Recurrent Esophageal Carcinoma Research Articles

Roles of squamous cell cancer antigen, cytokeratin 21-1 fragment, and carcinoembryonic antigen in the diagnosis and prognosis of postoperative locoregional recurrence in esophageal carcinoma

Background: Locoregional recurrence (LR) is the major cause for poor response after radical resection in patients with esophageal carcinoma (EC). Therefore, early diagnosis and positive treatment is crucial for the extension of overall survival in EC patients. We aim to investigate the feasibility of squamous cell cancer antigen (SCC-Ag), cytokeratin 21-1 fragment (CYFRA21-1), and carcinoembryonic antigen (CEA) in the diagnosis of postoperative LR in patients with EC, and the correlation between their expression and the prognosis of the disease.

ラリンジアルマスクを用いジェット換気下に Nd-YAG レーザー治療を行った食道癌再発による気管狭窄の 1 例

ラリンジアルマスクを用いジェット換気下に Nd-YAG レーザー治療を行った食道癌再発による気管狭窄の 1 例

Clinical research of raltitrexed plus nedaplatin combined with concurrent radiotherapy for loco-regional recurrence of esophageal carcinoma after surgery

Objective To evaluate the efficacy, safety and prognostic factors of raltitrexed plus nedaplatin combined with concurrent radiotherapy for loco-regional recurrence of esophageal squamous cell carcinoma after surgery. Methods Between October 2011 and March 2015, 54 patients with loco-regional recurrence of esophageal carcinoma after surgery in Sichuan Cancer Hospital and Institute were treated with raltitrexed plus nedaplatin combined with concurrent radiotherapy. The patients were irradiated with a dose of 60-66 Gy in 30-33 fractions. At least 2 cycles of concurrent chemotherapy were administered during radiotherapy, with 3 mg/m2 raltitrexed and 80 mg/m2 nedaplatin on the first day, every 21 days. Results The complete response rate was 7.4% (4/54), and the partial response rate was 70.4% (38/54). The total response rate was 77.8%. The 1-, 2-, 3-year survival rates and median survival time were 62.9%, 27.5%, 12.2% and 18.0 months, respectively. The 1-, 2-year progression-free survival rates and median progression-free survival time were 33.9%, 12.6% and 8.0 months, respectively. In univariate analysis, the short-time curative effect (χ2=3.935, P=0.047), the site of recurrence (χ2=11.280, P=0.001), postoperative stage (χ2=5.141, P=0.023) were related to the survival rate. COX multiple factors regression analysis showed that the short-time curative effect (χ2=6.044, P=0.014), the site of recurrence (χ2=7.019, P=0.013), postoperative stage (χ2=3.404, P=0.036) were independent prognostic factors for survival. The incidence rates of ≥grade 3 leukopenia, hypochromia, thrombocytopenia were 24.1%, 3.7% and 13.0%, respectively. Gastrointestinal adverse reactions were grade 1-2 nausea and vomiting and acute diarrhea, and the incidence rates were 18.5% and 7.4%, respectively. The incidence rates of grade 1-2 acute radiation-induced esophagitis and acute radiation-induced pneumonia were 27.8% and 20.4%, respectively. Conclusion Raltitrexed plus nedaplatin combined with concurrent radiotherapy can enhance the response rate and prolong the survival of patients with loco-regional recurrence of esophageal carcinoma after surgery, which has mild toxicity and is worthy of randomized controlled clinical study. After treatment, the recent curative effect is good, and the prognosis of patient with recurrence of single part and early postoperative pathologic staging is better. Key words: Esophageal neoplasms; Neoplasm recurrence, local; Radiotherapy, intensity-modulated; Prognosis; Raltitrexed

Significance of regions of abdominal lymph node metastasis for target volume delineation in postoperative radiotherapy for patients with recurrent esophageal carcinoma after radical surgery

