Cases Of Esophageal Carcinoma Research Articles

A novel screening test for esophageal squamous cell carcinoma: sirtuin-3.

Human sirtuin-3, a protein involved in the mediation of tumors, has been shown to be present in malignancies. The goal of this study was to measure serum sirtuin-3 levels in esophageal squamous cancer cells and to determine whether sirtuin-3 may possess predictive value in advanced cases of esophageal squamous cell carcinoma (ESCC). A total of 130 ESCC patients and 50 healthy control subjects participated to the study. Serum sirtuin-3 levels for all 180 subjects were measured using enzyme-linked immunosorbent assay (ELISA). Median sirtuin-3 levels were significantly higher in patients with ESCC than in the control subjects. The presence of considerably elevated levels of sirtuin-3, could be a powerful mediator of advanced ESCC in ESCC patients, suggests that sirtuin-3 may be a useful indicator of the disease.

A rare case of esophageal lymphoepithelial carcinoma without Epstein–Barr virus infection

A rare case of esophageal lymphoepithelial carcinoma without Epstein–Barr virus infection

The notch pathway is activated in neoplastic progression in esophageal squamous cell carcinoma

The Notch signaling pathway is integral to normal human development and homeostasis and has a deterministic function on cell differentiation. Recent studies suggest aberrant Notch signaling may contribute to neoplastic progression by an increase in stem cell survival, chemoresistance, and the promotion of epithelial-to-mesenchymal transition. The goals of our study were to determine, utilizing quantitative technologies, the expression of activated Notch 1 in esophageal squamous cell carcinoma (SCC) and to determine the relationship between Notch 1 expression and various clinicopathologic parameters. Immunohistochemical staining for Notch intracellular domain (NICD) was performed on 60 consecutive cases of esophageal squamous cell carcinoma, 42 cases of benign esophageal squamous epithelium, and 13 cases of eosinophilic esophagitis diagnosed in our department from 2007 through 2015, and exact nuclear staining and nuclear characteristics were graded using the Vectra imaging system. Clinicopathologic data (gender, age at diagnosis, smoking status, tumor grade, tumor stage, tumor location, and survival) were collected for each SCC case and these were correlated with NICD staining. Cases of esophageal SCC demonstrated significantly higher NICD staining compared to cases of benign and reactive esophageal epithelium (P=.003 and .005, respectively). Among cases of esophageal SCC, nuclear NICD staining was significantly correlated with both tumor grade and stage. Following classification and regression tree analysis, esophageal SCC patients with increased NICD expression were found to be more likely to die from their disease than those with lower levels of expression. Taken together, the findings suggest that increased Notch 1 may contribute to the development and aggressiveness of esophageal SCC.

Clinical analysis of 10 cases of advanced esophageal carcinoma treated with radioactive gastric tube of 125I seeds

Objective To explore the feasibility, safety and preliminary efficacy of radioactive gastric tube of 125I seeds in the treatment of advanced esophageal carcinoma. Methods For 10 cases with advanced esophageal carcinoma, the tumor target area was outlined in the TPS system according to preoperative CT images. Prescription dose was 60 Gy with 125I seed radioactivity of 2.22×107 Bq. Accordingly, the 125I seeds number and the appropriate gastric tube was decided. Then, depending on the location of the tumor and certain rules, 125I seeds were fixed in the tube wall to make the radioactive 125I seeds gastric tube. Under the C- arm X-ray fluoroscopy, the radioactive 125I seeds gastric tubes were placed into esophageal carcinoma site of the patients. Results The radioactive 125I seeds gastric tubes of 10 patients were successfully placed, without esophageal perforation, bleeding complications and so on. In one month after operation, all patients with dysphagia′s Stooler classification score were 2-3 level, of which one case died of other basic diseases in three months after operation, and six cases achieved 0-1 level while the other three cases achieved 1-2 level in four months after operation. There were no cases of postoperative chest pain, bleeding, pneumonia and other related complications. Conclusions The radioactive 125I seeds gastric tube could not only help to solve nutrition problems, but also the intracavitary brachytherapy inhibit the growth of tumor, which is safe and feasible in clinical use. It can be used as a palliative treatment for patients with advanced esophageal carcinoma. Key words: Esophageal carcinoma; 125I seed; Gastric tube; Intracavitary brachytherapy

