Metastatic Esophageal Carcinoma Research Articles

Metastatic Oesophagus Carcinoma Presented with Neck and Arm Pain: A Case Report

Oesophageal carcinoma is among malignancies with poor prognosis due to the late onset symptoms related with large submucosal involvement, early lymphatic metastasis and its multicentric characteristics, majority of the patients decrease within the first year of diagnosis. However, bone metastasis is uncommon and reported to be 1% to 14% in autopsy series. Herein we report a case that was admitted to our outpatient clinics with severe neck and arm pain as presenting symptoms and diagnosed as metastatic oesophageal carcinoma afterwards.

Gastric bypass after liver transplantation

Few data are available for assessing the outcomes of bariatric surgery for patients who have undergone orthotopic liver transplantation (OLT). The University of Minnesota bariatric surgery database and transplant registry were retrospectively reviewed to identify patients who had undergone OLT and then open Roux-en-Y gastric bypass (RYGB) surgery between 2001 and 2009. Comorbidity-appropriate laboratory values, body mass indices (BMIs), histopathology reports, and immunosuppressive regimens were collected. Seven patients were identified with a mean age of 55.4 ± 8.64 years and a mean follow-up of 59.14 ± 41.49 months from the time of RYGB. The mean time between OLT and RYGB was 26.57 ± 8.12 months. The liver disease etiologies were hepatitis C (n = 4), jejunoileal bypass surgery (n = 1), hemangioendothelioma (n = 1), and alcoholic cirrhosis (n = 1). There were 2 deaths for patients with hepatitis C 6 and 9 months after bariatric surgery due to multiple-organ dysfunction syndrome and metastatic esophageal squamous carcinoma, respectively. One patient with hepatitis C required a reversal of the RYGB because of malnutrition and an inability to tolerate oral intake. Four of the 7 patients had type 2 diabetes mellitus (T2DM), 4 had hypertension, and 6 patients had dyslipidemia. All patients were on immunosuppressive medications, but only 4 were on corticosteroids. Glycemic control was improved in all surviving patients with T2DM. The mean BMI was 34.27 ± 5.51 kg/m(2) before OLT and 44.34 ± 6.08 kg/m(2) before RYGB; it declined to 26.47 ± 5.53 kg/m(2) after RYGB. In conclusion, in this case series of patients undergoing RYGB after OLT, we observed therapeutic weight loss, improved glycemic control, and improved high-density lipoprotein levels in the presence of continued dyslipidemia. RYGB may have contributed to the death of 1 patient due to multiple-organ dysfunction syndrome.

Critical Airway Obstruction by Mediastinal Masses in the Intensive Care Unit

Critical airway obstruction is a dreaded complication of a mediastinal mass. The acute management is difficult and catastrophic outcomes have been reported. A total of 19 patients, aged between 13 and 69 years, who had critical major airway obstruction due to mediastinal mass requiring mechanical ventilation were reviewed. Three patients had benign pathologies (retrosternal goitre, bronchogenic cyst, giant left atrium) and three had lymphoma. The remaining patients had advanced malignancies: metastatic mediastinal lymphadenopathy (n=6), thyroid carcinoma (n=1) and oesophageal carcinoma (n=6). Three patients underwent surgery, three received chemotherapy and 15 had airway stenting under deep intravenous sedation. Apart from one patient who had brain haemorrhage and nosocomial infection after cardiac surgery, all other patients were successfully weaned off ventilation within five days after the interventions to alleviate the major airway obstruction without major complications. All patients were discharged from hospital without supplemental oxygen. Patients who had benign pathologies and lymphoma (n=6, 32%) were still alive after a mean follow-up period of six years (range 3 to 10) and those with metastatic disease died after a mean survival period of 3.3 months (range 1 to 9). In summary, critical major airway obstruction is caused by a heterogeneous group of mediastinal pathologies, and the definitive treatment and long-term prognosis of these patients are highly dependent on the underlying aetiology. Combining various therapeutic modalities can lead to successful separation of these patients from mechanical ventilation within a short period of time.