Objective To analyze the regions of abdominal lymph node metastasis in recurrent thoracic esophageal squamous cell carcinoma (TE-SCC) after radical surgery, and to guide the design of target volume in postoperative adjuvant radiotherapy. Methods Patients with TE-SCC who were admitted to our hospital from February 2005 to April 2013 were enrolled as subjects. All patients were diagnosed with abdominal lymph node metastasis by imaging after R0 radical surgery. The exact regions of abdominal lymph node metastasis were classified according to the 7th edition of American Joint Committee on Cancer (AJCC) TNM staging system for gastric cancer, and then retrospectively analyzed. The difference of two group was analyzed by χ2 test. Results Among the 1593 eligible patients, 148(9.3%) were diagnosed with abdominal lymph node metastasis after surgery. In the 148 patients, the abdominal lymph node metastasis rates in the upper, middle, and lower thoracic esophagus were 2.3%, 7.8%, and 26.6%, respectively (P=0.000); the incidence rates of pathological stages T1/2 and T3/4 were 8.7% and 9.5%, respectively (P=0.601); the incidence rates of 0-2 and ≥3 metastatic lymph nodes in postoperative pathological examination were 4.8% and 20.1%, respectively (P=0.000). The abdominal lymph node metastasis rate was the highest in the para-aortic lymph node (16a2), followed by para-aortic lymph node (16a1) and the lymph nodes around the celiac trunk, posterior area of the pancreatic head, and common hepatic artery (64.9%, 41.2%, 37.8%, 32.4%, and 20.9%), yielding an overall metastasis rate of 91.9%. Conclusions The major regions of abdominal lymph node metastasis in esophageal carcinoma after radical surgery include para-aortic lymph nodes (16a2 and 16a1) and the lymph nodes around the celiac trunk, posterior area of the pancreatic head, and common hepatic artery. These regions are the abdominal target volumes of postoperative adjuvant radiotherapy. Key words: Esophageal neoplasms/surgery; Lymph node metastasis; Esophageal neoplasms/radiotherapy; Target

Prognosis and Treatment After Diagnosis of Recurrent Esophageal Carcinoma Following Esophagectomy with Curative Intent.

BackgroundStrategies for the treatment of recurrence after initial curative esophagectomy are increasingly being recognized. The aim of this study was to identify prognostic factors that affect survival in patients with recurrence and to evaluate treatment strategies.MethodsA prospective database (2003–2013) was used to collect consecutive patients with esophageal carcinoma treated with initial curative esophagectomy. Locations, symptoms, and treatment of recurrence were registered. Post-recurrence survival was defined as the time between the first recurrence and death or last follow-up.ResultsOf the 335 selected patients, 171 (51 %) developed recurrence. Multivariable analysis identified distant recurrence as opposed to locoregional recurrence [hazard ratio (HR) 2.15, 95 % confidence interval (CI) 1.27–3.65; p = 0.005], more than three recurrent locations (HR 2.42, 95 % CI 1.34–4.34; p = 0.003), and treatment (HR 0.29, 95 % CI 0.20–0.44; p < 0.001) as independent prognostic factors associated with post-recurrence survival. Primary tumor characteristics, including neoadjuvant therapy, histological type, pTN stage, and radicality, did not independently influence post-recurrence survival. Treatment was initiated in 62 patients (37 %) and included chemotherapy, radiotherapy, and/or surgery. Median post-recurrence survival of all patients was 3.0 months (range 0–112). In total, six patients (4 %) were still disease-free following treatment, indicating cure.ConclusionsIn patients treated for esophageal cancer at curative intent, distant recurrence and more than three recurrent locations were independent prognostic factors associated with worse post-recurrence survival, irrespective of primary tumor characteristics. Although survival after recurrence was poor, treatment can prolong survival and can even lead to cure in selected patients.

