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1. Malaisrie SC, Hofstetter WL, Correa AM, Ajani JA, Komaki RR, Rice DC, Vaporciyan AA, Walsh GL, Roth JA, Wu TT, Swisher SG: The addition of induction chemotherapy to preoperative, concurrent chemoradiotherapy improves tumor response in patients with esophageal adenocarcinoma. Cancer; 2006 Sep 1;107(5):967-74
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] The addition of induction chemotherapy to preoperative, concurrent chemoradiotherapy improves tumor response in patients with esophageal adenocarcinoma.
  • BACKGROUND: Tumor viability assessed by pathologic analysis of resected specimens in patients with preoperatively treated esophageal adenocarcinoma (EAC) is a prognostic indicator.
  • The feasibility of induction chemotherapy followed by concurrent chemoradiotherapy (CCRT) and surgery for patients with locoregionally advanced EAC has been demonstrated.
  • METHODS: The authors retrospectively reviewed 247 consecutive patients with EAC who presented for planned surgery after treatment with either CCRT or CRT from January 1997 through August 2003.
  • Pathologic tumor response, overall survival, and disease-free survival were assessed according to treatment.
  • Subset analysis of patients with clinical Stage III/IVA disease showed a median overall survival of 51 months with a 3-year overall survival rate of 58% in the CCRT group and a median overall survival of 20 months with a 3-year overall survival rate of 28% in the CRT group (HR, 0.57; P = .019).
  • [MeSH-major] Adenocarcinoma / therapy. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Esophageal Neoplasms / therapy
  • [MeSH-minor] Adult. Aged. Combined Modality Therapy. Disease-Free Survival. Female. Humans. Male. Middle Aged. Neoadjuvant Therapy. Retrospective Studies. Survival Rate

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  • [CommentIn] Cancer. 2007 Apr 1;109(7):1448-9; author reply 1449 [17328063.001]
  • (PMID = 16874819.001).
  • [ISSN] 0008-543X
  • [Journal-full-title] Cancer
  • [ISO-abbreviation] Cancer
  • [Language] eng
  • [Publication-type] Evaluation Studies; Journal Article
  • [Publication-country] United States
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2. Hirsh V, Soulieres D, Duclos M, Faria S, Del Vecchio P, Ofiara L, Ayoub JP, Charpentier D, Gruber J, Portelance L, Souhami L: Phase II multicenter trial with carboplatin and gemcitabine induction chemotherapy followed by radiotherapy concomitantly with low-dose paclitaxel and gemcitabine for stage IIIA and IIIB non-small cell lung cancer. J Thorac Oncol; 2007 Oct;2(10):927-32
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  • [Title] Phase II multicenter trial with carboplatin and gemcitabine induction chemotherapy followed by radiotherapy concomitantly with low-dose paclitaxel and gemcitabine for stage IIIA and IIIB non-small cell lung cancer.
  • INTRODUCTION: The optimal combination of concomitant radiotherapy (RT) and chemotherapy in stage III unresectable non-small cell lung cancer (NSCLC) remains unclear.
  • The role of induction chemotherapy with carboplatin/gemcitabine regimen has not been established in stage III NSCLC.
  • METHODS: Forty-two stage III NSCLC patients, 41 assessable, with a median age of 60 years and good performance status, entered this trial between January 2003 and November 2004.
  • They received carboplatin area under the curve 5 on day 1 and gemcitabine 1000 mg/m2 on days 1 + 8 every 3 weeks for two cycles, followed on day 50 by RT 60 Gy, concomitantly with paclitaxel 50 mg/m2 and gemcitabine 100 mg/m2 on days 1 + 8 every 3 weeks for two cycles.
  • During concomitant RT and chemotherapy, grade 3 neutropenia, thrombocytopenia, and anemia occurred in eight, three, and three patients, respectively, and grade 4 neutropenia and thrombocytopenia in one patient each.
  • One patient developed an esophageal fistula and died shortly after, which was considered a grade 5 toxicity; one patient developed grade 4 interstitial pneumonitis, and three patients developed grade 3 esophagitis.
  • Further studies using this approach are warranted in patients with stage III NSCLC.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Carcinoma, Non-Small-Cell Lung / therapy. Lung Neoplasms / therapy
  • [MeSH-minor] Adenocarcinoma / drug therapy. Adenocarcinoma / pathology. Adenocarcinoma / radiotherapy. Adult. Aged. Carboplatin / administration & dosage. Carcinoma, Large Cell / drug therapy. Carcinoma, Large Cell / pathology. Carcinoma, Large Cell / radiotherapy. Carcinoma, Squamous Cell / drug therapy. Carcinoma, Squamous Cell / pathology. Carcinoma, Squamous Cell / radiotherapy. Combined Modality Therapy. Deoxycytidine / administration & dosage. Deoxycytidine / analogs & derivatives. Dose-Response Relationship, Drug. Female. Humans. Male. Maximum Tolerated Dose. Middle Aged. Neoplasm Staging. Paclitaxel / administration & dosage. Prognosis. Prospective Studies. Radiotherapy Dosage. Remission Induction. Survival Rate. Treatment Outcome

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  • (PMID = 17909355.001).
  • [ISSN] 1556-1380
  • [Journal-full-title] Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
  • [ISO-abbreviation] J Thorac Oncol
  • [Language] eng
  • [Publication-type] Clinical Trial, Phase II; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0W860991D6 / Deoxycytidine; B76N6SBZ8R / gemcitabine; BG3F62OND5 / Carboplatin; P88XT4IS4D / Paclitaxel
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3. Keresztes RS, Port JL, Pasmantier MW, Korst RJ, Altorki NK: Preoperative chemotherapy for esophageal cancer with paclitaxel and carboplatin: results of a phase II trial. J Thorac Cardiovasc Surg; 2003 Nov;126(5):1603-8
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  • [Title] Preoperative chemotherapy for esophageal cancer with paclitaxel and carboplatin: results of a phase II trial.
  • OBJECTIVE: Paclitaxel has one of the highest response rates when used as a single agent in patients with esophageal cancer.
  • Patients with stage I disease and those with visceral metastases were excluded.
  • All underwent preoperative computed tomography scanning and endosonography for staging.
  • RESULTS: Twenty-six (11 epidermoid, 15 adenocarcinoma) patients completed the trial.
  • Preoperative staging showed: stage IIA, 6 patients; stage IIB, 1 patient; and stage III, 19 patients.
  • All patients completed their preoperative chemotherapy.
  • There was no unexpected chemotherapy-related toxicity.
  • CONCLUSION: Paclitaxel-carboplatin combination is a safe and well-tolerated regimen for esophageal cancer with clinical response rates comparable to historical controls.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / administration & dosage. Carboplatin / administration & dosage. Esophageal Neoplasms / drug therapy. Esophageal Neoplasms / mortality. Paclitaxel / administration & dosage
  • [MeSH-minor] Adenocarcinoma / drug therapy. Adenocarcinoma / mortality. Adenocarcinoma / pathology. Adenocarcinoma / surgery. Adult. Aged. Analysis of Variance. Biopsy, Needle. Carcinoma, Squamous Cell / drug therapy. Carcinoma, Squamous Cell / mortality. Carcinoma, Squamous Cell / pathology. Carcinoma, Squamous Cell / surgery. Chemotherapy, Adjuvant. Confidence Intervals. Dose-Response Relationship, Drug. Esophagectomy / methods. Female. Follow-Up Studies. Humans. Male. Maximum Tolerated Dose. Middle Aged. Neoplasm Staging. Pilot Projects. Preoperative Care / methods. Risk Assessment. Survival Analysis. Treatment Outcome