Palliative concurrent chemoradiotherapy in locally advanced and metastatic esophageal cancer patients with dysphagia.

Dysphagia is the most common and serious symptom in patients with esophageal cancer. Several management options have been developed to palliate dysphagia in unresectable and metastatic esophageal carcinoma patients. The aim of this prospective study was to evaluate the efficacy and toxicity of palliative chemoradiotherapy in locally advanced and metastatic esophageal cancer as regard improvement of dysphagia, primary tumor response and survival time. This prospective study was conducted on 25 patients with advanced and metastatic esophageal carcinoma. A radiation dose of 40 Gy/22 fractions was given concomitantly with chemotherapy, consisted of cisplatin 70 mg/m2 infusion on day 1, plus continuous infusion of 5-fluorouracil at 700 mg/m2 per day from day 1 to day 4. Dysphagia improved in 18 (72%) of the 25 patients. The median duration of dysphagia improvement was 5 months after treatment in these patients. Overall, treatment was well tolerated; acute haematologic toxicities were limited, with anaemia (80%) the commonest. The most common non-haematologic toxicity was esophagitis. There were no reports of grade IV toxicities. The activity of the concurrent chemoradiotherapy regimen was good, achieving incomplete response in 18 patients (72%), 5 patients showed stable disease (20%) and 2 patients showed progressive disease (8%). The median overall and progression free survival were 7 and 4 months, respectively. Our study showed that palliative concurrent chemo-radiotherapy is an effective and well tolerated treatment for dysphagia in patients with advanced and metastatic esophageal carcinoma.

Case of childhood laryngeal papillomatosis with metastatic carcinoma esophagus in adulthood

A young male patient was diagnosed to have laryngeal papillomas at the age of 3 years for which he underwent permanent tracheostomy and also multiple surgical and laser excision procedures. Then, later in life, the patient had progressive breathlessness and dysphagia. On examination, he had supraclavicular lymphadenopathy showing squamous carcinoma pathology. Since laryngeal papillomas have a high propensity to transform into laryngeal squamous cell carcinoma, he was first evaluated for laryngeal carcinoma which was negative. Esophagoscopy showed a growth in the esophagus, the biopsy of which was positive for squamous malignant cells. Patient was then started on palliative chemotherapy with combination of paclitaxel and carboplatin, and at progression with weekly nanoxel with stable disease. This is a rare case of childhood laryngeal papillomatosis progressing to metastatic esophageal carcinoma. This case has been presented to highlight the fact that patients with laryngeal papillomas are not only at high risk of progressing to laryngeal carcinoma but can also have other malignancies of the upper aerodigestive tract and lung. Most of them have been correlated to human papilloma virus (HPV), but in our patient HPV DNA was negative.

Involvement of CXCR4 Chemokine Receptor in Metastastic HER2-Positive Esophageal Cancer

A functional linkage of the structurally unrelated receptors HER2 and CXCR4 has been suggested for breast cancer but has not been evaluated for esophageal carcinoma. The inhibition of HER2 leads to a reduction of primary tumor growth and metastases in an orthotopic model of esophageal carcinoma. The chemokine receptor CXCR4 has been implicated in metastatic dissemination of various tumors and correlates with poor survival in esophageal carcinoma. The aim of this study was to investigate a correlation between the expression levels of HER2 and CXCR4 and to evaluate the involvemnent of CXCR4-expression in HER2-positive esophageal carcinoma. The effects of HER2-inhibition with trastuzumab and of CXCR4-inhibition with AMD3100 on primary tumor growth, metastatic homing, and receptor expression were evaluated in vitro and in an orthotopic model of metastatic esophageal carcinoma using MRI for imaging. The clinical relevance of HER2- and CXCR4-expression was examined in esophageal carcinoma patients. A significant correlation of HER2- and CXCR4-expression in primary tumor and metastases exists in the orthotopic model. Trastuzumab and AMD3100 treatment led to a significant reduction of primary tumor growth, metastases and micrometastases. HER2-expression was significantly elevated under AMD3100 treatment in the primary tumor and particularly in the metastases. The positive correlation between HER2- and CXCR4-expression was validated in esophageal cancer patients. The correlation of CXCR4- and HER2-expression and the elevation of HER2-expression and reduction of metastases through CXCR4-inhibition suggest a possible functional linkage and a role in tumor dissemination in HER2-positive esophageal carcinoma.