Nutrition Status and Inflammatory Indexes Could Predict Acute Toxicity After Concurrent Chemoradiation Therapy for Esophageal Carcinoma

To evaluate the influence on acute toxicity with different nutrition status and inflammatory indexes ofthe patients after concurrent chemoradiotherapy in esophageal carcinoma. A total of 338 cases of esophageal carcinoma who underwent intensity modulated radiation therapy (IMRT)with concurrent chemotherapy were eligible for retrospectively analysis. The influence on acute toxicity with different nutrition status such as body mass index level (BMI), albumin level (ALB), total lymphocyte count level (TLC), anemia and inflammatory indexes including neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) were observed after the treatment. The incidence rate of malnutrition according to different nutrition status was ranging from 5.62% to 54.14%. The incidence of acute radiation esophagitis of grade 2 and above in low ALB group were higher than that in normal ALB group (χ2=75.677，P=0.000). The incidence of hematologic toxicity among different TLC levels had statistical difference significantly. With the decline of TLC level, the incidence of hematologic system toxicity was increased (χ2=12.891，P=0.006), but the rate of acute radiation pneumonitis was decreased (χ2=19.775，P=0.001). The incidences of acute radiation esophagitis of grade 2 and above in anemia group were much higher than that in normal group (χ2=37.774, P=0.000). An higher incidence of acute radiation esophagitis was shown in NLR and PLR high level groups than in lower NLR and PLR groups (χ2=64.207, P=0.000; χ2=11.260, P=0.004). Accompanied by NLR and PLR levels elevate,the rate of acute radiation esophagitis is ascendant, where as the rate is decendant with ALB and Hb levels decline. The occurrence of hematologic system toxicity will increases and acute radiation pneumonitis decreases when TLC levels goes down.

Chewing 50 times per bite could help to resume oral feeding on the first postoperative day following minimally invasive oesophagectomy.

In our previous study, early oral feeding following McKeown minimally invasive oesophagectomy (MIE) has been shown to be a safe and a feasible approach for early recovery of intestinal function and an improvement of quality of life. This study investigates the effect of 'chewing 50 times per bite' on early oral feeding following MIE. Between May 2016 and December 2016, we retrospectively analysed 95 cases of oesophageal carcinoma in patients who underwent MIE in our department. All patients received instructions for a 'chewing 50 times per bite' method for solid food intake on postoperative day (POD) 1. The primary end-points were the incidence of pneumonia and anastomotic leakage rate. In addition, postoperative nutritional status was studied. Overall, 95 patients willingly started oral nutrition on POD 1. The rates of anastomotic leakage and pneumonia incidence were 2.1% and 7.4%, respectively. The caloric intake means on POD 1, POD 3 and POD 5 were 1388 ± 184, 1549 ± 206 and 1522 ± 203 respectively, which were 78%, 88% and 77% of the mean caloric requirements, respectively. There were no significant differences in protein index values between the preoperative measurements and the hospital discharge measurements. The '50 chewing times per bite' solid food intake method on POD 1 in patients with MIE was shown to be feasible and safe, because the application of this method helps to convert solid food into liquid nutrition. More importantly, we demonstrated that it is possible for patients to be able to eat at will on Day 1 following MIE.