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  • (PMID = 14666040.001).
  • [ISSN] 0022-5223
  • [Journal-full-title] The Journal of thoracic and cardiovascular surgery
  • [ISO-abbreviation] J. Thorac. Cardiovasc. Surg.
  • [Language] eng
  • [Publication-type] Clinical Trial; Clinical Trial, Phase II; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] BG3F62OND5 / Carboplatin; P88XT4IS4D / Paclitaxel
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4. Stiles BM, Christos P, Port JL, Lee PC, Paul S, Saunders J, Altorki NK: Predictors of survival in patients with persistent nodal metastases after preoperative chemotherapy for esophageal cancer. J Thorac Cardiovasc Surg; 2010 Feb;139(2):387-94
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  • [Title] Predictors of survival in patients with persistent nodal metastases after preoperative chemotherapy for esophageal cancer.
  • OBJECTIVE: In patients with esophageal cancer, a complete pathologic response after preoperative therapy is universally regarded as a favorable prognostic factor.
  • METHODS: We reviewed a prospectively maintained esophageal cancer database.
  • Patients with positive lymph nodes after preoperative therapy and surgery were selected.
  • RESULTS: Ninety-six patients with 1 or more positive nodes received preoperative therapy.
  • Final pathologic stages were IIB in 18 (19%), III in 49 (51%), and IV in 29 (30%).
  • Postoperatively, 44 (46%) patients received additional chemotherapy.
  • On univariate analysis, pathologic stage, pathologic T classification, and number of positive nodes significantly affected overall survival.
  • On multivariate analysis, clinical stage (hazard ratio [HR], 2.25; P = .05), pathologic T classification (HR, 3.06; P = .006), and number of positive nodes (HR 1.03 per node, P = .09) were significant predictors of overall survival.
  • CONCLUSION: Long-term survival can be achieved in patients with esophageal cancer who have persistent nodal disease after neoadjuvant therapy and surgical resection.
  • Clinical stage, pathologic T classification, and number of positive nodes best predict survival.
  • Postoperative chemotherapy conferred no additional survival benefit in this patient population.
  • [MeSH-major] Adenocarcinoma / mortality. Carcinoma, Squamous Cell / mortality. Esophageal Neoplasms / mortality. Esophageal Neoplasms / pathology
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Chemotherapy, Adjuvant. Esophagectomy. Female. Humans. Lymphatic Metastasis. Male. Middle Aged. Multivariate Analysis. Neoadjuvant Therapy. Patient Selection. Retrospective Studies. Survival Analysis. Young Adult

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  • [Copyright] 2010. Published by Mosby, Inc.
  • (PMID = 20006355.001).
  • [ISSN] 1097-685X
  • [Journal-full-title] The Journal of thoracic and cardiovascular surgery
  • [ISO-abbreviation] J. Thorac. Cardiovasc. Surg.
  • [Language] eng
  • [Grant] United States / NCRR NIH HHS / RR / UL1-RR024996
  • [Publication-type] Journal Article; Research Support, N.I.H., Extramural
  • [Publication-country] United States
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5. Lustberg MB, Bekaii-Saab T, Young D, Otterson G, Burak W, Abbas A, McCracken-Bussa B, Lustberg ME, Villalona-Calero MA: Phase II randomized study of two regimens of sequentially administered mitomycin C and irinotecan in patients with unresectable esophageal and gastroesophageal adenocarcinoma. J Thorac Oncol; 2010 May;5(5):713-8
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  • [Title] Phase II randomized study of two regimens of sequentially administered mitomycin C and irinotecan in patients with unresectable esophageal and gastroesophageal adenocarcinoma.
  • BACKGROUND: Based on the observation of topoisomerase-1, upregulation by mitomycin C (MMC), and the phase I antitumor activity of sequential MMC/irinotecan in esophageal cancer, we conducted a phase II evaluation of two schedules of this combination in previously untreated stage III/IV esophageal/gastroesophageal junction adenocarcinomas.
  • A two-stage Simon minimax design was used for each arm, with a "pick-the-winner" approach based on efficacy.
  • CONCLUSION: Irinotecan/MMC is feasible in esophageal/gastroesophageal junction adenocarcinoma.