Analysis of prognostic factors in patients with recurrent and metastatic esophageal carcinoma

The aim of this study was to explore the influencing factors of prognosis for recurrent and metastatic esophageal carcinoma, and to provide reference for clinical treatment for these patients. The clinicopathological and follow-up data of 247 patients with recurrent and metastatic esophageal squamous cell carcinoma after radical resection were retrospectively reviewed, combined with analysis of prognostic factors in these patients. Kaplan-Meier method was used to analyze the survival, difference between groups was compared by Log rank test, and Cox model was used for multivariate analysis. Among the 247 recurrent and metastatic patients, locoregional recurrence was in 139 patients (56.3%), distant metastasis in 60 patients (24.3%), and combined recurrence in 48 patients (19.4%). The survival time was 1 to 42 months in the 247 patients, and the median survival time was 10 months. The 1-, 3- and 5-year survival rate after recurrence and metastasis was 26.4%, 6.3% and 2.4%, respectively. Univariate analysis indicated that regional lymph node metastasis of the primary tumor, distant lymph node metastasis, clinical staging, interval between operation and recurrence, recurrent and metastatic patterns, and treatment methods after recurrence and metastasis were influencing factors of prognosis (all P<0.05). Cox multivariate analysis indicated that clinical staging of the primary tumor, interval between operation and recurrence, recurrent and metastatic patterns, and treatment methods after recurrence and metastasis were independent factors influencing prognosis (all P<0.05). The prognosis of patients with recurrent and metastatic esophageal carcinoma is poor, and it is affected by many factors. Comprehensive treatment is effective in prolonging the survival time of the patients.

WISP-1 contributes to fractionated irradiation-induced radioresistance in esophageal carcinoma cell lines and mice.

Cancer cells that survive fractionated irradiation can be radioresistant and cause tumor recurrence. However, the molecular mechanisms underlying the development of radioresistance in cancer cells remain elusive. The aim of this study was to investigate the role of WISP-1 in the development of radioresistance in esophageal carcinoma during fractionated irradiation. Radioresistant esophageal cancer cells were generated from normal esophageal cancer cells via fractionated irradiation, and expression levels of related proteins were determined by Western blot. Radiosensitivity of cells was established by clonogenic cell survival assays, and cell cycle distribution was evaluated by flow cytometry. Protein distributions were determined by immunofluorescence, and cell toxicity was evaluated by cell counting kit-8 assays. In vivo validations were performed in a xenograft transplantation mouse model. Our data indicate that WISP-1 plays an important role in the development of radioresistance in esophageal cancer cells during fractionated irradiation. The overexression of WISP-1 in esophageal cancer cells was associated with radioresistance. Depletion of extracellular WISP-1 by antibody neutralizing reversed radioresistance and directly induced mitotic catastrophe resulting in cell death. WISP-1 may be a candidate therapeutic target in the treatment of recurrent esophageal carcinoma after radiotherapy.

Therapeutic effects of re-radiotherapy combined with S-1 in treatment of recurrent esophageal carcinoma

Therapeutic effects of re-radiotherapy combined with S-1 in treatment of recurrent esophageal carcinoma

Recurrent oesophageal cancer complicated by tracheo-oesophageal fistula: improved palliation by means of parallel tracheal and oesophageal stenting

Recurrent oesophageal carcinoma complicated by the development of a tracheo-oesophageal fistula is a crushing condition. In this situation, endoscopic double stenting may provide a quick and safe option for palliation. The outcomes of patients who received endoscopic parallel stent implantation for tracheo-oesophageal fistula due to recurrent oesophageal cancer at a German tertiary referral hospital between 2006 and 2013 were reviewed in a retrospective case study. A total of 9 patients were identified (mean age 59.9 years). Tumour entity was squamous cell carcinoma, adenocarcinoma and neuroendocrine cancer of the oesophagus in 5, 3 and 1 case, respectively. The mean interval between primary treatment and recurrence was 19.2 months. Successful double-stent placement was always feasible. Complete closure of the communication between oesophagus and respiratory system was accomplished in all cases by stent implantation. There were no stent-associated complications. The mean survival following stent insertion was 64 days (6-121 days). After successful double stenting, 5 patients were fit enough to receive palliative chemo- or radiotherapy. Seven patients were finally discharged home after adequate oral intake had been achieved. Fatal aspiration pneumonia with respiratory failure occurred in 2 cases. Endoscopic parallel stent implantation provides an easy and ubiquitous available technique for closure and palliation of tracheo-oesophageal fistula caused by recurrent oesophageal cancer. Immediate sealing of the fistula and relief of symptoms related to aspiration is achieved while hazardous operations are avoided. Therefore, we recommend endoscopic parallel stent insertion as the treatment of choice in case of tracheo-oesophageal fistula caused by recurrent oesophageal cancer.

