival (OS) time was 6.3, 11.2, and 4.4 months in patients with cT4b, SCLNM, and distant metastases, respectively (P < .001). Multivariable Cox regression showed that patients with cT4b (hazard ratio 1.44, 95% CI 1.04‐1.99) and patients with distant metastases (hazard ratio 1.42, 95% CI 1.12‐1.80) had a worse survival time compared with patients with SCLNM. Among patients who received chemoradiotherapy and/or underwent resection (primary tumor and/or metastases), median OS was 11.9, 16.1, and 14.0 months in patients with cT4b, SCLNM, and distant metastases, respectively (P = .76). Patients with SCLNM had a better survival time compared with patients with cT4b and patients with distant metastases. Survival of patients with advanced unresectable ESCC in clinical practice was poor, even in patients treated with curative intent.

  • Research Article
  • Cite Count Icon 6
  • 10.21037/atm-22-2779
Efficacy and safety of combined treatment with pembrolizumab in patients with locally advanced or metastatic esophageal squamous cell carcinoma in the real world
  • Jun 1, 2022
  • Annals of Translational Medicine
  • Pei Zhang + 11 more

BackgroundTreatments for patients with advanced esophageal cancer are still limited. Pembrolizumab has demonstrated antitumor activity in patients with advanced esophageal cancer in previous studies. Few studies have assessed safety and efficacy in routine clinical practice. We investigated the real-world outcomes of pembrolizumab for patients with advanced esophageal cancer.MethodsThis retrospective, observational study collected 57 advanced esophageal squamous cell carcinoma (ESCC) patients from October 1, 2019 to October 1, 2021, 57 who received different patterns of treatments according to the staging were collected. Briefly, patients diagnosed with locally advanced and surgically resectable ESCC received neoadjuvant therapy followed by surgery. For patients with locally advanced, unresectable ESCC, the treatment regimen including chemoradiotherapy combined with pembrolizumab was performed. Patients with metastatic ESCC or those not suitable for radiotherapy received pembrolizumab plus chemotherapy. Safety was assessed in all treated patients. The objective response rate (ORR) was used to evaluate the efficacy.ResultsThe ORR was 74.1% (40/54) among all patients. The most common adverse events (AEs) were leukopenia (36.8%, 21/57), nausea (28.1%, 16/57), and thrombocytopenia (14%, 8/57). Grade III and higher AEs were observed in 9 of the 57 patients (15.8%).ConclusionsFor patients with advanced ESCC, combined treatment with pembrolizumab was effective and safe. Multicenter studies should be carried out for further confirmation.

  • Research Article
  • 10.1200/jco.2019.37.15_suppl.tps4147
A single-arm, open phase II clinical trial of anti-programmed death-1 antibody SHR-1210 combined with nimotuzumab as second-line treatment of advanced esophageal squamous cell carcinoma.
  • May 20, 2019
  • Journal of Clinical Oncology
  • Feng Wang + 2 more

TPS4147 Background: Approximately 40% of patients (pts) with esophageal cancer are diagnosed with advanced unresectable or metastatic disease; the 5-year survival rate for advanced disease is 5%. No standard therapy is available in China for Advanced Esophageal Squamous Cell Carcinoma(ESCC) patients progressed after first-line chemotherapy.Inhibition of programmed cell death protein-1 (PD-1) has demonstrated promising antitumor activity and manageable safety in pts with advanced unresectable or metastatic ESCC. SHR-1210, a humanized IgG4 monoclonal antibody, has high affinity and specificity for PD-1 molecule. SHR-1210 was generally well tolerated and had preliminary antitumor effects in pts with solid tumors, including ESCC. Nimotuzumab, a humanized anti-epidermal growth factor receptor monoclonal antibody h-R3, has been shown to be effective and safe in the treatment of head and neck cancer,non-small cell lung cancer (NSCLC) and esophageal Cancer in several phase II studies.The purpose of this study is to observe and evaluate the efficacy and safety of anti-PD-1 antibody SHR-1210 combined with nimotuzumab as second-line therapy in patients with advanced ESCC. Methods: Patients, age 18-75, with measurable tumor lesion, failed in or progression after 1st line chemotherapy, were enrolled in this study.Patients received SHR-1210 200 mg once every 2 weeks (Q2W) combined nimotuzumab 200 mg weekly until disease progression, death or unacceptable toxicity.Assessments included response by RECIST v1.1 every 6 wks and safety (physical examination, vital signs, ECOG PS, laboratory tests).The primary endpoint is the objective response rate (ORR),and the secondary end points include the diseases control rate (DCR),duration of response (DOR),progression-free survival (PFS),and overall survival(OS). Additionally, we try to identify biomarker to predict efficacy of SHR-1210 and Nimotuzumab with target capture sequencing and gene expression profile as exploratory endpoints. Clinical trial information: NCT03766178.