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  • (PMID = 20354452.001).
  • [ISSN] 1556-1380
  • [Journal-full-title] Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
  • [ISO-abbreviation] J Thorac Oncol
  • [Language] ENG
  • [Grant] United States / NCI NIH HHS / CA / P30 CA16059; United States / NCI NIH HHS / CA / R21 CA092956; United States / NCRR NIH HHS / RR / UL1 RR025755; United States / NCI NIH HHS / CA / K12 CA133250; United States / NCI NIH HHS / CA / P30 CA016059; United States / NCI NIH HHS / CA / R21CA92956
  • [Publication-type] Clinical Trial, Phase II; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural
  • [Publication-country] United States
  • [Chemical-registry-number] 50SG953SK6 / Mitomycin; 7673326042 / irinotecan; XT3Z54Z28A / Camptothecin
  • [Other-IDs] NLM/ NIHMS460376; NLM/ PMC3641556
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6. Farzad M, De Luca MC, Rubino G, Pirtoli L, Pepi F, Sebaste L, Ponticelli P, Atzeni G, Maranzano E, Silvano G: [Effort to radically cure stage III and IV esophageal carcinoma with simultaneous radiotherapy and chemotherapy in standard clinical practice]. Radiol Med; 2001 Jul-Aug;102(1-2):72-7
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  • [Title] [Effort to radically cure stage III and IV esophageal carcinoma with simultaneous radiotherapy and chemotherapy in standard clinical practice].
  • [Transliterated title] L'intento di cura radicale del carcinoma esofageo al III e IV stadio con radioterapia e chemioterapia concomitanti nella pratica clinica comune.
  • PURPOSE: Chemotherapy and concurrent irradiation, intended to cure, are presently standard treatments for non metastatic, unresectable oesophageal cancer.
  • The results of the combined therapy are superior to those of radiotherapy alone, attaining 25-35% 2-year survival rates.
  • However these results mainly refer to stage I and II tumours as most of the available literature has focussed on these groups.
  • The aim of our report is to present our experience with Stage III and IV patients.
  • MATERIAL AND METHODS: Sixty-four Stage III and IV oesophageal cancer patients were referred to our Departments from January 1, 1990 to December 31, 1996.
  • Diagnosis was obtained through oesophagoscopy and biopsy, stage was assessed by physical examination, chest CT scan, bronchoscopy, barium X-ray examination, upper abdomen ultrasonography and bone nuclide scan.
  • The case features were as follows: histology of squamous cell carcinoma in 32 cases, of adenocarcinoma in 2; tumour in the upper third of the oesophagus in 11 (32.5%), in the middle third in 18 (53%), in the lower third in 5 (14.5%); male/female ratio 29/5, age 48-68 years (mean 56), Karnofsky performance status of 60% or higher.
  • Twenty-one had Stage III (61.75%) and 13 stage IV (38.25%) cancer, with metastasis limited to the supraclavicular or coeliac nodes, which could be included in the radiation volume.
  • In all cases chemotherapy consisted of 5-Fluoruracil (administered in a continuous i.v. infusion, from day 1 to 5, with a 750-1.000 mg/n.sq daily dose) and Cisplatin (75-100 mg/n.sq on the first day, or 20 mg/n.sq for 5 consecutive daily doses, administered by i.v. bolus).
  • Irradiation started with the first cycle of chemotherapy in 5 patients, with the second or third cycle in 29.
  • At least two cycles of chemotherapy were administered during the course of radiation.
  • Radiotherapy was performed with 4 to 18 MeV linear accelerator X-rays, or telecobalt, through opposite anterior and posterior treatment portals or more complex field arrangements.
  • The doses were in the range of 44-66 Gy, with fractionation of 5x180-200 cGy weekly sessions.
  • After treatment, periodic follow-up controls were carried out in all cases.
  • Data on improvement of swallowing were always available, however, and the early therapeutic results were analysed accordingly.
  • Two-year survival after conclusion of the treatment was calculated according to Kaplan and Maier.
  • Survival was analysed (log-rank test) according to stage, Performance Status, oesophagectomy and body weight loss.
  • RESULTS: After treatment, subjective symptomatic relief occurred in 17 of the 22 patients presenting dysphagia (77.5%).
  • Acute toxicity (Grade III or IV WHO) of the treatment accounted for 47% of hematologic adverse effects, 40% of mucositis, 20.5% of vomiting or diarrhoea not responding to drug treatment.
  • Treatment delays of more than one week, due to toxicity, occurred in 23.5%.
  • Survival analysis, according to stage, showed 2 year values of 24% in Stage III and 0% in Stage IV (p=0.09).
  • Six patients showed a remarkable improvement in symptoms and general conditions after treatment, and were restaged with oesophagoscopy, thoracic CT scan and bronchoscopy, which evidenced resectable residual tumors, and they were then operated.
  • DISCUSSION AND CONCLUSIONS: Many Stage III and IV patients, selected for an aggressive chemo-radiation approach on the grounds of satisfactory medical conditions, can obtain relief of dysphagia.
  • Some cases, without extrathoracic spread of the tumor can achieve long term survival (in our experience 24% 2-year survival in Stage III, in our experience which favourably compares with the results obtained by other authors).
  • Whether surgery may improve the therapeutic results of chemo-radiotherapy in patients whose tumour has become resectable, is an issue that cannot be satisfactorily addressed on the basis of our experience, nor are the results from the available literature exhaustive to this regard.
  • [MeSH-major] Esophageal Neoplasms / drug therapy. Esophageal Neoplasms / radiotherapy
  • [MeSH-minor] Aged. Combined Modality Therapy. Female. Humans. Male. Middle Aged. Neoplasm Staging

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  • (PMID = 11677442.001).
  • [ISSN] 0033-8362
  • [Journal-full-title] La Radiologia medica
  • [ISO-abbreviation] Radiol Med
  • [Language] ita
  • [Publication-type] English Abstract; Journal Article
  • [Publication-country] Italy
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7. Iranzo V, Bremnes RM, Almendros P, Gavilá J, Blasco A, Sirera R, Camps C: Induction chemotherapy followed by concurrent chemoradiation for patients with non-operable stage III non-small-cell lung cancer. Lung Cancer; 2009 Jan;63(1):63-7
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  • [Title] Induction chemotherapy followed by concurrent chemoradiation for patients with non-operable stage III non-small-cell lung cancer.
  • Combined modality treatment with chemotherapy (CT) and radiotherapy (RT) in stage III non-small-cell lung cancer is considered as standard therapy.
  • As concomitant CT appears to be beneficial, the choice of anticancer agents and the role of induction chemotherapy is still unresolved.
  • 31 patients with non-operable stage IIIA or IIIB NSCLC without pleural effusion were included in this study: 30 males, 1 female; median age 66 years (range: 50-81); 32% with non-operable stage IIIA and 68% with stage IIIB without pleural effusion; 61% squamous cell carcinoma, 32% adenocarcinoma and 7% other histologies.
  • Patients received 3 courses of induction CT with carboplatin AUC=6 and paclitaxel 175 mg/m(2), administrated i.v. on day 1 of each 21-day cycle, followed by thoracic irradiation (total dose 60-65 Gy, daily fractions 1.8-2 Gy) with two concurrent courses of carboplatin/paclitaxel.
  • Esophageal G2 toxicity (RTOG) was observed in 28.1% of cases.
  • The induction CT followed by concomitant chemoradiation used in this study appears feasible, safe and effective when administered to an unselected inoperable NSCLC stage III patient cohort in the everyday routine clinical practice.
  • Further, our results are comparable to previously published phase III studies.
  • [MeSH-major] Carcinoma, Non-Small-Cell Lung / drug therapy. Carcinoma, Non-Small-Cell Lung / radiotherapy. Lung Neoplasms / drug therapy. Lung Neoplasms / radiotherapy
  • [MeSH-minor] Aged. Aged, 80 and over. Antineoplastic Agents / therapeutic use. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Carboplatin / administration & dosage. Combined Modality Therapy. Disease Progression. Female. Humans. Male. Medical Oncology / methods. Middle Aged. Paclitaxel / administration & dosage. Retrospective Studies