Survival After Recurrent Esophageal Carcinoma Has Not Improved Over the Past 18 Years

Numerous patients will develop recurrent disease after esophagectomy for esophageal carcinoma (EC). In literature, survival after recurrent EC is poor with 6-8months. In these studies, diagnostic imaging during follow-up (FU) is routinely performed. In the Netherlands, routine imaging is not part of FU and only performed on indication. The aim of this study was to determine survival after diagnosis of recurrent disease in patients after esophagectomy without routine imaging during FU. All EC patients who underwent esophagectomy between 1993 and 2010 were included and followed for clinical evidence of recurrent EC. Location, symptoms, diagnosis, and treatment of recurrent disease were registered. Pattern of recurrence was compared between patients who underwent neoadjuvant therapy and patients who underwent surgery alone. Survival after detection of recurrence was determined in all patients and related to the year of surgery. A total of 493 of 1,088 patients (45%) who underwent esophagectomy between 1993 and 2010 developed recurrent disease. Median interval between esophagectomy and recurrence was 10.5months. Within the first 2years after surgery, 33% of patients developed recurrent EC. The majority of patients (51%) were diagnosed with distant metastases. Locoregional recurrence occurred significantly less often among patients who underwent neoadjuvant therapy (6 vs 16%, p=.017). Median survival after diagnosis of recurrent disease was 3months. No relation was observed between the year of surgery and survival after recurrent disease (p=.931). Survival after recurrent EC in patients who undergo FU without routine imaging after esophagectomy is approximately 3months and has not improved over the past 18years.

Pattern of Postoperative Recurrence and Hepatic and/or Pulmonary Resection for Liver and/or Lung Metastases From Esophageal Carcinoma

We assessed the benefit of hepatic and pulmonary resections in patients with liver and lung recurrences, respectively, after resection of esophageal carcinoma. The study population consisted of 138 consecutive patients with recurrent esophageal carcinoma after esophagectomy conducted between 2003 and 2005. The pattern, timing of appearance, and the prognosis of these recurrences were investigated, paying particular attention to those undergoing hepatic and pulmonary resections. In total, 55 and 92 patients developed locoregional and distant-organ metastases 13 and 6 months (median) after surgery, respectively, including 9 patients with both types of recurrence. The distant-organ metastases were found in the liver (n = 26), lung (n = 27), bone (n = 21), and other organs (n = 29). Patients with pulmonary recurrences had a better overall prognosis (median survival after recurrence detection 13 months) than those with hepatic metastases (5 months) or nonhepatic nonpulmonary metastases. (3 months) Hepatic and pulmonary resections were carried out in patients with oligonodular (n = ≤ 2) isolated liver and lung metastases (n = 5, respectively). Although the survivals of patients with lung metastases who were treated/not treated by pulmonary resection were different (median survival: 48 vs. 10 months, p < 0.01), the difference in the survivals between patients with hepatic metastases who were treated/not treated by hepatic resection reached only borderline statistical significance (13 vs. 5 months, p = 0.06). Resection of pulmonary metastases yields a survival benefit in properly selected patients. The benefit of resection for hepatic metastases remains controversial.

Salvage Treatment in Locoregional Recurrent Esophageal Carcinoma (EC) Using Intensity Modulated Radiation Therapy - Helical Tomotherapy (IMRT-HT)