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  • Cite Count Icon 5
  • 10.1200/jco.2017.35.15_suppl.e15573
Nimotuzumab plus paclitaxel and cisplatin as 1st line treatment for unresectable esophageal squamous cell carcinoma: Long term follow-up of survival in a phase II study.
  • May 20, 2017
  • Journal of Clinical Oncology
  • Xiaodong Zhang + 13 more

e15573 Background: The role of anti-epidermal growth factor receptor (EGFR) targeting treatment in esophageal squamous cell carcinoma (ESCC) is still uncertain. We conducted a prospective phase 2 study of paclitaxel, cisplatin, and nimotuzumab (TPN) as first-line treatment in unresectable or metastatic ESCC (NCT01336049). The objective response rate was 51.8%. Here we reported long-term follow-up results of that initial trial. Methods: 59 patients were enrolled from Mar 2011 to Apr 2013 and treated with the TPN regimen (nimotuzumab 200mg weekly, paclitaxel 175mg/m2 on day1, and cisplatin 30mg/m2 on day1 and 2, repeat every 3 weeks for total six cycles). Patients were allowed to receive sequential radiotherapy in case of local-regional disease or controlling symptom. Results: 56 of 59 patients were eligible for evaluation. After a median follow-up of 32.2months, the median progression-free survival (PFS) and overall survival (OS) were 18.1±4.2 months (95% Confidence: 9.8-26.4) and 26.2±10.0 months (95% Confidence: 6.6-45.8) in 29 patients with unresectable local-regional disease, while those were 6.6±0.4 months (95% Confidence: 5.8-7.5) and 11.5±3.7 months (95% Confidence: 4.2-18.8) respectively in 27 patients with metastatic disease. Patients of male, with multiple lymph node station metastasis, visceral metastasis, no response to TPN treatment, and without radiotherapy had worse OS. Even in some patients with multiple stations lymph node metastasis or recurrent disease of local-regional lymph node metastasis, TPN with sequential radiation seemed could bring longer survival time. But multivariate cox-regression analysis only confirmed that the TPN treatment was associations with OS. Compared with those of complete and partial response, patients of stable disease and progression had poor OS (HR = 2.32, 95% CI: 1.03-5.05, p = 0.03). Conclusions: the combination of nimotuzumab, paclitaxel, and cisplatin is effective as first-line treatment for patients with unresectable and metastatic ESCC, especially those with sequential radiotherapy. Clinical trial information: NCT01336049.

  • Research Article
  • 10.3760/cma.j.issn.1006-9801.2016.02.004
Prognostic analysis of 169 patients with unresectable esophageal squamous cell carcinoma treated by three dimensional conformal radiation therapy
  • Feb 28, 2016
  • Cancer Research and Clinic
  • Yibiao Chen + 5 more

Objective To study long-term outcome and prognostic factors of esophageal squamous cell carcinoma patients treated by three dimensional conformal radiation therapy (3DCRT). Methods 169 patients with unresectable esophageal squamous cell carcinoma treated by 3DCRT were enrolled in the study. The survival rates of 1 year, 3 years and 5 years were estimated by life-table method. Univariate prognostic factor was tested by Log-rank method. Multivariate prognostic factor was analyzed by Cox model. Results The 1 year, 3 years and 5 years survival rates were 63.2 %, 34.1 % and 21.3 %, respectively. Univariate analyses showed that the length of tumor, the site of lesion, chemotherapy, the dose of plan gross tumor volume (PGTV) and the short-term outcomes after treatment were the important prognostic factors for the long-term survival (P < 0.05), and multivariate analyses showed that the length of tumor, chemotherapy and the short-term outcomes after treatment were the independent prognostic factors for the long-term survival (P < 0.05). Conclusions The patients with unresectable esophageal squamous cell carcinoma treated by 3DCRT have a good long-term prognosis. The length of tumor, chemotherapy and the short-term outcomes after treatment are the important prognostic factors for the long-term survival of the patients. Chemotherapy can improve the long-term prognosis significantly. Key words: Esophageal neoplasms; Radiotherapy, conformal; Prognosis