Small Bowel Obstruction: A Unique Presentation of Metastatic Esophageal Carcinoma

Introduction: Esophageal cancer is known to metastasize to various organs, but its initial presentation as a small bowel obstruction (SBO) appears to be a unique occurrence. We report the case of a patient who presented with an SBO and further work up identified metastatic esophageal squamous cell carcinoma as its likely source. Case Report: A frail 77-year-old male presented with a two-week history of progressive abdominal discomfort. He denied recent vomiting, diarrhea, or GI bleeding, and he initially reported no dysphagia. He was a life-long smoker with a medical history of anemia with recent transfusion, and diverticulosis. His surgical history included an appendectomy, a left inguinal hernia repair, and a left upper extremity amputation secondary to infection from a brown recluse spider bite. Except for a hemoglobin level of 8.6 g/dL, the patient's lab values were relatively unremarkable. His abdomen was softly distended, and without appreciable masses or significant tenderness. An abdominal CT scan, however, showed a high-grade bowel obstruction. Conservative management failed to relieve the patient's worsening symptoms. He then underwent an exploratory laparotomy and an obstructive mass with adhesions necessitated the resection of approximately 12 cm of small bowel. Microscopic examination of the resected specimen identified poorly differentiated carcinoma with squamous differentiation. A subsequent CT of chest revealed a 2.7 × 1.6 cm mid-esophageal mass along with left axillary lymphadenopathy. Upon further questioning, the patient stated he had experienced mild dysphagia and some weight loss over a few months prior to his presentation. The patient thereafter underwent an EGD that demonstrated an ulcerative lesion at the mid esophagus. Biopsies confirmed invasive squamous cell carcinoma as the source of both the primary malignancy and the small bowel obstruction. Discussion: It is rare for metastases to the small bowel to present with clinically significant symptoms. In fact, they are often merely a finding on autopsy. Even more unusual are intestinal metastases as the causative agent of an SBO prior to an established diagnosis of the primary cancer. In this unique case, our patient arrived at the hospital, not with dysphagia suggesting esophageal cancer, but with typical SBO symptoms. Thus, the metastatic lesion of undiagnosed esophageal carcinoma first presented as a symptomatic obstruction of the small bowel. Consequently, while there are of course more common causes, it is still prudent to keep in mind metastatic disease in the evaluation of intestinal obstruction, even in the absence of established diagnosis of a primary cancer.

Differences in sensitivity to tumor-specific CTLs between primary and metastatic esophageal cancer cell lines derived from the same patient

MHC antigens and adhesion molecules, such as the intracellular adhesion molecule (ICAM-I), play an important role in cellular immune response. We examined the expression patterns of these molecules in both primary and metastatic esophageal carcinoma cells from the same patient and evaluated the cellular immune responses against these cells. In the esophageal cancer patient (H122), tumor cell lines were established from primary and subcutaneous metastatic lesions. We compared the expression of cell surface molecules on the metastatic tumor cell line (H122SC) with that on the primary tumor cell line (H122ESO) using flow cytometry. Moreover, we analyzed the differences in cellular immune responses against these cell lines, which expressed similar levels of the Tara antigen, using the Tara antigen-specific CTL clone. H122SC ICAM-1 expression was significantly lower in H122ESO, and the Tara antigen-specific CTL clone produced lower levels of TNF in response to H122SC than H122ESO. ICAM-1 transfection into the H122SC rendered these cells as sensitive to the CTL clone as the H122ESO. The metastatic tumor cells displayed lower regulated ICAM-1 expression levels and were less sensitive to specific CTLs. ICAM-1 downregulation may be one mechanism by which tumor cells escape immunologic surveillance.