Abstract 5745: Study on telomere shelterin component TPP1 in esophageal squamous cell carcinoma

Abstract Esophageal cancer (EC) is one of the most aggressive cancer and ranks the sixth leading cause of cancer-related mortality worldwide, approximately 70% of global esophageal carcinoma cases occur in China and esophageal squamous cell carcinoma (ESCC) is the most frequent histological subtype of EC. Lacking of reliable early diagnostic markers and efficient medical and surgical treatment approaches, the five-year survival rate of ESCC is only about 4.4%.Therefore exploration of the genetic basis and the affiliated molecular mechanisms in ESCC could be beneficial to improve the diagnosis, therapy, and prevention of this disease. As an important telomere binding protein, TPP1 protects the ends of telomeres and maintains the genomic stability and integrity of chromosomes in eukaryotes. Previous investigation discovered that TPP1 might play an important role in the carcinogenesis and progression of some cancers. However, whether and/or how TPP1 participates in ESCC remains unclear. Here TPP1 was studied in 65 ESCC patients’ specimens including tumor tissue, the adjacent tissue, and the peripheral blood leukocytes, also the ESCC cell lines were employed to further explore the molecular mechanisms of TPP1 involved in the tumorigenesis of ESCC. In this study, TPP1 mRNA and protein were measured in the ESCC tissue specimens, peripheral blood leukocytes and also in ESCC cell lines using real time RT-PCR and Western Blot. The results showed that TPP1 mRNA level was significantly higher in ESCC tumor tissues compared with the adjacent tissues (P<0.05); the same trend was observed in ESCC cells (Eca109, Kyse150) vs human esophageal epithelial cells (HET-1A), respectively. However, in peripheral blood leukocytes, the expression of TPP1 did not show any difference between the cancer patients and the healthy controls. Among the 65 ESCC patients, TPP1 protein expression in 46 patients was obvious higher in tumor tissues than that in the matched adjacent tissues, although there were 19 patients in exception. Moreover, the TPP1 expression was correlated with the lymph nodes metastasis and CYF2, which is one of the potential tumor markers for diagnosis of esophageal carcinoma. To further explore the potential biological function of TPP1 in ESCC, stably- transfecting shRNA-TPP1 (sh-TPP1) and shRNA-Negative Control (sh-NC) expression constructs in ESCC cell lines were performed to study TPP1’s roles in ESCC. The colongenic assay showed that depletion of TPP1 decreased ESCC cells proliferation and cell growth, and the wound healing experiment and cell invasion transwell chamber test demonstrated that down-regulation of TPP1 suppressed the cell migration and invasion capabilities in vitro. Taken together, our findings revealed that TPP1 might play crucial roles in the pathogenesis of ESCC and targeting TPP1 could be a valuable potential for ESCC early diagnosis, intervention and therapeutics. Note: This abstract was not presented at the meeting. Citation Format: Lihua Yao, Jiang Zou, Ru Sun, Jiajing Cai, Guangcheng Huang, Qiang Ma, Lei Xu, Mayong Fu, Xiaolan Guo. Study on telomere shelterin component TPP1 in esophageal squamous cell carcinoma [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 5745. doi:10.1158/1538-7445.AM2017-5745

Mcl-1 inhibitor suppresses tumor growth of esophageal squamous cell carcinoma in a mouse model.

Esophageal squamous cell carcinoma (ESCC) has a high morbidity in China, accounting for 90% of all esophageal carcinoma cases. Hence, identifying drug targets for prevention and treatment of ESCC is essential. Due to its critical role in the regulation of cell apoptosis, Mcl-1 holds great potential as a target for treatment against ESCC. In current study, we used a 4-nitroquinoline-1-oxide (4-NQO)-induced ESCC mouse model of test whether A-1210477, a Mcl-1 small molecular inhibitor, could repress ESCC development. We showed that A-1210477 treatment decreased ESCC formation and animal weight loss in a dose dependent manner. We detected decreased cellular proliferation in A-1210477-treated ESCC tissue by Ki67 expression. Moreover, A-1210477 treatment increased the number of apoptotic cells in ESCC tissues. Our study clearly demonstrates the contribution of Mcl-1 to ESCC development through promoting cell proliferation and inhibition of apoptosis, and provides a strong evidence for further evaluation of A-1210477 for treating ESCC.