  • Research Article
  • Cite Count Icon 5
  • 10.1038/s41598-025-06625-2
Anlotinib plus camrelizumab and chemotherapy as first-line treatment in patients with advanced esophageal squamous cell carcinoma
  • Jul 1, 2025
  • Scientific Reports
  • Mingfang Xu + 6 more

Advanced esophageal squamous cell carcinoma (ESCC) patients exhibit a ~ 50% objective response rate (ORR) and median progression-free survival (mPFS) of just 5–7 months when undergoing first-line immune-chemotherapeutic treatment, underscoring pronounced unmet clinical need. We assessed the efficacy and safety of Anlotinib plus Camrelizumab and chemotherapy for advanced, unresectable, or metastatic ESCC. This is an open-label, investigator-initiated, phase 2, non-randomized clinical trial enrolled patients from August 3, 2020, to August 10, 2022. Patients with treatment-naive unresectable stage III or IV ESCC received treatment which was patient-selected, including chemotherapy + camrelizumab + Anlotinib (TCAC group) or chemotherapy + Camrelizumab (TCC group) induction therapy for 4–6 cycles, followed by maintenance therapy. The primary endpoint was ORR, while secondary endpoints included mPFS, median overall survival (mOS), disease control rate (DCR), and treatment-related adverse events (TRAEs). 30 patients were included in each group. Over a median 14.5-month follow-up period, the ORR was 90.0%, 43.3%(P < 0 0.001) and the mPFS was 16.03, 7.30 months (HR 0.35, 95%CI, 0.19–0.65; P < 0 0.001) in TCAC and TCC groups, respectively. Grade 3 TRAEs were experienced by 12 patients (40.0%) in TCAC group, including decreased neutrophil counts (5 [16.7%]), decreased white blood cell counts (4 [13.3%]), reduced platelet counts (3 [10%]), and hypertension (2 [6.7%]). No patients experienced grade 4–5 TRAEs. The combination of Anlotinib plus Camrelizumab and chemotherapy had promising efficacy among patients with advanced ESCC in this study, which may be a promising first-line treatment regimen.Trial registration: Registered with ClinicalTrials.gov, NCT04471480. 15/07/2020.

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  • Cite Count Icon 2
  • 10.1016/j.ijrobp.2026.04.026
Consolidative Camrelizumab Following Definitive Concurrent Chemoradiation Therapy With Involved-Field Irradiation in Locally Advanced Esophageal Squamous Cell Carcinoma: A Single-Arm Phase 2 Trial.
  • Apr 1, 2026
  • International journal of radiation oncology, biology, physics
  • Yunjie Cheng + 11 more

Consolidative Camrelizumab Following Definitive Concurrent Chemoradiation Therapy With Involved-Field Irradiation in Locally Advanced Esophageal Squamous Cell Carcinoma: A Single-Arm Phase 2 Trial.

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  • Cite Count Icon 1
  • 10.1200/jco.2021.39.15_suppl.4037
Randomized phase II study comparing docetaxel versus paclitaxel in patients with esophageal squamous cell carcinoma who are refractory to fluoropyrimidine and platinum-based chemotherapy: OGSG1201.
  • May 20, 2021
  • Journal of Clinical Oncology
  • Takayuki Kii + 15 more

