Epidermoid Carcinoma Of Esophagus Research Articles

Chemoradiotherapy Alone as the Standard Treatment of Epidermoid Esophageal Carcinoma

Objectives: Surgery has traditionally been the treatment of choice for patients with potentially resectable esophageal carcinoma. Recently, however, definitive chemoradiotherapy (CRT) has been suggested as a preferred treatment modality. In this study, CRT results with or without surgery are compared. Methods: A total of 986 patients of esophageal carcinoma were categorized into two groups depending on the treatment: surgery (675 patients) or CRT (311 patients). These two groups were compared based on age, sex, weight loss, tumor location and length, tumor shape, grade, stage, delay in receiving treatment, event-free survival (EFS) and overall survival (OS). Results: Patients in the CRT arm were significantly older (p = 0.01), had a more significant adenocarcinoma histology (p = 0.015), upper esophageal carcinoma (p = 0.0001) and more advanced stages of the disease (p = 0.0001). The median EFS for the surgery group was 24.5 months [95% confidence interval (CI), 17–32] versus 22.5 months (95% CI, 16.7–28.2) for the CRT arm (p = 0.56). The mean OS was 59.25 months (95% CI, 53.8–64.7) for the surgery group compared to 58.77 months (95% CI, 50.9–66.6) for the CRT group (p = 0.78). Conclusion: Definitive CRT is effective enough so as to consider omitting surgery and could be used as a standard treatment for patients with esophageal carcinoma.

Tratamento endoscópico do câncer epidermóide do esôfago

In this article, it was evaluated the role of endoscopic procedures for the management of squamous cell esophageal cancer. Relevant publications cited at PubMed database in the last 10 years were analyzed and compared with the experience developed at the Gastrointestinal Endoscopy Division of the Department of Gastroenterology of the University of São Paulo School of Medicine. Mucosectomy and advanced tumor tunnelization were the most important developments in that area. Endoscopic mucosal resection of early epidermoid cancer of the esophagus is indicated when the lesion is confined to the epithelium (m1) or to the lamina propria (m2). The described 5-year survival rate after endoscopic mucosal resection of intramucosal epidermoid tumor of the esophagus approaches 95%. Based on the available evidence, it seems reasonable to indicate endoscopic mucosal resection as a first-choice treatment for patients with intramucosal epidermoid esophageal carcinoma. There are a variety of endoscopic palliative methods for dysphagia relief in advanced esophageal cancer. The choice will vary according to the anatomical features and location of the tumor, patient preferences, local and expertise availability. The technical success rate for placement of metal stents across the malignant stenosis is close to 100%. The rate of long-term palliation of dysphagia approaches 80% which makes expandable metal stents the treatment of choice for palliation of obstructive symptoms caused by advanced squamous cell cancer of the esophagus.

Cribado del carcinoma escamoso de esófago en población de riesgo

Together with adenocarcinoma, epidermoid esophageal carcinoma is the most clinically important neoplasm of the esophagus. Because of the low incidence of epidermoid esophageal carcinoma in the general population, strategies for its early diagnosis are not a priority compared with other neoplasms. However, because survival is low when the disease is diagnosed in symptomatic patients (less than 20% at 5 years), methods for its early diagnosis should be investigated. The use of cytology or Lugol chromoendoscopy in countries with a high incidence of epidermoid carcinoma or in individuals at increased risk (mainly alcoholics and smokers) has allowed early diagnosis and potentially curative treatment, substantially increasing life expectancy in this group of patients. These results should stimulate the evaluation and eventual implementation of programs to achieve early diagnosis and therefore greater survival in patients with epidermoid esophageal carcinoma in Western countries.

Preoperative radio-chemotherapy versus surgery in the treatment of epidermoid esophageal carcinoma

Preoperative radio-chemotherapy versus surgery in the treatment of epidermoid esophageal carcinoma

Interphase Cytogenetics of Gastric and Esophageal Adenocarcinomas

Numerical changes affecting chromosomes 1, 2, 3, 4, 6, 7, 8, 10, 11, 12, 16, 17, 18, and the X and Y chromosomes have been analyzed using chromosome-specific centromeric alpha-satellite repeat DNA probes in a panel of biopsies of six gastric and three esophageal adenocarcinoma and one epidermoid carcinoma of esophagus obtained at surgery. For each case, with each probe, the number of hybridization signals were determined in 200 nuclei. Hybridization of each probe to phytohemagglutinin-stimulated normal peripheral blood lymphocytes served as controls. Monosomy was defined by loss of one signal in 15% or more cells and trisomy or tetrasomy was defined by the presence of 3 or 4 signals in 7% or more cells, respectively. The Y chromosome was lost in 6 of 8 cases and monosomy 10 was seen in 5 of 10 cases. Trisomy for chromosomes 17, 8, 7, 12, 11, and 1 was seen in 4 of 10, 4 of 10, 4 of 10, 2 of 10, 2 of 8, and 2 of 10 cases, respectively, and tetrasomy for chromosome 7 was seen in 1 of 10 cases. These data show that the Y chromosome and chromosomes 10, 8, 7, 17, and 12 are most frequently involved in nondisjunctional changes in these tumors. They also document the feasibility and utility of interphase cytogenetics of gastric adenocarcinomas.

Vinorelbine (Navelbine ®) is an active drug in metastatic epidermoid esophageal carcinoma (MEEC)

Vinorelbine (Navelbine ®) is an active drug in metastatic epidermoid esophageal carcinoma (MEEC)

Intermediate-dose methotrexate and cisplatin in the treatment of advanced epidermoid esophageal carcinoma. Response rate and disease-free survival

Seventeen patients with inoperable locoregional disease (epidermoid carcinoma of the esophagus) were treated only with two courses of intermediate-dose methotrexate (200 mg/m2 on day 1) and cisplatin (20 mg/m2/d for 5 days). According to the response criteria, 14 (82.4%) achieved a good response (GR) and 3 (17.6%) showed no response (NR). The median recurrence-free survival time was 5 months (range, 2 to 16 months) in seven patients with regular follow-up. Three patients are still alive and disease-free at 37+, 44+, and 51+ months. No patient received radiotherapy or surgery after chemotherapy until recurrence. This combination schedule appears to be effective in advanced esophageal carcinoma.

Anterior chemotherapy in esophageal cancer.

Front loading chemotherapy using methotrexate (200 mg/m2) alone or methotrexate (200 mg/m2) with cisplatin (20 mg/m2 daily for 5 days) was used in epidermoid carcinoma of esophagus. Evaluation after two courses showed objective response of 50% or greater in 48% of patients with methotrexate alone. Response rate was increased to 76.2% with addition of cisplatin to methotrexate. Small lesions (less than 10 cm) showed better response as compared to advanced cases. Therapy was generally well tolerated and good palliation was obtained even after the first course. Postchemotherpy treatment either with surgery or radiotherapy was tolerated without any major complications. The data confirm the short-term usefulness of initial chemotherapy with methotrexate and cisplatin in esophageal cancer. Results of prolonged follow-up will help to evaluate the role of front loading chemotherapy on long-term survival.