Preliminary study of clinical application on IMRT three-dimensional dose verification-based EPID system.

The three‐dimensional dose (3D) distribution of intensity‐modulated radiation therapy (IMRT) was verified based on electronic portal imaging devices (EPIDs), and the results were analyzed. Thirty IMRT plans of different lesions were selected for 3D EPID‐based dose verification. The gamma passing rates of the 3D dose verification‐based EPID system (Edose, Version 3.01, Raydose, Guangdong, China) and Delta4 measurements were then compared with treatment planning system (TPS) calculations using global gamma criteria of 5%/3 mm, 3%/3 mm, and 2%/2 mm. Furthermore, the dose–volume histograms (DVHs) for planning target volumes (PTVs) as well as organs at risk (OARs) were analyzed using Edose. For dose verification of the 30 treatment plans, the average gamma passing rates of Edose reconstructions under the gamma criteria of 5%/3 mm, 3%/3 mm, and 2%/2 mm were (98.58 ± 0.93)%, (95.67 ± 1.97)%, and (83.13 ± 4.53)%, respectively, whereas the Delta4 measurement results were (99.14% ± 1.16)%, (95.81% ± 2.88)%, and (84.74% ± 7.00)%, respectively. The dose differences between Edose reconstructions and TPS calculations were within 3% for D95%, D98%, and Dmean in each PTV, with the exception that the D98% of the PTV‐clinical target volume (CTV) in esophageal carcinoma cases was (3.21 ± 2.33)%. However, the larger dose deviations in OARs (such as lens, parotid gland, optic nerve, and spinal cord) can be determined based on DVHs. The difference was particularly obvious for OARs with small volumes; for example, the maximum dose deviation for the lens reached (−6.12 ± 5.28)%. A comparison of the results obtained with Edose and Delta4 indicated that the Edose system could be applied for 3D pretreatment dose verification of IMRT. This system could also be utilized to evaluate the gamma passing rate of each treatment plan. Furthermore, the detailed dose distributions of PTVs and OARs could be indicated based on DVHs, providing additional reliable data for quality assurance in a clinic setting.

Genomic analysis of oesophageal squamous-cell carcinoma identifies alcohol drinking-related mutation signature and genomic alterations

Approximately half of the world’s 500,000 new oesophageal squamous-cell carcinoma (ESCC) cases each year occur in China. Here, we show whole-genome sequencing of DNA and RNA in 94 Chinese individuals with ESCC. We identify six mutational signatures (E1–E6), and Signature E4 is unique in ESCC linked to alcohol intake and genetic variants in alcohol-metabolizing enzymes. We discover significantly recurrent mutations in 20 protein-coding genes, 4 long non-coding RNAs and 10 untranslational regions. Functional analyses show six genes that have recurrent copy-number variants in three squamous-cell carcinomas (oesophageal, head and neck and lung) significantly promote cancer cell proliferation, migration and invasion. The most frequently affected genes by structural variation are LRP1B and TTC28. The aberrant cell cycle and PI3K-AKT pathways seem critical in ESCC. These results establish a comprehensive genomic landscape of ESCC and provide potential targets for precision treatment and prevention of the cancer.