4037 Background: Fluoropyrimidine and platinum-based chemotherapy are considered first-line therapy options for patients with unresectable advanced or recurrent metastatic esophageal squamous cell carcinoma(ESCC). After fluoropyrimidine and platinum-based chemotherapy is failed, taxanes (docetaxel(DTX) and paclitaxel(PTX)) was mainly used as a second-line treatment for ESCC. Therefore, we conducted a trial to compare DTX and PTX in patients with unresectable advanced or recurrent ESCC who were failed to previous fluoropyrimidine and platinum-based chemotherapy. Methods: We did a randomized, an open-labeled and multicentre phase 2 study. Inclusion criteria included age 20 to 80 years with unresectable advanced or recurrent ESCC, Eastern Cooperative Oncology Group (ECOG) performance status score of 0 or 1. Patients who were refractory to fluoropyrimidine and platinum-based chemotherapy. Treatment consisted of DTX 70 mg/m2 repeated every 21 days or PTX 100 mg/m2 once weekly on days 1, 8, 15, 22, 29, and 36 of a 49-day cycle. Results: 80 patients were enrolled between May 2012 and April 2019. 41 patients received DTX and 39 patients received PTX. After assessment of eligibility, two patients proved uneligible (one for double cancer, one for contraindication to DTX) and were excluded from the analysis. But, 80 patients were evaluable for the toxicity analyses. A median follow-up time was 32 months. Overall survival was significantly longer in the PTX group than in the DTX group (median, 8.8 months vs. 7.3 months; hazard ratio, 0.62; 95% CI, 0.38 to 0.9998; P = 0.047). The median progression-free survival was significantly longer in the PTX group than in the DTX group (median, 4.4 months vs. 2.1 months; hazard ratio, 0.49; 95% CI, 0.30 to 0.78; P = 0.002). The median time to treatment failure was significantly longer in the PTX group than in the DTX group (median, 3.8 months vs. 2.1 months; hazard ratio, 0.45; 95% CI, 0.28 to 0.73; P<0.001). The most common adverse events of grade 3 or higher were a decreased neutrophil count (in 28% of the PTX group and in 80% of the DTX group). Febrile neutropenia was also more frequent in the DTX group than the PTX group (46% vs. 0%). There was one death from sudden death in which treatment-related mortality could not be ruled out. Conclusions: Secound-line treatment with PTX, as compared with DTX, reduced the risk of ESCC. Clinical trial information: UMIN000007940.

  • Research Article
  • 10.1158/1538-7445.am2017-2766
Abstract 2766: Esophageal stenting in resource-limited settings
  • Jul 1, 2017
  • Cancer Research
  • Michael M Mwachiro + 9 more

Background: Esophageal cancer is the 6th leading cause of cancer death globally, with geographical high-risk areas in Asia, the Middle East, and eastern and southern Africa. Esophageal squamous cell carcinoma (ESCC) is the more common variant in Africa. In Kenya, its incidence is 2nd in men after prostate cancer and 3rd in women after breast and cervix-uteri cancers. Late presentation is a common occurrence in developing countries and is multifactorial due to challenges in access to health care, low socioeconomic status and delayed or missed diagnosis. A large percentage of these tumors are thus unresectable and are only eligible for palliative care via stenting. Our hospital is a 300-bed referral center in southwestern Kenya, which is a hotspot for ESCC, and we see over 400 cases of ESCC annually. Methods: We have developed a technique for placement of esophageal self-expanding metallic stents (SEMS) without fluoroscopy that is safe and easily reproducible. This is an outpatient procedure, with the majority done under conscious sedation, and routine followup is not necessary. The tumor margins are noted at time of video endoscopy, a guidewire is placed, and dilation done with Savary dilators as required. The SEMS are then loaded on the stent delivery device and deployed into the proper position based on measurements, and placement is subsequently confirmed via endoscopic visualization. Results: A total of 3000 SEMS have been placed to date at our hospital, without using fluoroscopy. The male: female ratio has been 1.5:1, and the average age has been 60.4 years. The distribution of tumor locations was 67% in the middle and distal third. The most common complications were tumor overgrowth with obstruction and stent migration. Procedure related mortality was 0.3%. Post-procedure improvement in dysphagia score was seen in over 80% , and patient satisfaction was high. Initial data puts our post stent survival time around 8 months/ 250 days Conclusions: Placement of SEMS for ESCC, without fluoroscopy, is a safe and reproducible procedure which has a low rate of adverse events. This procedure results in effective palliation of a difficult disease and can easily be done in resource-limited settings which have endoscopy capabilities. Current efforts are ongoing to increase opportunities for training endoscopists in this procedure and for provision of affordable stents in Africa. Citation Format: Michael M. Mwachiro, Robert K. Parker, Stephen Burgert, Justus Lando, Sinkeet Rankeeti, Robert Chepkwony, Emmanuel Kiniga, Sanford Dawsey, Mark Topazian, Russell E. White. Esophageal stenting in resource-limited settings [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2766. doi:10.1158/1538-7445.AM2017-2766