Palliative Chemotherapy Does Not Improve Survival in Metastatic Esophageal Cancer

Background: The role of chemotherapy in metastatic esophageal carcinoma (MEC) remains a matter of debate. The aim of this retrospective study was to analyze the survival impact of chemotherapy after stratification for prognostic factors. Methods: Consecutive patients with MEC (1995 to 2008) were randomly assigned to a development (n = 171) and a validation cohort (n = 113). We had first identified prognostic factors using the Kaplan-Meier and Cox methods in the development cohort and then validated them in the validation cohort. Then, we analyzed the impact of chemotherapy after stratification for these prognostic factors. The majority of patients had squamous cell carcinoma (80%). Results: The Cox model has retained 2 prognostic factors only: associated cancers (hazard ratio = 2.77, range 1.39–5.54, p = 0.004) and grade 3–4 dysphagia (hazard ratio = 1.44, range 1.08–2.14, p = 0.007). Median survival was 10.9 in patients with 0 (n = 77), 6.2 in those with 1 (n = 65) and 1.8 months in those with 2 prognostic factors (n = 11/171; p = 0.025). The median survival times of the patients with 0, 1 and 2 prognostic factors were 13 versus 9 months (nonsignificant, NS), 6 versus 5 months (NS) and 5 versus 1.3 months (NS) in patients with and without chemotherapy, respectively. Conclusion: Our data suggest that chemotherapy has no significant effect on survival for unselected MEC patients, regardless of the prognostic factors we identified.

Effective Therapeutic Targeting of the Overexpressed HER-2 Receptor in a Highly Metastatic Orthotopic Model of Esophageal Carcinoma

This study aimed to determine the targeted efficacy of trastuzumab (Herceptin) on human epidermal growth factor receptor 2 (HER-2)-overexpressing metastatic esophageal cancer in an orthotopic mouse model. HER-2 overexpression and amplification of human esophageal primary and metastatic tumors were shown with HER-2-fluorescence in situ hybridization analysis and HER-2 immunostaining. Following orthotopic implantation with the HER-2-overexpressing OE19 human esophageal cancer cell line, mice were treated with trastuzumab. Sequential magnetic resonance imaging was used to monitor primary tumor and metastasis during treatment. After six weeks, a significant inhibition of primary tumor development was imaged in trastuzumab-treated animals in comparison with the control group. Trastuzumab treatment also led to a reduction of lymphatic metastasis. Thus, HER-2 targeted therapy with trastuzumab resulted in a significant primary tumor growth reduction as well as a decrease of lymph node metastases in the orthotopic model of metastatic esophageal carcinoma. The results of the present study suggest the clinical use of trastuzumab for HER-2-overexpressing esophageal cancer, which is a significant fraction of the patient population. Treatment of this highly treatment-resistant disease with trastuzumab in the adjuvant setting to prevent lymph node metastasis after primary tumor resection is suggested by the data in this report.

Esophageal Metastasis From Occult Lung Cancer

A 66-year-old man with dysphagia was found to have a poorly differentiated esophageal carcinoma by incision biopsy. Following esophagectomy, reconstruction with a gastric tube was performed. Pathological examination and immunohisto-chemistry showed infiltration of adenocarcinoma cells with positive thyroid transcription factor 1-staining in the submucosal layer, which indicated metastatic esophageal carcinoma. Although no pulmonary lesion could be visualized by imaging or bronchoscopy, pulmonary origin was highly suspected as a result of positive thyroid transcription factor 1-staining. To the best of our knowledge, this is the first reported case of metastatic esophageal carcinoma from occult lung cancer (AJCC TNM stage TX).