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  • (PMID = 18550204.001).
  • [ISSN] 0169-5002
  • [Journal-full-title] Lung cancer (Amsterdam, Netherlands)
  • [ISO-abbreviation] Lung Cancer
  • [Language] eng
  • [Publication-type] Clinical Trial; Journal Article
  • [Publication-country] Ireland
  • [Chemical-registry-number] 0 / Antineoplastic Agents; BG3F62OND5 / Carboplatin; P88XT4IS4D / Paclitaxel
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8. Albregts M, Hulshof MC, Zum Vörde Sive Vörding PJ, van Lanschot JJ, Richel DJ, Crezee H, Fockens P, van Dijk JD, González González D: A feasibility study in oesophageal carcinoma using deep loco-regional hyperthermia combined with concurrent chemotherapy followed by surgery. Int J Hyperthermia; 2004 Sep;20(6):647-59
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  • [Title] A feasibility study in oesophageal carcinoma using deep loco-regional hyperthermia combined with concurrent chemotherapy followed by surgery.
  • This phase I-II study investigated the feasibility of external deep loco-regional hyperthermia in localized primarily operable carcinoma of the thoracic oesophagus and gastro-oesophageal junction.
  • Toxicity when combining neo-adjuvant hyperthermia with concurrent chemotherapy (CDDP and etoposide) was evaluated.
  • Temperatures were monitored rectally, intra-oesophageal at tumour level and intramuscular near the spine.
  • The combined treatment courses were repeated every 3 weeks for a maximum of four courses.
  • Pre-treatment tumour stage mainly consisted of T3N1 (stage III) tumours, with a mean length of 6 cm.
  • Combined hyperthermia and chemotherapy was given 55 times in 26 patients.
  • Twenty-two patients underwent oesophageal-cardia resection with gastric tube reconstruction.
  • There was no report of complications in the post-operative phase, which could be contributed to either the prior chemotherapy or the hyperthermia.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Esophageal Neoplasms / therapy. Hyperthermia, Induced / methods
  • [MeSH-minor] Adenocarcinoma / drug therapy. Adenocarcinoma / surgery. Adenocarcinoma / therapy. Adult. Aged. Carcinoma, Squamous Cell / drug therapy. Carcinoma, Squamous Cell / surgery. Carcinoma, Squamous Cell / therapy. Cisplatin / administration & dosage. Cisplatin / adverse effects. Combined Modality Therapy. Etoposide / administration & dosage. Etoposide / adverse effects. Feasibility Studies. Female. Humans. Male. Middle Aged. Neoplasm Staging. Patient Selection. Survival Rate. Tomography, X-Ray Computed. Treatment Outcome

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  • (PMID = 15370820.001).
  • [ISSN] 0265-6736
  • [Journal-full-title] International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group
  • [ISO-abbreviation] Int J Hyperthermia
  • [Language] eng
  • [Publication-type] Clinical Trial; Clinical Trial, Phase I; Clinical Trial, Phase II; Journal Article
  • [Publication-country] England
  • [Chemical-registry-number] 6PLQ3CP4P3 / Etoposide; Q20Q21Q62J / Cisplatin
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9. Swisher SG, Pisters PW, Komaki R, Lahoti S, Ajani JA: Gastroesophageal junction adenocarcinoma. Curr Treat Options Oncol; 2000 Dec;1(5):387-98
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  • [Title] Gastroesophageal junction adenocarcinoma.
  • The incidence rate of adenocarcinoma of the esophagogastric junction (AEG) is increasing in association with the epidemiologic rise in distal esophageal adenocarcinoma and gastric cardial (AEG type III) tumors.
  • The overall survival rate is poor in most patients with AEG because lymph node or visceral metastases are frequently present at the time patients become symptomatic.
  • Early stage AEG (T1N0 or T2NO, carcinoma in situ, or severe dysplasia ) can in many instances be cured with surgery alone.
  • Ablative treatments for early stage AEG, including endoscopic fulguration by cautery and laser or photodynamic therapy, are investigational at this time.
  • Locoregionally advanced AEG (T3, T4, N1, or M1a ) without distant systemic metastases (M1b) has a poor overall survival rate with surgery alone or definitive chemotherapy and radiation therapy without surgery.
  • Analysis of the use of multimodality treatment strategies for locoregionally advanced AEG types I and II have demonstrated improved survival rates in two small phase III trials with preoperative concurrent chemoradiotherapy followed by surgical resection.
  • In contrast, three small phase III trials with preoperative concurrent or sequential chemoradiotherapy in patients with predominantly squamous cell carcinoma did not demonstrate any clear survival advantage.
  • Additionally, a randomized phase III study evaluating preoperative chemotherapy without radiation therapy in esophageal cancer (predominantly adenocarcinoma) has demonstrated no survival benefit.
  • In light of these results, additional large randomized phase III studies are needed to confirm the potential benefit of preoperative concurrent chemoradiotherapy.
  • At the present time, preoperative chemoradiotherapy remains investigational.
  • For locoregionally advanced gastric adenocarcinoma, including AEG type III, postoperative concurrent 5-fluorouracil (5-FU)-based chemoradiotherapy is associated with improved survival as demonstrated in a recently completed random assignment trial (INT 0116).
  • As a result, surgery with postoperative chemoradiotherapy has recently become the standard of care for patients with AJCC stage II and III gastric adenocarcinoma (including patients with AEG type III).
  • Metastatic AEG (M1b) should be treated with palliative chemotherapy (in good performance patients) or supportive care (poor performance) in asymptomatic patients.
  • Radiation therapy and endoscopic stent placement (expandable wire mesh) can be used to palliate dysphagia in patients with M1b disease.
  • [MeSH-major] Adenocarcinoma / therapy. Esophageal Neoplasms / therapy. Esophagogastric Junction / pathology
  • [MeSH-minor] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Combined Modality Therapy. Esophagectomy. Humans. Neoplasm Staging. Radiotherapy