Purpose/Objectives: Patients with locally advanced esophageal carcinoma are recommended to undergo treatment with radiation and chemotherapy, which may be followed by surgery in appropriate operative candidates. Radiation has traditionally been delivered with 3D conformal radiation therapy (3D CRT). This study is evaluating early outcomes and acute and late toxicity in patients treated with Intensity Modulated Radiation Therapy (IMRT) with concurrent chemotherapy. Materials/Methods: This is a retrospective review of 17 patients with esophageal carcinoma treated with IMRT and chemotherapy from 2008 2010. Pathology includes squamous cell and adenocarcinomas. Tumor sites include middle thoracic, lower thoracic and GE junction. Initial clinical stages are TX-T3, N0-3, and M0-1. All patients received at least one cycle of concurrent 5-fluorouracil with either cisplatin or oxaliplatin. IMRT dose was 50.4 Gy in 28 fractions prescribed to a target volume which included the tumor and regional lymphatics. All IMRT plans utilized coplanar beams in a 7-9 beam arrangement. Results: Median follow-up is 9 months (range, 4-20). Median patient age is 72 (range, 55-87). Sixteen patients received 50.4 Gy via an IMRT plan, and one received 25.2 Gy. Trimodality treatment was completed in 11 patients (65%). Surgery was either esophagogastrectomy or minimally invasive esophagectomy. Of the 11 patients who proceeded to surgery, 3 (27%) had a pathologic complete response, 7 (64%) had a partial response (PR) and 1 patient (9%) had stable disease. Of the 6 patients who received chemotherapy and IMRT alone, 2 patients had a clinical PR, 1 had disease progression, and 3 did not have follow-up data available. In the initial 17 patients, there were no local or regional recurrences, though 2 patients developed distant metastases. Twelve patients are alive at last follow-up. Of the 5 deaths, 2 were due to esophageal cancer, 1 from radiation complications, 1 from chemotherapy complications, and 1 from surgical complications. Acute CTCAE V4.0 grade 3 toxicities from concurrent chemotherapy and IMRT developed in the following patients: 2 esophagitis, 1 fatigue, 1 nausea/vomiting, 4 dehydration, 1 anemia, 1 thrombocytopenia and 5 neutropenia. Patients with grade 4 toxicities included 1 thrombocytopenia and 1 neutropenia. Four patients developed late grade 3 esophageal strictures. There was one grade 4 cardiac complication, and one grade 5 pleuro-esophageal fistula. There were no cases of radiation pneumonitis or ulcers. Conclusions: IMRT is a feasible treatment modality, which may be equally efficacious to 3D CRT for the treatment of esophageal carcinoma, and may offer fewer treatment complications, including a lower incidence of pneumonitis. Author Disclosure: K.V. Kowalchik: None. G. Kim: None. E. Johnson: None. N. Paryani: None. S. Ko: None.

A phase I study of salvage photodynamic therapy (PDT) using talaporfin sodium and a diode laser for local failure of esophageal carcinoma (EC) after chemoradiotheapy (CRT).

123 Background: We recently reported that porfimer sodium (Photofrin)-based PDT was a less invasive, curative treatment option for carefully selected patients with locally residual EC after CRT (Endoscopy 2011:43:657-63). However, porfimer sodium-based PDT has some problems (long light shielding and skin phototoxicities). Conversely, talaporfin sodium (Laserphyrin)-based PDT using a diode laser system can overcome these problems. Therefore, we conducted a phase I study to establish the recommended dose of laser irradiation and to evaluate safety of talaporfin sodium-based PDT as a salvage treatment after CRT. (UMIN000003970). Methods: We recruited patients with residual or recurrent EC at primary site and who were treated with more than 50 Gy of (chemo)radiotherapy. To determine the dose limiting toxicity (DLT) according to the energy of the diode laser, dose escalation was set at three energy levels (50,75 and 100J/cm2). The DLT was defined as follows; 1) severe pain, 2) ≥ grade 2 CTC-AE fever, 3) esophageal fistulae or stenosis, 4) ≥ grade 3 CTC-AE hemorrhage, and 5) ≥ grade 4 CTC-AE non-hematologic toxicity. Results: Between Oct. 2010 and May 2011, a total of 9 patients (9 men, median age of 72 y-o) were recruited and were treated using up to the third energy level in groups of three individuals. The initial T stage was T1/T2/T3(4/2/3) and recurrent T stage was T1/T2(6/3). None of the patients experienced DLT at all energy levels. A complete response was achieved in 5 of 9 patients (56%). Conclusions: Based on the results of our phase I study, we concluded that irradiation at 100J/cm2 appeared to be a recommended dose for talaporfin sodium-based PDT as a salvage treatment for locally residual esophageal carcinoma after CRT. We are currently running a phase II part of the study to investigate efficacy of salvage talaporfin sodium-based PDT.