Phase II study of 5-fluorouracil/leucovorin in combination with paclitaxel and oxaliplatin (POF) in patients with primary refractory or relapsed advanced oesophageal and gastric carcinoma.

4157 Background: Primary results of POF as 1st-line treatment for AGC have been presented at ASCO 2008. The purpose of this study was to assess the efficacy and toxicity of POF in primary refractory or relapsed locally advanced or metastatic oesophageal and gastric carcinoma. Methods: From February 2006 to May 2009, 34 eligible patients were enrolled in this study. All had received one line of chemotherapy, and 4 had received at least two lines of chemotherapy. The median treatment-free interval was 40.0 days, and twenty-five patients (73.5%) had suffered cancer progression within 90 days after the withdrawal of previous chemotherapy. Twenty-eight patients (82.4%) had previously received a fluoropyrimidine agent. Twenty-six patients (76.5%) had previously received a platinum agent. Thirteen patients (38.2%) had previously received a taxane agent. Seven patients (20.6%) had previously received an irinotecan agent. The POF regimen was comprised of a 3-hour infusion of 135 mg/m2 of paclitaxel followed by oxaliplatin 85 mg/m2 and leucovorin 400 mg/m2, administered simultaneously as a 2-hour infusion, then continued a 46-hour infusion of FU 2.4 g/m2 using an ambulatory pump. Results: A total of 183 cycles of POF were administered with a median of 4 (range 1- 15) cycles. The median patient age was 53 years (range, 37 to 74 years), 25 were males and 9 were females. Twenty-four patients had measurable lesions. Four CRs, nine PRs and nine SDs were observed. At a median follow-up of 623 days, the median survival was 236 days. Frequent grade 3 to 4 toxicities were: neutropenia (38.2%), anaemia (23.5%), thrombocytopenia (17.6%), hepatic dysfunction (8.8%), stomatitis (5.9%), peripheral neuropathy (2.9%), lethargy (2.9%). No treatment-related death occurred. Conclusions: POF regimen is active as second-line chemotherapy in chemotherapy-resistant advanced or metastatic oesophageal and gastric carcinoma. The toxicity profile is moderate. No significant financial relationships to disclose.

Chemotherapy for metastatic carcinoma of the esophagus and gastro-esophageal junction

More than 50% of patients with esophageal cancer have metastatic disease at presentation. The use of chemotherapy for this patient group is increasing with the intention of local and distant tumor control, improving quality of life and prolongation of survival. To assess the effectiveness of a) chemotherapy versus best supportive care or b) different chemotherapy regimes against each other, in metastatic esophageal carcinoma. Trials were identified by searching MEDLINE 1950- November week 3 2008, Central (Cochrane Library 4th Quarter 2008), Embase 1980 - 2008 week 50. We did not confine our search to English language publications. Searches in all databases were updated in February 2005, February 2006 and December 2008.The Cochrane Highly Sensitive Search Strategy for identifying randomized trials in MEDLINE, Sensitivity maximising version; Ovid format was combined with the following search terms to identify RCTs in MEDLINE. The MEDLINE search strategy was adapted for use in the other databases searched. Members of the Cochrane UGPD Group, and experts in the field were contacted and asked to provide details of outstanding clinical trials and any relevant unpublished materials. Randomized controlled trials comparing chemotherapy versus best supportive care, or different chemotherapy regimes against each other in patients with metastatic carcinoma of the esophagus or gastro-esophageal junction. Two authors (MYVH/EJK) extracted data and assessed trial quality. Study authors were contacted to obtain subgroup results of patients with metastatic esophageal carcinoma. Only two RCTs with a total of 42 participants compared chemotherapy with best supportive care for metastatic esophageal cancer. No survival benefit was shown for chemotherapy treatment in these RCTs. Five RCTs with a total of 1242 participants compared different chemotherapy regimes. Due to variation in patient population and chemotherapy regimes, it was not possible to perform a formal pooled analysis. There was no consistent benefit of any specific chemotherapy regimen. There is a need for well designed, adequately powered, phase III trials comparing chemotherapy versus best supportive care for patients with metastatic esophageal cancer. Chemotherapy agents with promising response rates and tolerable toxicity are cisplatin, 5-fluorouracil (5-FU), paclitaxel and antracyclins. Future trials comparing palliative treatment modalities should assess quality of life with validated quality of life measures.