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  • (PMID = 12057146.001).
  • [ISSN] 1527-2729
  • [Journal-full-title] Current treatment options in oncology
  • [ISO-abbreviation] Curr Treat Options Oncol
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 47
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10. Liao Z, Zhang Z, Jin J, Ajani JA, Swisher SG, Stevens CW, Ho L, Smythe R, Vaporciyan AA, Putnam JB Jr, Walsh GL, Roth JA, Yao JC, Allen PK, Cox JD, Komaki R: Esophagectomy after concurrent chemoradiotherapy improves locoregional control in clinical stage II or III esophageal cancer patients. Int J Radiat Oncol Biol Phys; 2004 Dec 1;60(5):1484-93
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  • [Title] Esophagectomy after concurrent chemoradiotherapy improves locoregional control in clinical stage II or III esophageal cancer patients.
  • PURPOSE: To evaluate the effect of surgical resection on the outcome of patients with clinical Stage II or III cancer of the esophagus treated with concurrent chemoradiotherapy.
  • METHODS AND MATERIALS: A retrospective review of 132 consecutive patients with clinical Stage II or III esophageal cancer treated with concurrent chemoradiotherapy between January 1990 and December 1998 was performed.
  • The median radiation dose was 50 Gy (range, 30-64.8 Gy) in the definitive chemoradiation group and 45 Gy (range, 30-50.4 Gy) in the chemoradiation plus esophagectomy group.
  • Patients who underwent definitive chemoradiotherapy were older (p = 0.0004) and more likely to have squamous cell carcinoma than adenocarcinoma (p <0.000), upper thoracic or cervical esophageal tumors (p <0.000), and T4 tumors (p = 0.024).
  • Patients treated with chemoradiation plus esophagectomy had statistically significant superior 5-year loco-regional control (67.1% vs. 22.1%, p <0.000), disease-free survival (40.7% vs. 9.9%, p < 0.000), and 5-year overall survival (52.6% vs. 6.5%, p < 0.000) rates and median survival time (62 vs. 12 months) compared with patients treated with chemoradiotherapy only.
  • CONCLUSIONS: Locoregional control was better in clinical Stage II or III esophageal cancer patients treated with concurrent chemoradiation plus esophagectomy.
  • The results from this study suggest the need for a randomized trial to compare chemoradiation with or without esophagectomy in the treatment of cancer of the esophagus.
  • [MeSH-major] Carcinoma, Squamous Cell / surgery. Esophageal Neoplasms / surgery. Esophagectomy
  • [MeSH-minor] Adenocarcinoma / drug therapy. Adenocarcinoma / pathology. Adenocarcinoma / radiotherapy. Adenocarcinoma / surgery. Adult. Aged. Aged, 80 and over. Analysis of Variance. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Cisplatin / administration & dosage. Combined Modality Therapy. Female. Fluorouracil / administration & dosage. Humans. Male. Middle Aged. Neoplasm Staging. Radiotherapy Dosage. Retrospective Studies. Treatment Failure

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  • (PMID = 15590179.001).
  • [ISSN] 0360-3016
  • [Journal-full-title] International journal of radiation oncology, biology, physics
  • [ISO-abbreviation] Int. J. Radiat. Oncol. Biol. Phys.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] Q20Q21Q62J / Cisplatin; U3P01618RT / Fluorouracil
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11. Stilidi I, Davydov M, Bokhyan V, Suleymanov E: Subtotal esophagectomy with extended 2-field lymph node dissection for thoracic esophageal cancer. Eur J Cardiothorac Surg; 2003 Mar;23(3):415-20
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  • [Title] Subtotal esophagectomy with extended 2-field lymph node dissection for thoracic esophageal cancer.
  • OBJECTIVE: To examine the efficacy of the Ivor Lewis esophagectomy with extended 2-field lymph node dissection for thoracic esophageal carcinoma we reviewed our experience.
  • METHODS: We analyzed the cases of 147 consecutive patients who underwent subtotal esophagectomy with extended 2-field lymph node dissection through Ivor Lewis approach for esophageal cancer from January 1996 through December 2000.
  • Eighty-six patients were operated on for cancer of the midthoracic esophagus, 48 for cancer of the lower thoracic esophagus, and 13 for cancer of the aortal segment of the esophagus.
  • No patient had received chemotherapy or radiotherapy before operation.
  • Postsurgical pathological studies revealed squamous cell carcinoma in 139 patients (94.6%), adenocarcinoma in five (3.4%), and adenosquamous carcinoma in three (2%).
  • Postsurgical staging was as follows: stage I in three patients (2%), stage IIa in 20 (13.6%), stage IIb in 29 (19.7%), stage III in 54 (36.8%), and stage IV in 41 (27.9%).
  • The 5-year survival rate for patients in stage IIa was 59%; for those in stage IIb, 39.5%; for patients in stage III, 26.7%; and 0% for patients in stage IV.
  • CONCLUSIONS: Subtotal esophagectomy with extended 2-field lymph node dissection through Ivor Lewis approach for esophageal cancer is a safe operation.
  • Long-term survival is stage dependent.
  • Effective multimodality treatment may be helpful for patients with advanced disease.
  • [MeSH-major] Esophageal Neoplasms / surgery. Esophagectomy / methods
  • [MeSH-minor] Adenocarcinoma / pathology. Adenocarcinoma / secondary. Adenocarcinoma / surgery. Aged. Carcinoma, Adenosquamous / pathology. Carcinoma, Adenosquamous / secondary. Carcinoma, Adenosquamous / surgery. Carcinoma, Squamous Cell / pathology. Carcinoma, Squamous Cell / secondary. Carcinoma, Squamous Cell / surgery. Female. Humans. Lymph Node Excision. Lymphatic Metastasis. Male. Middle Aged. Neoplasm Staging. Prognosis. Survival Rate. Treatment Outcome

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  • (PMID = 12614816.001).
  • [ISSN] 1010-7940
  • [Journal-full-title] European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
  • [ISO-abbreviation] Eur J Cardiothorac Surg
  • [Language] eng
  • [Publication-type] Evaluation Studies; Journal Article
  • [Publication-country] England
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12. Bubis JA, Williams I, Dragnev KH, Sutton JE, Gordon SR, Zaki BI, Cole BF, Rigas JR, Comprehensive Thoracic and Gastrointestinal Oncology Programs, Norris Cotton Cancer Center: Docetaxel (DTX) and carboplatin (CP) followed by a dose-ranging study of oral capecitabine, weekly DTX, concomitant radiotherapy and surgery for the treatment of patients with stage II-III carcinoma of the esophagus. J Clin Oncol; 2004 Jul 15;22(14_suppl):4049

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  • [Title] Docetaxel (DTX) and carboplatin (CP) followed by a dose-ranging study of oral capecitabine, weekly DTX, concomitant radiotherapy and surgery for the treatment of patients with stage II-III carcinoma of the esophagus.
  • : 4049 Background: We previously reported promising phase I data using neoadjuvant weekly DTX and 5-fluorouracil (5-FU) with thoracic irradiation followed by surgery in patients with locally advanced esophageal cancer.
  • This trial was modified in an attempt to improve the pathological complete response rate by increasing the 5-FU exposure during thoracic radiation with oral capecitabine (C).
  • METHODS: 18 patients with esophageal cancer (16 = adenocarcinoma, 2 = squamous) were consented and enrolled on this study.
  • Neoadjuvant therapy included DTX, 80 mg/M<sup>2</sup>, and CP, AUC 6, intravenously every three weeks for 2 cycles.
  • Subsequently, concomitant chemoradiotherapy (CXRT) was initiated with DTX, 15 mg/M<sup>2</sup>, weekly for five doses and C (7 = 500 mg, 3 = 1000 mg, 8 = 1500 mg) orally prior to each fraction of irradiation (50.4 Gy in 28 fractions).
  • RESULTS: Patient characteristics: EUS stage, 1 = T3N0, 2 = T2N1, 15 = T3N1.
  • Only 3 pts required a feeding tube; 11 pts had weight gain over the course of therapy.
  • Antitumor response following chemotherapy and CXRT was 78% (95% confidence interval: 52%-94%) by EUS.
  • Pts have tolerated combined modality therapy well with minimal side effects, thereby allowing for weight gain without the need for a feeding tube in the majority of enrollees.