Prospective pilot study of adoptive immunotherapy with autologous αβT cells for five cases of advanced and/or recurrent esophageal squamous cell carcinoma

Although several clinical trials of vaccination and cellular immunotherapy for esophageal cancer have been reported, clinical trials of anti-CD3-activated autologous αβT cell therapy for patients with esophageal squamous cell carcinoma are limited. A total of five patients with recurrent esophageal squamous cell carcinoma were enrolled in this prospective pilot study. Peripheral blood mononuclear cells from the patients were cultured with immobilized anti-CD3 antibody and interleukin-2 for approximately 14 days, and 5 × 109 lymphocytes were harvested. Expanded lymphocytes were intravenously infused every 2 weeks for six courses. All patients were followed up until death. The treatment response was assessed by the number of lymphocytes, CD4/CD8 ratio, serum tumor markers, and computed tomography scan. A total of 23 courses of treatment were completed. Three of the five patients (cases 2, 3, and 4) completed six courses of cell therapy according to the protocol. However, case 1 quit treatment after three courses and case 5 quit treatment after two courses because of tumor progression. There were no adverse effects related to cell therapy. Although cases 1 and 5 did not show any treatment benefits, cases 2, 3, and 4 showed some treatment benefits. Cases 2 and 4 showed long-term survived for more than 1 year. These results might suggest the safety and benefits of anti-CD3-activated autologous αβT cell therapy for the part of the patients with esophageal squamous cell carcinoma.

Expressions of HPV 16-E6 in esophageal carcinoma and its clinical significance

Aim: The aim of the study was to explore the association between HPV16-E6 protein and esophageal squamous cell carcinoma.Methods: SP immunohistochemical method was used to examine the expression of HPV 16-E6 in 50 cases of esophageal squamous cell carcinoma, 10 cases of normal esophageal squamous cell and 10 cases of adjacent tissue.Result: The expressions of HPV 16-E6 was significantly higher in esophageal carcinoma than in normal esophageal mucosa and in adjacent tissue. The expressions of HPV 16-E6 had a significant correlation with invasive depth (P<0.05), but not with the patient age, lymph node metastasis and tumor size (P>0.05).Conclusion: HPV 16-E6 can promote the growth and metastasis of esophageal squamous cell carcinoma and can be a prognostic factor of esophageal squamous cell carcinoma.

Nut and peanut butter consumption and the risk of esophageal and gastric cancer subtypes

Background: Nut consumption has been associated with decreased risk of colorectal, endometrial, lung, and pancreatic cancers. Polyphenols, fiber, vitamins, and minerals in nuts may confer this observed protective effect. To our knowledge, no prospective study has evaluated the effect of nut consumption on esophageal and gastric cancers.Objective: The objective was to evaluate the associations between nut and peanut butter consumption and the risk of esophageal and gastric cancers and their different subtypes.Design: In this study we used data from the NIH-AARP Diet and Health Study, which enrolled 566,407 persons who were 50-71 y old at baseline (1995-1996). The median follow-up time was 15.5 y. Intakes of nuts and peanut butter were assessed through the use of a validated food-frequency questionnaire. We used Cox proportional hazard models to estimate HRs and 95% CIs for esophageal and gastric cancers and their subtypes.Results: We identified 966 incident cases of esophageal adenocarcinomas, 323 cases of esophageal squamous cell carcinoma, 698 cases of gastric cardia adenocarcinoma, and 732 cases of gastric noncardia adenocarcinoma. Compared with those who did not consume nuts or peanut butter [lowest category of consumption (C0)], participants in the highest category of nut consumption (C3) had a lower risk of developing gastric noncardia adenocarcinoma [C3 compared with C0, HR: 0.73 (95% CI: 0.57, 0.94)]. This inverse association was also seen for peanut butter consumption [C3 compared with C0, HR: 0.75 (95% CI: 0.60, 0.94)]. We observed no significant associations between the highest and lowest intakes of nuts or peanut butter and the risk of gastric cardia adenocarcinoma, esophageal adenocarcinoma, or esophageal squamous cell carcinoma.Conclusions: Among older American adults, both nut and peanut butter consumption were inversely associated with the risk of gastric noncardia adenocarcinoma. This trial was registered at clinicaltrials.gov as NCT00340015.