Randomised, non-comparative phase II study of weekly docetaxel with cisplatin and 5-fluorouracil or with capecitabine in oesophagogastric cancer: the AGITG ATTAX trial

Background:Docetaxel administered 3-weekly with cisplatin and 5-fluorouracil leads to better survival than does standard therapy in patients with oesophagogastric cancer, but leads to high rates of haematological toxicity. Weekly docetaxel is associated with less haematological toxicity. This randomised phase II study tested weekly docetaxel-based combination chemotherapy regimens, with the aim of maintaining their activity while reducing toxicity.Methods:Patients with histologically confirmed metastatic oesophageal or gastric carcinoma were randomised to receive weekly docetaxel (30 mg m−2) on days 1 and 8, cisplatin (60 mg m−2) on day 1, and 5-fluorouracil (200 mg m−2 per day) continuously, every 3 weeks (weekly TCF, wTCF); or docetaxel (30 mg m−2) on days 1 and 8 and capecitabine (1600 mg m−2 per day) on days 1–14, every 3 weeks (weekly TX, wTX).Results:A total of 106 patients were enrolled (wTCF, n=50; wTX, n=56). Response rates, the primary end point, were 47% with wTCF and 26% with wTX. Rates of febrile neutropenia were low in each arm. Median progression-free and overall survival times were 5.9 and 11.2 months for wTCF and 4.6 and 10.1 months for wTX, respectively.Conclusion:Weekly TCF and TX have encouraging activity and less haematological toxicity than TCF administered 3-weekly. Weekly docetaxel-based combination regimens warrant further evaluation in this disease.

Vascular endothelial growth factors and their receptors in the novel human cell line, HN-Eso-1, established from esophageal spindle cell carcinoma

Human carcinosarcomas of esophagus are uncommon malignant neoplasms that are composed both carcinomatous and sarcomatous components. We established a novel cell line, HN-Eso-1, from the metastatic esophageal spindle cell carcinoma (so-called carcinosarcoma). In this study, we estimated the vascular endothelial growth factors (VEGFs) and VEGF receptors (VEGFRs). Reverse transcription polymerase chain reaction (RT-PCR) studies revealed that VEGF-A, -C, -D and VEGFR-1, -2 were upregulated. Cisplatin reduced the cell viability of HN-Eso-1 cells and VEGF attenuated its effect. These results suggest that expression of VEGF-A, VEGF-C, VEGF-D, VEGFR-1, and VEGFR-2 are involved in the cell's autocrine system and that VEGF protected these cells from the anti-tumor agent.

Phase I dose-escalating study of PM02734 in a 24-hour infusion schedule every 21 days in advanced solid tumors

