Recurrence In Esophageal Cancer Patients Research Articles

Prospective Study of Adjuvant Radiotherapy on Preventing Lymph Node Metastasis After Ivor-Lewis Esophagectomy in Esophageal Cancer

To investigate whether Ivor-Lewis esophagectomy combined with adjuvant radiotherapy prevents lymphatic metastatic recurrence in esophageal cancer patients. A total of 113 stage IIA esophageal squamous cell carcinoma patients after Ivor-Lewis esophagectomy were accepted mRNA expression of Mucoid 1 (MUC1) gene detection. Positive patients were enrolled onto the adjuvant radiotherapy group (with postoperative adjuvant radiotherapy). Negative patients were enrolled onto the control group (without postoperative adjuvant radiotherapy or chemotherapy). The radiotherapy area consisted of the neck, supraclavicular region, and superior mediastinum (including paraesophageal and paratracheal region). Survival difference was compared by the χ(2) test, and the Kaplan-Meier method was performed to calculate the survival rate and recurrence rate. Logistic regression analysis was performed to determined independent risk factors. The radiotherapy area lymphatic metastatic recurrence rate in adjuvant radiotherapy group (16.7%, 5 of 30) was lower than patients without postoperative adjuvant radiotherapy (45.8%, 38 of 83) (P<0.05). Only compared to positive patients without postoperative adjuvant radiotherapy (60.0%, 6 of 10) was the rate (16.7%, 5 of 30) significantly lower (P<0.01). Cancer recurrence was recognized in 48.6% (55 of 113) patients within 3years after surgery, including 38.1% (43 of 113) patients with radiotherapy area recurrence. Logistic analysis revealed that T status (P<0.01) and adjuvant radiotherapy (P<0.05) were independent risk factors of lymph node metastasis in the first 3years after surgery. In MUC1 mRNA-positive esophageal squamous cell carcinoma patients, adjuvant radiotherapy could significantly reduce the lymph node metastasis rate in the radiotherapy area after Ivor-Lewis esophagectomy. Compared with traditional therapeutic methods, Ivor-Lewis esophagectomy combined with adjuvant radiotherapy can achieve similar curative effects in MUC1 mRNA-positive patients.

Clinical significance of circulating tumor cells in blood from patients with advanced or recurrent esophageal cancer.

19 Background: Circulating tumor cells (CTCs) measured by the CellSearch system in metastatic breast cancer have been reported to correlate with the response to chemotherapy. The purpose of this study was to clarify the clinicopathologic characteristics of CTCs in patients with advanced or recurrent esophageal cancer. Methods: CTCs from 35 patients with advanced or recurrent esophageal cancer were measured by this system before initiation of a new line of therapy and more than 3 weeks after initiation of therapy. Correlation between CTC counts and clinicopathologic variables was examined. Results: Of the 35 patients, 14 patients (40%) had recurrent esophageal cancer and 21 patients (60%) had primary advanced esophageal cancer. Their mean age was 65 years (range, 43 to 89 ). Of the 14 patients with recurrent esophageal cancer, measurable lesions included metastasis to lymph nodes, kidney metastasis, liver metastasis, and lung metastasis. With regard to their therapeutic effect, 1 patient (3%) obtained a complete response, 14 (40%) had a partial response, 9 (26%) had stable disease, 11 (31%) had progressive disease. Of the 15 patients with complete response and partial response, the number of CTCs diminished in 8 patients (53%). Of the 20 patients with stable disease and progressive disease, the number of CTCs increased in 16 patients (80%). The change in CTCs tended to correlate with disease progression and chemotherapeutic effect (P=0.07). The survival of patients with &gt;3 CTCs was shorter than that of patients with &lt;3 CTCs both before initiation of a new line of therapy (P=0.026) and more than 3 weeks after initiation of therapy (P=0.003). Conclusions: This study suggests that measurement of CTCs in advanced or recurrent esophageal cancer patients could be useful as a tool for predicting patients’ survival and monitoring response to cancer therapy.

A Retrospective Comparison of Docetaxel and Paclitaxel for Patients with Advanced or Recurrent Esophageal Cancer Who Previously Received Platinum-Based Chemotherapy

Objective: To retrospectively compare docetaxel (DTX) with paclitaxel (PTX) with regard to efficacy and safety in advanced or recurrent esophageal cancer patients who previously received platinum-based chemotherapy. Methods: We retrospectively analyzed 124 advanced or recurrent esophageal cancer patients who had received platinum-based chemotherapy and then received DTX or PTX from April 2006 to November 2010. Results: Eighty-six patients (69.4%) received DTX and 38 patients (30.6%) received PTX monotherapy. Due to toxicity, dose reduction was needed in 36.0 and 27.8% of patients and treatment was discontinued in 10.5 and 2.6% of patients receiving DTX and PTX, respectively. The objective response (25.7 vs. 10.3%, p = 0.03) and disease control rates (60.0 vs. 34.6%, p = 0.01) were higher in the PTX group than in the DTX group, respectively. There were no significant differences in median progression-free survival (2.1 vs. 3.5 months) and overall survival (6.1 vs. 7.2 months) between the DTX and PTX groups, respectively. Grade 3–4 neutropenia (48.8 vs. 21.1%, p = 0.003) and febrile neutropenia (20.9 vs. 5.3%, p = 0.029) were more frequent in the DTX patients than in the PTX patients, respectively. Conclusion: Although the efficacy of DTX and PTX for advanced or recurrent esophageal cancer patients after platinum-based chemotherapy was not significantly different in terms of survival, PTX was a more feasible treatment. PTX provided similar efficacy to DTX with less febrile neutropenia.