Salvage radiotherapy in patients with recurrent esophageal carcinoma

The feasibility and effectiveness of radiotherapy in the management of recurrent esophageal carcinoma (REC) is reported. A consecutive cohort of 54 patients with rcT1-4, rcN0-1, or cM0 recurrent esophageal carcinoma (69% squamous cell carcinoma, 31% adenocarcinoma) was treated between 1988 and 2010. The initial treatment for these patients was definitive radiochemotherapy, surgery alone, or neoadjuvant radiochemotherapy + surgical resection in 8 (15%), 33 (61%), and 13 (24%) patients, respectively. The median time to recurrence from initial treatment was 19 months (range 4-79 months). The site of the recurrence was anastomotic or local, nodal, or both in 63%, 30%, and 7% of patients, respectively. Salvage radio(chemo)therapy was carried out with a median dose of 45 Gy (range 30-68 Gy). Median follow-up time for surviving patients from the start of R(C)T was 38 months (range 10-105 months). Relief of symptoms was achieved in 19 of 28 symptomatic patients (68%). The median survival time was 12 months (95% confidence interval (CI) 7-17 months) and the median recurrence-free interval was 8 months (95% CI 4-12 months). The survival rates at 1, 2, and 3 years were 55 ± 7%, 29 ± 6%, and 19 ± 5%, respectively. The recurrence-free survival rates at 1, 2, and 3 years were 44 ± 7%, 22 ± 6%, and 15 ± 5%, respectively. A radiation dose ≥ 45 Gy and conformal RT were associated with a better prognosis. RT is feasible and effective in the management of recurrent esophageal carcinoma, especially for relief of symptoms. Toxicity is in an acceptable range. The outcome of REC is poor; however, long-term survival of patients with recurrent esophageal carcinoma after radiochemotherapy might be possible, even with a previous history of radiotherapy in the initial treatment. If re-irradiation of esophageal carcinoma is contemplated, three-dimensional conformal techniques and a minimum total dose of 45 Gy are recommended.

Analysis of prognostic factors in patients with locoregional recurrence of esophageal carcinoma after curative treatment

The aim of this paper was to evaluate the treatment outcome of multimodal treatment for 196 patients with locoregional recurrent esophageal cancer after curative treatment and to determine the prognostic factors of recurrence. One hundred and ninety six patients with locoregional recurrent esophageal cancer curatively treated in our hospital were included in this study. Kaplan-Meier method was used to analyze the survival rate. Log rank test was used to evaluate the difference between the groups. Multivariate survival analysis was conducted using a Cox proportional hazard regression model with a backward stepwise procedure. The overall 1-, 2- and 3-year survival rates were 29.8%, 5.9% and 4.0%, respectively, with a median survival time of 8.0 months. The univariate analysis showed that ECOG PS, the interval between initial treatment and recurrence, the regimens of initial treatment and retreatment were independent prognostic factors. The multivariate analysis showed that the regimens of initial treatment and retreatment were independent prognostic factors. Retreatment methods significantly influenced the survival. The median survival time of chemoradiotherapy, radiation therapy alone, chemotherapy alone, EGFR-TKI and best supportive care were 13.0, 7.0, 6.0, 4.0 and 3.0 months, respectively (P = 0.000). The prognosis of patients with locoregional recurrent esophageal cancer after curative treatment is poor. The main prognostic factors are the regimens of initial treatment and retreatment. Multimodal treatment including radiotherapy and chemotherapy may improve the long-term survival of the patients.

Double stents: airway stenting after esophageal-stent implantation for esophageal cancer.