2511 Background: PM02734 is a chemically synthesized depsipeptide with a broad spectrum of activity against solid tumors in vitro (breast, colon, lung, neuroblastoma, prostate, sarcoma and thyroid) and in vivo (breast, prostate, melanoma); as well as an acceptable non-clinical toxicology profile. Methods: Patients (pts) with metastatic or advanced solid tumors were enrolled in a phase I, open-label, dose-escalating study to assess safety, tolerability, pharmacokinetics (PK), and to identify the dose limiting toxicity (DLT) and recommended dose (RD) of PM02734 infused over 24 hours every 21 days (d). The starting dose was 0.48 mg/m2. Cohorts of 1–6 pts were treated at different dose levels. Results: Thirty seven pts were treated in this study. The median age was 55 years (40–75), sex: males/females 20/19. The median PS was 1 (range 0–2). The most frequent cancer types were colon/ gastric/ sarcoma (n=8/5/5). Most patients were heavily pretreated, with a median of prior therapy lines of 4 (1–12). Patients were treated at 8 dose levels (0.48, 0.72, 1.0, 1.6, 2.4, 3.6, 5.4, and 6.8 mg/m2), the MTD was 6.8 mg/m2 and the RD was 5.4 mg/m2 (10 mg flat dose).Common toxicities grade ≤ 2 included asthenia, nausea/emesis, lymphopenia, injection site reactions and asymptomatic elevated transaminases (TAs). DLT were grade 3 asymptomatic, reversible TA elevations at 6.8 mg/m2. Preliminary PK data is characterized by long half life (>100 h), a wide distribution and high inter-patient variability. Clearance was not correlated with dose or body surface area (BSA), therefore, flat dose was implemented and the RD was explored with this schedule. Efficacy data showed one complete response (CR) of +28 months observed in a pt with metastatic large cell esophageal carcinoma, and five more showed stable disease (SD) for more than 3 months in different histologies. Conclusions: PM02734 shows to be safe, well tolerated and with evidence of activity (1 CR and 5 SD > 3 months) in pts with advanced solid tumors. The DLT was grade 3 asymptomatic and reversible TA elevations, and the RD for further phase II studies is 10 mg. [Table: see text]

Response to Oxaliplatin with Cetuximab in Minor Salivary Gland Adenoid Cystic Carcinoma

Esophageal localization of adenoid cystic carcinoma of minor salivary glands is rare; it may occur in the early to mid-sixties' age group and is more frequently encountered in men than women. In the majority of cases, it arises from subepithelial glands of the middle to lower third of the esophagus, a similar distribution as squamous cell carcinoma. Prognosis depends mostly on tumor staging and resectability, which represents the only chance of cure. Due to the extreme rarity of this condition, there is limited experience with systemic therapy for advanced disease. We report a case of a patient with metastatic primary esophageal adenoid cystic carcinoma progressing on platinum- and irinotecan-based regimens, who achieved an objective response with oxaliplatin-based chemotherapy in combination with cetuximab.

Phase II evaluation of nedaplatin and paclitaxel in patients with metastatic esophageal carcinoma

To evaluate the efficiency and toxicities of nedaplatin and paclitaxel in patients with metastatic carcinoma of the esophagus. Thirty-nine untreated patients with confirmed metastatic tumors were enrolled. Patients were treated with nedaplatin 80 mg/m(2) and paclitaxel 175 mg/m(2) on day 1. Treatment was repeated every 21 days. Thirty-six patients were eligible to be evaluated to have had a response. The overall response rate was 43.6% (17/39), with complete response and partial response rates of 2.6 and 41%, respectively. The median progression-free survival and overall survival time was 6.1 and 10.3 months, respectively. Grade 3/4 toxicities were only observed in six patients [neutropenia in three patients (7.7%) and nausea/vomiting in three patients (7.7%)]. Comparing to other regimens, combination of nedaplatin and paclitaxel achieved an encouraging clinical outcome, with relatively minimal toxicities for patients with metastatic esophageal carcinoma.

Acrokeratosis Paraneoplastica (Bazex’ Syndrome) Associated With Metastatic Squamous Cell Esophageal Carcinoma

Acrokeratosis Paraneoplastica (Bazex’ Syndrome) Associated With Metastatic Squamous Cell Esophageal Carcinoma

Re: Metastatic oesophageal carcinoma presenting in a finger

Re: Metastatic oesophageal carcinoma presenting in a finger