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  • (PMID = 28014356.001).
  • [ISSN] 1527-7755
  • [Journal-full-title] Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • [ISO-abbreviation] J. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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13. Horgan AM, Darling G, Wong R, Visbal A, Guindi M, Jonker D, Liu G, Hornby J, Xu W, Knox JJ: Adjuvant sunitinib following chemoradiotherapy (CRT) and surgery for esophageal cancer: A phase II trial. J Clin Oncol; 2009 May 20;27(15_suppl):e15550

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Adjuvant sunitinib following chemoradiotherapy (CRT) and surgery for esophageal cancer: A phase II trial.
  • : e15550 Background: Locally advanced esophageal cancer (LAEC) has a 5-year survival of < 30 %.
  • Most patients (pts) fail after curative intent tri-modality treatment with distant metastatic disease.
  • This phase II trial aims to determine if adjuvant targeted therapy, after neoadjuvant CRT plus surgery for resectable LAEC, may impact on systemic disease without significant toxicity.
  • METHODS: Pts with LAEC of the thoracic esophagus or gastroesophageal junction, ECOG PS 0,1 and surgical candidates treated with: preoperative Irinotecan (65mg/m<sup>2</sup> initially, ammended to 50mg/m<sup>2</sup>) + Cisplatin (30mg/m<sup>2</sup>) on weeks 1,2,4,5,7,8 + concurrent conformal radiotherapy (50Gy/25 fractions) on weeks 4-8.
  • Median age 64 yr (43-71), male: 22, adenocarcinoma: squamous 22:6; 10 pts stage IIA, 5 IIB and 13 III.
  • 28 pts completed CRT - 18 pts (64%) received ≥80% of planned chemotherapy dose, 23 pts (82%) received full radiation dose.
  • 2 deaths on chemotherapy (1 bacterial meningitis, 1 FN) leading to irinotecan dose- reduction.

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  • (PMID = 27962341.001).
  • [ISSN] 1527-7755
  • [Journal-full-title] Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • [ISO-abbreviation] J. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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14. Visbal AL, Allen MS, Miller DL, Deschamps C, Trastek VF, Pairolero PC: Ivor Lewis esophagogastrectomy for esophageal cancer. Ann Thorac Surg; 2001 Jun;71(6):1803-8
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  • [Title] Ivor Lewis esophagogastrectomy for esophageal cancer.
  • BACKGROUND: To examine the efficacy of the Ivor Lewis esophagogastrectomy for esophageal carcinoma prior to the widespread use of preoperative chemotherapy and irradiation, we reviewed our experience.
  • METHODS: We reexamined the cases of 220 consecutive patients who underwent an Ivor Lewis esophagogastrectomy for esophageal cancer from January 1992 through December 1995.
  • The results of pathological study showed adenocarcinoma in 188 patients (85.5%), squamous cell carcinoma in 31 (14.1%), and leiomyosarcoma in 1 patient (0.5%).
  • Postsurgical staging was as follows: stage 0 in 10 patients, stage I in 19, stage IIa in 38, stage IIb in 28, stage III in 111, and stage IV in 14.
  • The overall 5-year survival rate was 25.2%; it was 80% for patients in stage 0, 94.4% for those in stage I, 36.0% for those in stage IIa, 14.3% for patients in stage IIb, 10% for those in stage III and 0% for patients in stage IV.
  • CONCLUSIONS: Ivor Lewis esophagogastrectomy for esophageal cancer is a safe operation.
  • Long-term survival is stage dependent.
  • The low survival associated with advanced cancers should stimulate the search for effective neoadjuvant therapy.
  • [MeSH-major] Adenocarcinoma / surgery. Carcinoma, Squamous Cell / surgery. Esophageal Neoplasms / surgery. Esophagectomy / methods. Gastrectomy / methods

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  • (PMID = 11426751.001).
  • [ISSN] 0003-4975
  • [Journal-full-title] The Annals of thoracic surgery
  • [ISO-abbreviation] Ann. Thorac. Surg.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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15. Zhang Z, Chen Y, Chen Y, Jeter M, Hofstetter WL, Ajani J, Swisher SG, Chang JY, Allen PK, Cox JD, Komaki R, Liao ZX: Outcomes with esophageal cancer radiation therapy. J Thorac Oncol; 2009 Jul;4(7):880-8
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  • [Title] Outcomes with esophageal cancer radiation therapy.
  • PURPOSE: Esophageal cancer is the seventh leading cause of cancer death worldwide and is responsible for 4% of the cancer deaths in the United States annually.
  • Changing epidemiologic patterns and expanded treatment options have brought this often deadly cancer to the forefront.
  • METHODS AND MATERIALS: To characterize epidemiological changes, the effect of treatment advances, and patient outcomes over time, we retrospectively reviewed 756 consecutive esophageal cancer cases treated between 1985 to 2003 at The University of Texas M. D.
  • Men make up 75% or more of the patients with esophageal cancer, most patients have adenocarcinoma in the gastroesophageal junction, and almost 75% have stage II or III disease.
  • By multivariate Cox regression analysis, significant reductions in relative risk were associated with having good performance status (relative risk [RR] = 0.68 [95% confidence interval (CI) = 0.56-0.83]; p < 0.001), being treated in the most recent interval (2000-2003) than in the first (1985-1989) (RR = 0.63 [95% CI = 0.44-0.88]; p = 0.007), with improved therapies, including induction chemotherapy plus concurrent chemoradiotherapy (RR = 0.68 [CI = 0.56-0.84]; p < 0.001), explaining the reductions.
  • CONCLUSION: Although fully delineated comparisons must await incorporation and study of data through 2007, this analysis suggests that multimodality management that has been adapted in recent years may be associated with the improvements in outcomes of these cases of largely stage II and III esophageal adenocarcinoma found at the gastroesophageal junction.
  • [MeSH-major] Esophageal Neoplasms / mortality. Esophageal Neoplasms / radiotherapy
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Combined Modality Therapy. Disease Progression. Female. Humans. Male. Middle Aged. Neoplasm Staging. Proportional Hazards Models. Retrospective Studies. Survival Rate. Texas / epidemiology. Tomography, X-Ray Computed. Treatment Outcome

