Persistent Esophageal Cancer Research Articles

Modern approaches to esophageal squamous cell carcinoma therapy: paradigm shift?

Esophageal cancer (EC) is one of the most aggressive malignant neoplasms, ranking sixth among oncological causes of death. According to GLOBOCAN, more than half a million people die from this disease every year, and by 2040 this indicator is expected to increase almost twice. In most patients, esophageal cancer is diagnosed at stages III–IV of the disease. Currently, the standard of treatment for inoperable patients with EC is simultaneous chemoradiotherapy.One of the main methods of treatment of patients with non-metastatic esophageal lesion remains surgical intervention in the volume of esophagectomy with radical lymph dissection, accompanied by quite frequent serious postoperative complications. However, the results of surgical treatment of locally advanced esophageal cancer alone remain unsatisfactory, and the fiveyear survival rate is less than 20 %. In order to improve the oncological results of treatment, various combinations of drug and radiation therapy are used (preoperative chemotherapy or chemoradiotherapy, independent chemoradiotherapy). To date, recommendations for the treatment of locally advanced esophageal cancer vary from country to country. Trimodal therapy (preoperative chemoradiotherapy up to TFD – 46 Gy with 5 cycles of weekly chemotherapy according to the carboplatin + paclitaxel scheme followed by surgical treatment) is the standard in operable patients with non-metastatic squamous cell carcinoma of the esophagus in our and European countries. In Asian countries, preference is given to neoadjuvant chemotherapy, based on the data of the JCOG1109 (NExT) study, in which it was shown that the addition of docetaxel to neoadjuvant therapy with cisplatin and fluorouracil is accompanied by an improvement in overall survival and acceptable toxicity, compared with the CF regimen and chemoradiotherapy. A separate issue is the place of lifesaving esophagectomy in patients who have received a course of radical chemoradiotherapy. Unfortunately, according to several researchers, recurrent or persistent esophageal cancer remains an urgent problem with a risk of relapse of the disease in up to 60 % of cases.We have studied the data of the Russian and global literature concerning the treatment of squamous cell carcinoma of the esophagus.

Endoluminal high-dose-rate brachytherapy for locally recurrent or persistent esophageal cancer

PurposeManagement of locally recurrent or persistent esophageal cancer (EC) after standard chemoradiation is challenging. This study updates our experience of treating medically inoperable EC patients with endoluminal high-dose-rate brachytherapy (EHDRBT) including the patients treated with a novel multiballoon channel centering esophageal applicator. Methods and MaterialsThirty-three consecutive patients with early-stage primary (n = 7), posttreatment persistent (n = 7), and recurrent (n = 19) EC treated with EHDRBT at our institution were included. Median dose and treatment lengths were 14 Gy (range 10–17.5 Gy) and 6 cm (3.5–9.0 cm), respectively. Endoscopy and biopsy were performed 3 months after EHDRBT and then every 3–6 months thereafter. ResultsMedian followup was 17.4 months (range 5.0–88.3). Grade 1 and 2 toxicities were observed in 13 (44.8%) and 11 (37.9%) patients, respectively. Grade 3 toxicity (tracheoesophageal fistula) was observed in 1 patient who had previously received two courses of external beam radiotherapy as well as a stent insertion. Median overall survival (OS) for entire cohort was 20.9 months, and 1-year OS was 78%. Complete response was achieved in 58.6% of patients with median time to failure and 1-year disease-free survival of 10.3 months (range 5.4–28.2) and 27%, respectively. ConclusionsFor medically inoperable patients with early-stage primary or local posttreatment residual or recurrent EC, EHDRBT is a well-tolerated treatment option with minimal Grade ≥3 toxicity. Brachytherapy in our hands continues to be a safe treatment option. Although 58.6% of patients achieved a complete response and the OS of this cohort is relatively good, long-term local control and cure remains a challenge.

Safety of stent placement in recurrent or persistent esophageal cancer after definitive chemoradiotherapy: a case series

The prognosis of patients with esophageal cancer is dismal. More than 50% of patients receive diagnoses of incurable disease because of metastasis or locally advanced disease at the time of presentation.1 In recent years, definitive chemoradiotherapy (CRT) has proved to be a curative alternative both in patients with unresectable locally advanced (T4) carcinoma and in patients who are unfit for operation because of comorbidity.2-4 However, failure of treatment is frequently observed in the long term, with a 5-year survival of around 25%.

Multimodal Approaches Including Three-dimensional Conformal Re-irradiation for Recurrent or Persistent Esophageal Cancer: Preliminary Results

The purpose of this study was to assess the toxicity and efficacy of multimodal approaches, including three-dimensional conformal re-irradiation, for patients with recurrent or persistent esophageal cancer after radiotherapy. Thirty-one patients with esophageal cancer treated with three-dimensional conformal re-irradiation were retrospectively analyzed. Of the 31 patients, 27 patients received concurrent chemotherapy, and 14 patients underwent regional hyperthermia during the re-irradiation. We divided the patients into two groups on the basis of their clinical condition: the curative group (n = 11) or the palliative group (n = 20). Severe toxicities were detected in one patient with Grade 3 esophageal perforation in the curative group, and 5 patients had a Grade 3 or higher toxicity of the esophagus in the palliative group. Advanced T stage at the time of re-irradiation was found to be significantly correlated with Grade 3 or higher toxicity in the esophagus. For the curative group, 10 (91%) of 11 patients had an objective response. For the palliative group, symptom relief was recognized in 8 (57%) of 14 patients with obvious swallowing difficulty. In conclusion, in the curative group with early-stage recurrent or persistent esophageal cancer, the multimodal approaches, including three-dimensional conformal re-irradiation, may be feasible, showing acceptable toxicity and a potential value of promising results, although further evaluations especially for the toxicities of the organs at risk are required. In the palliative group, the benefit of our therapy may be restrictive because severe esophageal toxicities were not uncommon in the patients with advanced T stage at the time of re-irradiation.

Salvage photodynamic therapy for persistent esophageal cancer after chemoradiation therapy

Locally advanced esophageal cancer may not be completely eradicated after chemoradiation therapy (CRT) and further treatment options are limited. Since 1998, we have used porfimer sodium photodynamic therapy (PDT) for inoperable patients with persistent mucosal carcinoma after CRT. Seven patients have undergone PDT after CRT: median age 75 (range 68-85), four patients male, three patients female. After upper endoscopy with biopsies documented neoplasm after CRT, patients were evaluated with contrast-enhanced computed tomography of the chest and abdomen as well as endoscopic ultrasound to confirm persistence/recurrence of only mucosal disease. Two patients had squamous carcinoma while five patients had Barrett's adenocarcinoma (Barrett's median segment length=8cm; range 5-10cm). PDT was performed after infusion of 2mg/kg porfimer sodium using a median light dose of 150J/cm (range 100-200) using the bare fiber method. After PDT, all patients developed strictures requiring dilation (median number of dilations required=5, range 1-18). These patients have subsequently been followed with endoscopy every 3-6 months (mean follow up=30 months, range 12-50 months). After an initial response, the two patients with squamous cell carcinoma have subsequently been found to have recurrent disease and are being treated with erlotinib. The other five patients treated for Barrett's carcinoma have remained disease free although one had died 33 months from metastatic colon cancer. In selected patients, PDT may be useful in the treatment of persistent/recurrent mucosal esophageal cancer after incomplete response to CRT.

Salvage photodynamic therapy for persistent esophageal cancer after chemo-radiation therapy

Salvage photodynamic therapy for persistent esophageal cancer after chemo-radiation therapy