The values of pre-operative T staging of potentially resectable esophageal cancer: Blade combining with breath-free radial VIBE

Objective To analyze the value of conventional T2WI combining with breath-hold Cartesian VIBE sequence, and compared with Blade combining with breath-free radial VIBE sequences in pre-operative T staging of potentiallly resectable esophageal carcinoma. Methods Sixty-five cases of esophageal carcinoma were concluded prospectively. All patients had received pathological examination of gastroscope biopsy before MRI. Patients received MR examination, including T2WI, breath-hold VIBE, Blade, and breath-free radial VIBE sequences. Two radiologists with more than five years experiences in the diagnosis of chest, performed T staging in MRIby referring to the the 7th edition of UICC-AJCC TNM classification. The results of MRI T staging and the postoperative pathological T staging were analyzed by χ2 test. Results Sixty-five patients were included. Diagnostic coincidence rates of the preoperative T staging by using conventional T2WI combining with breath-hold Cartesian VIBE sequences and Blade combining with breath-free radial VIBE sequences were 51%(33/65) and 88%(57/65) ,with 32 and 8 cases overstaging or understaging respectively, and the statistical differences were significant(χ2=20.80, P<0.05). The former diagnostic accuracy of esophageal carcinoma in situ, muscularis violation and esophageal fiber membrane were 42%(8/19), 54%(14/26), 55%(11/20), and the latter were 89% (17/19), 88% (23/26), and 85% (17/20). Conclusions Diagnostic coincidence rate of the preoperative T staging by using Blade combining with breath-free radial VIBE sequences is much higher than conventional T2WI combining with breath-hold Cartesian VIBE sequences. Blade combining with breath-free radial VIBE sequences could be used as non-invasive imaging method in preoperative T staging of potentially resectable esophageal carcinoma. Key words: Esophageal neoplasms; Magnetic resonance imaging; Comparative study

Natural History Analysis of 101 Severe Dysplasia and Esophageal Carcinoma Cases by Endoscopy

Objectives. Our research is to realize the natural history from dysplasia to carcinoma and to provide evidence for exploring proper screening intervals. Methods. After the onset endoscopy screening, 2093 of the patients participated in the endoscopic follow-up voluntarily. Totally, 101 severe dysplasia and carcinoma cases, either diagnosed in the first endoscopy without treatment or diagnosed in the second endoscopy, were included in our study. We compared the pathologic results of their two endoscopies and calculate the mean and median progression time. Results. Of the 39 severe dysplasia cases diagnosed by the onset endoscopy, only 8 progressed to carcinoma. For severe dysplasia cases diagnosed by the follow-up endoscopy, mean progression times are 55.0, 49.8, and 38.0 months and median progression times are 43, 56, and 31 months for esophagitis, mild dysplasia, and moderate dysplasia, respectively. For superficial carcinoma cases diagnosed by the second endoscopy, mean progression times are 76.0, 57.4, and 47.0 months and median progression times are 77, 63, and 35 months for mild dysplasia, moderate dysplasia, and severe dysplasia, respectively. Conclusions. Population-based severe dysplasia cases may have much lower carcinoma progression rate than specific-selected ones. The progression time for most enrolled cases seems longer than that of the recent screening protocol recommended.

化学放射線療法が著効した高齢者食道小細胞癌の1例

化学放射線療法が著効した高齢者食道小細胞癌の1例

初診時に脳転移を認めた下咽頭・頸部食道扁平上皮癌の1例

頭頸部癌領域で脳転移を経験する場合，多くは多臓器転移後であるが，稀に初診時から単発性脳転移をきたす場合がある。症例は71歳の男性で，嚥下時痛を主訴に当科を受診した。精査にて下咽頭から頸部食道に進展する扁平上皮癌を認めた。単発性脳転移以外は，他臓器への遠隔転移なく，全身状態良好なため，優先的に開頭腫瘍摘出術を施行。術後3週間目から原発巣に対し化学放射線療法を行った。その後外来化学療法を続け，脳転移や局所の再燃なく，12か月生存中である。初診時から遠隔転移を有する場合，治療選択に難渋することが多いが，条件を満たせば局所よりも優先して脳転移への積極的治療を行う事は，その後のQOLの維持に重要と思われた。

A newly developed continuous zoom-focus endocytoscope.