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  • (PMID = 19458557.001).
  • [ISSN] 1556-1380
  • [Journal-full-title] Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
  • [ISO-abbreviation] J Thorac Oncol
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
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16. Liang Z, Hu WD, Gu ZD, Xiong HC, Chen KN: [Evaluation of transhiatus esophagectomy for patients with esophageal cancer]. Zhonghua Wei Chang Wai Ke Za Zhi; 2008 Sep;11(5):451-3
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  • [Title] [Evaluation of transhiatus esophagectomy for patients with esophageal cancer].
  • OBJECTIVE: To evaluate the transhiatus esophagectomy for patients with esophageal cancer.
  • METHODS: Clinicopathological data of 46 patients with esophageal cancer undergone transhiatus esophagectomy by single surgeon team from May 2000 to July 2007 were analyzed retrospectively.
  • RESULTS: These 46 patients included 44 esophageal squamous cell carcinomas,1 esophageal adenocarcinoma and 1 esophageal carcinoid.
  • All the patients were classified according to UICC TNM stage classification: 3 cases as stage 0, 6 cases as stage I, 17 cases as stage II a, 2 cases as stage II b, 16 cases as stage III.
  • Six patients received preoperative chemotherapy and pathological complete response was seen in 2 cases.
  • CONCLUSION: Transhiatus esophagectomy is an ideal choice in surgical treatment for patients with esophageal cancer, especially for the ones of aged, poor cardiac or pulmonary function, who can not afford the thoracotomy.
  • [MeSH-major] Carcinoma, Squamous Cell / surgery. Esophageal Neoplasms / surgery. Esophagectomy / methods

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  • (PMID = 18803048.001).
  • [ISSN] 1671-0274
  • [Journal-full-title] Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery
  • [ISO-abbreviation] Zhonghua Wei Chang Wai Ke Za Zhi
  • [Language] chi
  • [Publication-type] English Abstract; Evaluation Studies; Journal Article
  • [Publication-country] China
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17. Swanson SJ, Batirel HF, Bueno R, Jaklitsch MT, Lukanich JM, Allred E, Mentzer SJ, Sugarbaker DJ: Transthoracic esophagectomy with radical mediastinal and abdominal lymph node dissection and cervical esophagogastrostomy for esophageal carcinoma. Ann Thorac Surg; 2001 Dec;72(6):1918-24; discussion 1924-5
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  • [Title] Transthoracic esophagectomy with radical mediastinal and abdominal lymph node dissection and cervical esophagogastrostomy for esophageal carcinoma.
  • BACKGROUND: Several techniques for esophageal resection have been reported.
  • This study examines the morbidity, mortality, and early survival of patients after transthoracic esophagectomy for esophageal carcinoma using current staging techniques and neoadjuvant therapy.
  • The technique includes right thoracotomy, laparotomy, and cervical esophagogastrostomy (total thoracic esophagectomy) with radical mediastinal and abdominal lymph node dissection.
  • METHODS: Three hundred forty-two patients had surgery for esophageal carcinoma between 1989 and 2000 at our institution.
  • Kaplan-Meier curves and univariate and multivariate analyses were performed by postsurgical pathologic stage.
  • Eighty-one percent (202) had induction chemotherapy (all patients with clinical T3/4 or N1).
  • Overall survival at 3 years was 44%; median survival was 25 months, and 3-year survival by posttreatment pathologic stage was: stage 0 (complete response) (n = 60), 56%; stage I (n = 32), 65%; stage IIA (n = 67), 41%; stage IIB (n = 30), 46%; and stage III (n = 49), 17%.
  • Five patients with tumor in situ, 6 patients with stage IV disease, and 1 patient who could not be staged (12 pts) were excluded from survival and multivariate calculations.
  • CONCLUSIONS: Total thoracic esophagectomy with node dissection for esophageal cancer appears to have acceptable morbidity and mortality with encouraging survival results in the setting of neoadjuvant therapy.
  • [MeSH-major] Adenocarcinoma / surgery. Barrett Esophagus / surgery. Carcinoma, Squamous Cell / surgery. Esophageal Neoplasms / surgery. Esophagectomy / methods. Gastrostomy / methods. Lymph Node Excision / methods. Precancerous Conditions / surgery

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  • (PMID = 11789772.001).
  • [ISSN] 0003-4975
  • [Journal-full-title] The Annals of thoracic surgery
  • [ISO-abbreviation] Ann. Thorac. Surg.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Netherlands
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18. Kenjo M, Uno T, Murakami Y, Nagata Y, Oguchi M, Saito S, Numasaki H, Teshima T, Mitsumori M: Radiation therapy for esophageal cancer in Japan: results of the Patterns of Care Study 1999-2001. Int J Radiat Oncol Biol Phys; 2009 Oct 1;75(2):357-63
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  • [Title] Radiation therapy for esophageal cancer in Japan: results of the Patterns of Care Study 1999-2001.
  • PURPOSE: To describe patient characteristics and the process of radiotherapy (RT) for patients with esophageal cancer treated between 1999 and 2001 in Japan.
  • Detailed information was accumulated on 621 patients with thoracic esophageal cancer who received RT.
  • Fifty-five percent had the main lesion in the middle thoracic esophagus.
  • Fourteen percent had clinical Stage 0-I disease, 32% had Stage IIA-IIB, 43% had Stage III, and 10% had Stage IV disease.
  • Chemotherapy was given to 63% of patients; 39% received definitive chemoradiotherapy (CRT) without surgery and 24% pre- or postoperative CRT.
  • Median total dose of external RT was 60 Gy for definitive CRT patients, 60 Gy for RT alone, and 40 Gy for preoperative CRT.
  • CONCLUSIONS: This PCS describes general aspects of RT for esophageal cancer in Japan.
  • The standard total external RT dose for esophageal cancer was higher in Japan than in the United States.
  • Chemoradiotherapy had become common for esophageal cancer treatment, but patients aged > or =75 years were more likely to be treated by RT only.
  • [MeSH-major] Carcinoma, Squamous Cell / radiotherapy. Esophageal Neoplasms / radiotherapy. Health Care Surveys
  • [MeSH-minor] Adenocarcinoma / drug therapy. Adenocarcinoma / pathology. Adenocarcinoma / radiotherapy. Adenocarcinoma / surgery. Aged. Carcinoma, Adenosquamous / drug therapy. Carcinoma, Adenosquamous / pathology. Carcinoma, Adenosquamous / radiotherapy. Carcinoma, Adenosquamous / surgery. Combined Modality Therapy / methods. Combined Modality Therapy / utilization. Female. Humans. Japan. Male. Middle Aged. Neoplasm Staging. Radiotherapy / methods

