Unresectable Esophageal Cancer Research Articles

Endoscopic microwave coagulation for treatment of a case of unresectable esophageal cancer

A 71-year-old woman was admitted to our hospital with dysphagia. X-ray examination revealed an 11 cm-long stenosis of the esophagus, and a biopsy specimen revealed poorly differentiated squamous cell carcinoma. The patient underwent 60 Gys of radiation therapy for primary esophageal tumor. Endoscopic and X-ray examinations revealed a significant diminution in the lesion, so she was discharged.Six months later, the patient returned to our hospital with dysphagia.We applied endoscopic microwave coagulation therapy (EMCT) for the esophageal stricture. After 4 sessions of EMCT therapy, significant improvements were seen in symptoms and in endoscopic and X-ray findings.We concluded that EMCT can be used accurately and safely as palliative treatment for malignant stricture of the esophagus.

Management of unresectable oesophageal cancer: a review of 537 patients.

We compared and contrasted the potentials of palliation afforded by various management methods in a retrospective study of all patients referred to one surgical team in a 20-year period. Five hundred thirty-seven patients had unresectable oesophageal cancer. There were five treatment groups: group 1-dilatation plus external radiotherapy (DXR, n = 95), group 2-gastrostomy plus DXR (n = 18), group 3-permanent intubation (n = 329), group 4-oesophageal bypass (BP, n = 70), and group 5-YAG laser plus brachytherapy (n = 25). Groups 1 and 2 had high mortality (4% and 25%) and poor symptom relief, with an average survival of 2.5 and 3.5 months, respectively. Group 3 had a 20% mortality rate, moderate-to-good symptom relief and an average survival of 4.2 months. This method was best for lower oesophageal cancer. Group 4 had a 22% mortality rate, good symptom relief and an average survival of 10.5 months. The BP method was suitable for patients with oesophago-airway fistula (OAF) and those with lower oesophageal cancer found unresectable at operation. Group 5 had a hospital mortality rate of 8%, good symptom control and an average survival of 6.2 months. This was suitable for all patients (except those with OAF). In palliation of carcinoma of the oesophagus the selection of method should be made to suit the characteristic and location of the tumour.

Long term results of radiotherapy combined with chemotherapy (CDDP+MTX+PEP) for unresectable esophageal cancer

Materials & Methods:35 patients with unresectable esophaqeal cancer were treated with radiotherapv between June 1985 and June 1986 at Hiroshima University‘Hoipital. During this short period, combination treatment of radiation and chemotherapy (CMP;cisplatinum 50mg/m2, methotrexate 40mq/m2, peplomvcin 5mgx5) was the first choice in case of-certain eligible criteria. Only 19 cases were-matched 'to -the criteria and were treated with radiotherapy and chemotherapy (CMP group). The mean numbers of CMP courses were 1.8. Out of uneligible cases for CMP , rapy (PM;peplomycin 5mgx6, mitomycin 10mg) and 6 were treated with radiotherapy and mild chemothe10 were treated with radiotherapy alone (non-CMP group). Mean total radiation dose were 56.3Gy for CMP group and 60.6Gy for non-CMP group.

切除不能進行・再発食道癌に対する温熱療法を加えた集学的治療

切除不能進行・再発食道癌に対する温熱療法を加えた集学的治療

Heat, drugs, and radiation given in combination is palliative for unresectable esophageal cancer