Esophageal stenting with self-expandable metallic stents can effectively relieve malignant esophageal strictures in patients in whom chemoradiotherapy has failed. However, airway stenosis can sometimes occur after esophageal stenting. This study aims to evaluate the efficacy of double stents (combined esophageal and airway stents) in patients with recurrent and unresectable esophageal carcinoma in whom definitive chemoradiotherapy has failed. We retrospectively studied 35 patients who underwent esophageal stenting for recurrent esophageal carcinoma after failure of chemoradiotherapy. These patients were divided into 2 groups; the E group, consisting of patients who underwent esophageal stenting alone and the D group, consisting of patients who required airway stenting after esophageal stenting due to airway compression. Bronchoscopy was performed before esophageal stenting in all patients. In all 5 patients developed airway stenosis after esophageal stenting. With regard to the bronchoscopic findings before esophageal stenting, the incidence of category-2b findings was significantly higher in the D group than in the E group. Mean survival was 60 days (range 24-102 days). Accurate bronchoscopic examination with special attention to compression of the airway should be performed before esophageal stenting in patients in whom the bronchoscopic findings are classified as category 2b or higher.

Radiation therapy for recurrent esophageal carcinoma

Radiation therapy for recurrent esophageal carcinoma

Salvage endoscopic submucosal dissection for recurrent esophageal squamous-cell carcinoma after definitive chemoradiotherapy.

Although concurrent definitive chemoradiotherapy (CRT) is considered a standard treatment for unresectable esophageal carcinoma, CRT is associated with local failure (40-50%), and further interventions are needed in these cases. However, morbidity and mortality rates remain high among patients undergoing salvage esophagectomy for recurrent tumors. Here, we report a rare experience of salvage endoscopic submucosal dissection (ESD) for recurrent esophageal squamous-cell carcinoma (SCC) after definitive CRT. A 55-year-old male was diagnosed with unresectable advanced mid-thoracic esophageal SCC with lymph node metastases involving the trachea. After definitive CRT with cis-diamminedichloroplatinum (CDDP)/5-fluorouracil (5-FU) and 60Gy irradiation was performed, complete response was obtained. However, a recurrent esophageal SCC was detected in the mid-thoracic esophagus on endoscopy performed 6months after CRT. The tumor was resected en bloc using ESD without any complications. There was no recurrence for 4months after ESD. Salvage ESD may be a safe and effective treatment for recurrent esophageal SCC after CRT.

The clinical features of thoracic stomach cancer after surgical treatment for esophageal carcinoma

Objective Postoperative recurrence of esophageal carcinoma was the main factor that affect the patients’ survival and quality of life. This study mainly investigated the clinical features of thoracic stomach cancer (TSC) after surgical treatment for esophageal carcinoma.

Lymph node dissection with cervical approach as a salvage surgery for locoregional failure after definitive chemoradiotherapy in a patient with recurrent esophageal carcinoma: report of a case

Salvage surgery is one important therapeutic option after locoregional failure of definitive chemoradiotherapy (dCRT) in patients with advanced or recurrent esophageal carcinoma. We have performed cervical lymph node dissection as a salvage surgery after chemoradiotherapy in a patient with recurrent esophageal carcinoma. A 54-year-old Japanese man was admitted to our hospital because of multiple lymph node metastases after endoscopic submucosal dissection (ESD) for early-stage esophageal carcinoma. The patient underwent a circumferential ESD of early-stage esophageal carcinoma in another hospital. The esophageal carcinoma, measuring 75 × 60 mm in size, was a superficial spreading type located in the middle portion of the thoracic esophagus. Histology of the resected specimen revealed a moderately to poorly differentiated squamous cell carcinoma, and the depth of invasion was limited within the mucosal layer associated with a small area being attached to the muscularis mucosae. Five months after ESD, lymph node metastases in the regions of right recurrent nerve and the left tracheobronchus were found, for which dCRT was performed. These metastatic lymph nodes disappeared in the chest CT scan images. Lymph node metastasis in the region of the right recurrent nerve then reappeared 8 months after the completion of CRT. Considering the solitary lymph node metastasis and surgical invasiveness, lymph node dissection using a cervical approach was selected as a salvage surgery. Cervical approach for the lymph node dissection in the region of right recurrent nerve may be one feasible option as a minimally invasive salvage surgery for patients with recurrent esophageal carcinoma after dCRT.