The Pattern of Recurrence in Esophageal Cancer Patients Treated with Concurrent Chemoradiation with or without Surgery

The Pattern of Recurrence in Esophageal Cancer Patients Treated with Concurrent Chemoradiation with or without Surgery

Combination chemotherapy with docetaxel and nedaplatin for recurrent esophageal cancer in an outpatient setting

The purpose of this study was to address the feasibility of combination chemotherapy of docetaxel and nedaplatin for recurrent esophageal cancer patients in an outpatient setting. Patients received docetaxel (30 mg/m(2) intravenously) on day 1 and nedaplatin (40 mg/m(2) intravenously) on day 1 every 2 weeks. In total, 28 patients with recurrent esophageal cancer after the initial treatment (esophagectomy, chemotherapy and/or chemoradiotherapy) were enrolled. Each patient received six cycles of treatment and was evaluated with a computed tomography scan. The percentage of patients who completed this therapy was 60.7%. Complete response and partial response were achieved by 3.6% and 35.7% of patients, respectively. The most frequent toxicities were leukopenia and anemia; non-hematological toxicities were generally mild. There was no treatment-related death. The median survival time and 1-year survival rate were 8.5 months and 15.9%, respectively. This outpatient combination chemotherapy was useful as second-line chemotherapy for recurrent esophageal cancer.

Salvage radiotherapy for postoperative loco-regional recurrence of esophageal cancer

The aim of this paper is to evaluate the treatment outcome of radiation therapy (RT) for 16 loco-regionally recurrent esophageal cancer patients. Between 1995 and 2004, patients with loco-regional recurrence of esophageal cancer after curative surgery received RT with or without chemotherapy (CTx) at an average total dose of 56.6 Gy (n = 16, REC group). The site of recurrence was the supraclavicular region in three patients, the mediastinal region in nine patients, and both the supraclavicular and mediastinal regions in four patients. We compared the data with those of patients receiving palliative RT with or without CTx for mediastinal relapse, distant metastasis or malignant pleural effusion (n = 39, META group) and with those of patients receiving postoperative RT with or without CTx in a planned fashion 4-6 weeks after esophagectomy (n = 27, PORT group). The median survival period was 13.8 months in the REC group, 3.5 months in the META group, and 19.1 months in the PORT group. The survival rates at 1 and 2 years were 56% and 19% in the REC group, 6% and 3% in the META group (P = 0.0003), and 70% and 43% in the PORT group (P = 0.1917), respectively. According to univariate analysis, the factor of worse prognosis was not found in the REC group. Complete or partial responses were observed in four (25%) and nine (56%) of the REC group patients, respectively. In the REC group, changes in clinical symptoms, such as dysphagia and recurrent nerve paralysis, could be evaluated in eight patients, and improvement in symptoms was obtained in five (63%) patients. The prognosis of patients who received RT for postoperative loco-regional recurrence of esophageal cancer was significantly better than that of the META group patients and compatible with that of the PORT group patients. Additionally, there is symptomatic relief in a substantial proportion of such patients, and long-term survival is possible in some patients.

Radiation therapy for loco-regionally recurrent esophageal cancer after surgery

Purpose: To evaluate the treatment outcome of radiation therapy for 33 loco-regionally recurrent esophageal cancer patients. Methods: Between 1988 and 1997, 33 patients with loco-regional recurrence of esophageal cancer after curative surgery received radiation therapy at an average total dose of 61 Gy. The site of recurrence was the supraclavicular region in 14 patients, the mediastinal region in 13 patients, and both the supraclavicular and mediastinal regions in six patients. If patients had ether distant metastasis or malignant pleural effusion, they were excluded from analysis. Patients who received prophylactic postoperative irradiation were also excluded from analysis. Results: The median survival period was 7 months. The survival rates at 1, 2, and 3 years were 33, 15, and 12%, respectively. In univariate analysis, patients with a short time interval between surgery and recurrence ( P=0.0098) and patients with recurrence in both the supraclavicular and mediastinal regions ( P=0.036) had a worse prognosis. In multivariate analysis, the time interval between surgery and recurrence ( P<0.001) and age (worse prognosis in younger patients, P=0.019) were the significant prognostic factors. Complete or partial responses were observed in nine (27%) and 21 (64%) of the patients, respectively. Changes in clinical symptoms, such as dysphagia, chest pain and back pain, could be evaluated in 11 patients, and improvement in symptoms was obtained in eight (73%) patients. Conclusions: The prognosis of patients who received radiation therapy for postoperative loco-regional recurrence of esophageal cancer is poor. However, there is symptomatic relief in a significant proportion of such patients, and long-term survival is possible in some patients.