Background and study aims We report the features of a newly developed endocytoscopy system (ECS), the GIF-Y0074. Patients and methods The GIF-Y0074 offers high-definition resolution with a consecutive increase of magnification to × 500. Using ECS, we observed 32 cases of esophageal squamous cell carcinoma (ESCC), 11 cases of gastric cancer, and five cases of duodenal adenoma. Results The images of cells obtained using the GIF-Y0074 at maximum magnification were brighter and clearer than those obtained with previous ECS systems. For diagnosis of ESCC, clearer visualization of the nucleus made nuclear abnormality easier to recognize. Cancer cells were visualized in 10/11 cases of gastric cancer, but removal of mucus still remained a problem. Duodenal adenomas were found to have atypical cells with villi and tubules at the mucosal surface, thus assisting their histological diagnosis in vivo. Conclusion The GIF-Y0074 is an excellent ECS in terms of ease of use, satisfactory resolution, and magnification power, and therefore achieves a level of utility that makes its commercial release justifiable. This ECS heralds a new era of endoscopic and histological diagnosis.

Treatment and survival outcomes of small cell carcinoma of the esophagus: an analysis of the National Cancer Data Base.

Given the paucity of esophageal small cell carcinoma (SCC) cases, there are few large studies evaluating this disease. In this study, the National Cancer Data Base (NCDB) was utilized to analyze the clinical features, treatment, and survival of patients with esophageal SCC in a large, population-based dataset. We selected patients diagnosed with esophageal SCC from 1998 to 2011. Patients were identified as having no treatment, chemotherapy alone, radiation ± sequential chemotherapy, concurrent chemoradiation, and esophagectomy ± chemotherapy and/or radiation. Overall survival (OS) was analyzed using the Kaplan-Meier method and compared using the log-rank test. Multivariate Cox regression analysis was conducted to identify factors associated with OS. A total of 583 patients were identified. Most patients had stage IV disease (41.7%). Regarding treatment selection, chemoradiation was the most commonly utilized for patients with nonmetasatic disease, whereas chemotherapy alone was most common for metastatic patients. Esophagectomy (median survival 44.9months with 3year OS 50.5%) was associated with the best OS for patients with localized (node-negative) disease compared with chemotherapy alone (p < 0.001) or chemoradiation (p = 0.01). For locoregional (node-positive) disease, treatment with chemoradiation resulted in a median survival of 17.8months and a 3year OS 31.6%. On multivariate analysis, treatment with chemotherapy alone (p = 0.003) was associated with worse OS while esophagectomy (p = 0.04) was associated with improved OS compared to chemoradiation. Esophageal SCC is an aggressive malignancy with most patients presenting with metastatic disease. Either esophagectomy or chemoradiation as part of multimodality treatment appear to improve OS for selected patients with nonmetastatic disease.

Case Report: Metastatic Esophageal Squamous Cell Carcinoma Successfully Treated with Immunotherapy: First Case Report in Thailand.

Metastatic esophageal carcinoma is considered one of the worst prognosis cancersworldwide. The goals of treatment are usually symptoms palliation and possible lifeprolongation. In recent years, the field of immuno-oncology has shown promising treatmentresults and caused a paradigm shift in many types of cancer, as the response is quitelong-lasting. Anti-programmed cell death 1 (anti PD-1) is one of the immuno-oncologydrugs which has been investigated in many types of cancer and currently has beenapproved to be used in melanoma, lung cancer, kidney cancer and bladder cancer. Wereport a case of metastatic esophageal squamous cell carcinoma which had been heavilypretreated but presented an almost complete response to the anti PD-1, pembrolizumab.