From April 1966 to April 1986, 101 men and women with unresectable squamous cell carcinoma of the esophagus were treated in our clinic. Since 1983, 21 were treated with a combination of hyperthermia, chemotherapy, and radiotherapy (group I). Before 1983, for another 80 patients, radiation plus chemotherapy had been prescribe (group II). Nine of 21 patients in group I had an unresectable carcinoma due to an advanced tumor, 9 had an associated severe clinical status, and 3 refused surgery. Out of 80 in group II, 50 had a far advanced tumor, 21 had a poor clinical condition, and 9 refused operation. With regard to staging, for 21 in group I, 6 were classified as Stage I, 5 as Stage II, 7 as Stage III, and 3 as Stage IV. As to the 80 in group II, those in Stage I, II, III, and IV accounted for 8, 22, 39, and 11, respectively. The median doses of each modality, for patients in group I, were 6 times of hyperthermia at 42–45°C for 30 minutes, 40 Gy of X ray and 30 mg of bleomycin. For patients in group II, a median dose of 56 Gy of X ray was given. Response rates determined by esophagograms and endoscopies for the patients in groups I and II were 76.2% ( 16 21 ; 4 CRs,12 PRs) and 39.2% ( 31 79 ; 2 Crs, 29 PRs), respectively ( p < 0.001). The effective rates determined by improvement in quality of life (relief of pain and dysphagia) for groups I and II were 61.9% and 37.2%, respectively. A longer survival was obtained for patients in group I (median survival: 9 months vs 6 months). Especially for the patients classified as Stage I, a significantly longer survival was obtained with a combination of hyperthermia, chemotherapy, and radiotherapy ( p < 0.01).

La sonda BICAP para tumores en el tratamiento paliativo del cancer de esofago

The purpose of this study was to present the result of the BICAP tumor probe used for palliation of esophageal cancers. Only patients with a circumferential stricture and esophageal wall thickness of at least 1 cm were included in this study. Thirty patients with dysphagia from an unresectable esophageal cancer were referred for endoscopic palliation. Seven patients who did not meet the selection criteria for BICAP were referred for other therapies. Twenty three patients were included in this study. Initial technical success was achieved in 22 and functional success in 19 (83%). During the follow-up period, maintenance of the functional improvement required new endoscopic or adjuvant treatments in all. The treatment was completed in 11 and the average duration of improvement was 15.9 weeks. No major complications occurred. The main advantages of the BICAP tumor probe over Nd: YAG laser are a faster improvement, and a good efficacy on infiltrative and submucosal cancers. But the BICAP treatment is limited to circumferential strictures with a minimum of about 1 cm esophageal wall thickness.

Motor Function in the Excluded Esophagus and Its Implications in the Management of Patients with Unresectable Carcinoma of the Esophagus

Palliative exclusion of the esophagus by use of transposed stomach was performed in a 63-year-old woman with unresectable cervical esophageal cancer. Twelve weeks after this operation, motor function of the excluded esophagus was assessed. All voluntary swallows produced a motor response in the esophageal body. Eighty-five per cent of the contractions were peristaltic and generated mean pressures of 28 mmHg. Fifteen per cent of the deglutitions were followed by nonpropulsive waves with mean pressures of 24 mmHg. Spontaneous tertiary activity occurred at a rate of 2.5 contractions per minute with an amplitude of 16 mmHg. Motor function in the excluded esophagus persists after bypass of the organ. This suggests that the excluded esophagus should be decompressed after surgery to prevent "blowout" of its closed ends.

Radiation-induced esophageal carcinoma responded well to hyperthermic chemotherapy

A 66-year-old man with multiple malignant lesions of the esophagus, as apparently induced by irradiation of 60 Gy of 60Co for a mediastinal tumor at the age of 36 y.o., was a poor operative risk because of severe lung disease. This man was treated with a combination of hyperthermia, oral administration of oil Bleomycin-polyacrylate paste and intravenous infusion of cis-Platinum. During 20 administrations of hyperthermia conducted at 42-45 degrees C for 30 min, 600 mg of oil Bleomycin and 200 mg of cis-Platinum, no complications occurred and the heat treatments were completed with no side effects. Repeatedly performed esophagogram and endoscopy showed a complete disappearance of three of the four lesions and a marked regression in the other one. There has been no regrowth or distant spread of the carcinoma up to the present 10 months of follow up. This combination of hyperthermia and chemotherapy may prove to be the optimal strategy for treatment of unresectable esophageal cancer, particularly when radiotherapy is contraindicated.