  • Research Article
  • 10.2147/jir.s525618
Comparison of Blood Inflammation Scores and Their Prognostic Value in Elderly Unresectable Esophageal Squamous Cell Carcinoma Patients Treated with Radiotherapy/Chemoradiotherapy
  • Oct 14, 2025
  • Journal of Inflammation Research
  • Yu Zhang + 8 more

ObjectiveTo investigate the predictive value of inflammation-based prognostic scores (IBs) on overall survival (OS) in elderly unresectable esophageal squamous cell carcinoma (ESCC) patients treated with radiotherapy (RT) or chemoradiotherapy (CRT).MethodsThis retrospective study included 120 elderly ESCC patients who received RT/CRT. IBs, including neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), prognostic nutritional index (PNI), systemic immune-inflammation index (SII), and systemic immune response index (SIRI), were calculated within one week before treatment and within two weeks after treatment.ResultsA total of 120 patients were included. The median age was 76 years. Significant differences were found between survivors (n=29) and non-survivors (n=91) in tumor size (p=0.018), T stage (p=0.006), and pre-treatment lymphocyte count (p=0.002). At the study endpoint, 75.8% of patients (91/120) had died, and 24.2% (29/120) remained alive. The median overall survival (OS) and progression-free survival (PFS) were 18 months and 15 months, respectively. The 1-year, 3-year, and 5-year OS rates were 61.7%, 18.3%, and 5.8%, respectively, and the corresponding PFS rates were 40.8%, 7.5%, and 1.7%. Pre-treatment NLR, SIRI, and SII were associated with OS. Post-treatment NLR and PLR were also predictors. However, in multivariate analysis, only age (p=0.002) and adverse events (p=0.003) remained independent predictors of OS.ConclusionHigh NLR, SII, and SIRI before treatment, and NLR and PLR after treatment, were associated with poorer OS in elderly ESCC patients undergoing RT/CRT. However, none of these IBs remained independent predictors in multivariate analysis, suggesting that their prognostic value may be influenced by confounding factors.

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  • Research Article
  • Cite Count Icon 6
  • 10.1007/s00066-024-02286-8
Conversion chemoradiotherapy combined with nab-paclitaxel plus cisplatin in patients with locally advanced borderline-resectable or unresectable esophageal squamous cell carcinoma: a phase i/ii prospective cohort study
  • Aug 12, 2024
  • Strahlentherapie und Onkologie
  • Nuo Yu + 21 more

BackgroundTo evaluate the efficacy and safety of nab-paclitaxel plus cisplatin as the regimen of conversional chemoradiotherapy (cCRT) in locally advanced borderline resectable or unresectable esophageal squamous cell carcinoma (ESCC).MethodsPatients with locally advanced ESCC (cT3‑4, Nany, M0‑1, M1 was limited to lymph node metastasis in the supraclavicular area) were enrolled. All the patients received the cCRT of nab-paclitaxel plus cisplatin. After the cCRT, those resectable patients received esophagectomy; those unresectable patients continued to receive the definitive chemoradiotherapy (dCRT). The locoregional control (LRC), overall survival (OS), event-free survival (EFS), distant metastasis free survival (DMFS), pathological complete response (pCR), R0 resection rate, adverse events (AEs) and postoperative complications were calculated.Results45 patients with ESCC treated from October 2019 to May 2021 were finally included. The median follow-up time was 30.3 months. The LRC, OS, EFS, DMFS at 1 and 2 years were 81.5%, 86.6%, 64.3%, 73.2 and 72.4%, 68.8%, 44.8%, 52.7% respectively. 21 patients (46.7%) received conversional chemoradiotherapy plus surgery (cCRT+S). The pCR rate and R0 resection rate were 47.6 and 84.0%. The LRC rate at 1 and 2 years were 95.0%, 87.1% in cCRT+S patitents and 69.3%, 58.7% in dCRT patients respectively (HR, 5.14; 95%CI, 1.10–23.94; P = 0.021). The toxicities during chemoradiotherapy were tolerated, and the most common grade 3–4 toxicitiy was radiation esophagitis (15.6%). The most common postoperative complication was pleural effusion (38.1%) and no grade ≥ IIIb complications were observed.Conclusionnab-paclitaxel plus cisplatin are safe as the regimen of conversional chemoradiotherapy of ESCC.

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