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  • (PMID = 19735863.001).
  • [ISSN] 1879-355X
  • [Journal-full-title] International journal of radiation oncology, biology, physics
  • [ISO-abbreviation] Int. J. Radiat. Oncol. Biol. Phys.
  • [Language] eng
  • [Publication-type] Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
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19. Taylor MD, Smith PW, Brix WK, Wick MR, Theodosakis N, Swenson BR, Kozower BD, Jones DR: Correlations between selected tumor markers and fluorodeoxyglucose maximal standardized uptake values in esophageal cancer. Eur J Cardiothorac Surg; 2009 Apr;35(4):699-705
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  • [Title] Correlations between selected tumor markers and fluorodeoxyglucose maximal standardized uptake values in esophageal cancer.
  • OBJECTIVE: Esophageal cancer tumor biology is best assessed clinically by 2-[18F]fluoro-2-deoxy-d-glucose (FDG)-PET.
  • Both FDG-PET maximal positron emission tomography (PET) standardized uptake values (SUVmax) and selected tumor markers have been shown to correlate with stage, nodal disease, and survival in esophageal cancer.
  • Interestingly, there is limited data examining the relationship between FDG-PET SUVmax and expression of these tumor markers in esophageal cancer.
  • The purpose of this study was to determine the correlation of tumor markers with FDG-PET SUVmax in esophageal cancer.
  • METHODS: FDG-PET SUVmax was calculated in 67 patients with esophageal cancer of which 59 (88%) had adenocarcinoma.
  • Neoadjuvant radiotherapy and/or chemotherapy were administered to 42% (28/67) of patients.
  • Esophageal tumor tissue and surrounding normal tissue was obtained and tissue microarrays were created.
  • Immunohistochemical analysis was performed for five known esophageal cancer tumor markers (GLUT-1, p53, cyclin D1, epidermal growth factor receptor (EGFR), and vascular endothelial growth factor (VEGF)).
  • Pathologic staging included stage I (n=29, 43%), stage II (n=19, 28%), stage III disease (n=18, 27%), and stage IV disease (n=1, 2%).
  • PET SUVmax correlated with T stage (p=0.001).
  • In patients undergoing surgery without induction therapy, increasing SUVmax values correlated with increased expression of GLUT-1 transporter (p=0.01).
  • CONCLUSIONS: FDG-PET SUVmax correlates with an increased expression of GLUT-1 transporter in esophageal cancer specimens not subjected to induction therapy.
  • No significant difference in tumor marker expression was noted between patients undergoing induction therapy or surgery alone except p53 expression decreased in primary tumors following induction therapy.
  • Failure of SUVmax values to correlate with known prognostic esophageal cancer tumor markers suggests that FDG-PET may have limited clinical utility in assessing response to therapies targeting these markers.

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  • (PMID = 19136271.001).
  • [ISSN] 1873-734X
  • [Journal-full-title] European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
  • [ISO-abbreviation] Eur J Cardiothorac Surg
  • [Language] ENG
  • [Grant] United States / NHLBI NIH HHS / HL / HL007849-09; United States / NHLBI NIH HHS / HL / T32 HL007849; United States / NHLBI NIH HHS / HL / T32 HL007849-09
  • [Publication-type] Journal Article
  • [Publication-country] Germany
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / Glucose Transporter Type 1; 0 / Neoplasm Proteins; 0 / Radiopharmaceuticals; 0Z5B2CJX4D / Fluorodeoxyglucose F18
  • [Other-IDs] NLM/ NIHMS189314; NLM/ PMC2878130
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20. Stiles BM, Mirza F, Port JL, Lee PC, Paul S, Christos P, Altorki NK: Predictors of cervical and recurrent laryngeal lymph node metastases from esophageal cancer. Ann Thorac Surg; 2010 Dec;90(6):1805-11; discussion 1811
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  • [Title] Predictors of cervical and recurrent laryngeal lymph node metastases from esophageal cancer.
  • BACKGROUND: Although patients with esophageal cancer (EC) often develop lymph node metastases in the cervical and recurrent laryngeal (CRL) distribution, lymphadenectomy in this field is rarely performed.
  • Final pathology stages (seventh edition) were I in 24 patients, II in 43, III in 109, and IV in 1 patient.
  • Eight patients had a major pathologic response after induction therapy.
  • There was no reduction in the rate of positive CRL nodes after induction chemotherapy.
  • CONCLUSIONS: Complete lymphadenectomy is necessary in esophageal cancer to appropriately stage patients.
  • Low rates of positive CRL nodes are present with early clinical stage, with pT0-2 tumors, and with pN0 classification, particularly in patients with adenocarcinoma and gastroesophageal junction tumors.
  • Dissection of the CRL field should be considered with advanced disease for adenocarcinoma and in all patients with squamous cell cancer.
  • [MeSH-major] Esophageal Neoplasms / secondary. Lymph Node Excision / methods. Lymph Nodes / pathology. Lymphatic Metastasis / diagnosis. Neoplasm Recurrence, Local / prevention & control
  • [MeSH-minor] Combined Modality Therapy. Female. Follow-Up Studies. Humans. Incidence. Larynx. Male. Neck. Neoplasm Staging. New York / epidemiology. Odds Ratio. Prognosis. Retrospective Studies. Risk Factors

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  • [Copyright] Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
  • (PMID = 21095315.001).
  • [ISSN] 1552-6259
  • [Journal-full-title] The Annals of thoracic surgery
  • [ISO-abbreviation] Ann. Thorac. Surg.
  • [Language] eng
  • [Grant] United States / NCRR NIH HHS / RR / UL1-RR024996
  • [Publication-type] Comparative Study; Journal Article; Research Support, N.I.H., Extramural
  • [Publication-country] Netherlands
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21. D'Angelillo RM, Trodella L, Ciresa M, Cellini F, Fiore M, Greco C, Pompeo E, Mineo TC, Paleari L, Granone P, Ramella S, Cesario A: Multimodality treatment of stage III non-small cell lung cancer: analysis of a phase II trial using preoperative cisplatin and gemcitabine with concurrent radiotherapy. J Thorac Oncol; 2009 Dec;4(12):1517-23
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  • [Title] Multimodality treatment of stage III non-small cell lung cancer: analysis of a phase II trial using preoperative cisplatin and gemcitabine with concurrent radiotherapy.
  • INTRODUCTION: We report the results of a phase II trial exploring the efficacy and the feasibility of combination of gemcitabine and cisplatin concurrent with radiotherapy followed by surgery in patients with stage III non-small cell lung cancer.
  • A 3D-conformal radiotherapy was delivered up to 50.4 Gy, with daily fractionation of 1.8 Gy.
  • RESULTS: The stage at diagnosis was IIIA-N2 in 29 patients and IIIB-T4N0-2 for vascular direct infiltration for the remaining 21.
  • Fifteen patients (30%) experienced acute grade 3 to 4 hematological toxicity, whereas acute grade 3 esophageal toxicity was recorded in three patients (6%).
  • One patient developed a grade 4 pulmonary toxicity (2%).
  • Final pathology showed a downstaging to stage 0 to I in 25 cases (50%).
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Carcinoma, Non-Small-Cell Lung / drug therapy. Carcinoma, Non-Small-Cell Lung / radiotherapy. Lung Neoplasms / drug therapy. Lung Neoplasms / radiotherapy
  • [MeSH-minor] Adenocarcinoma / drug therapy. Adenocarcinoma / radiotherapy. Adenocarcinoma / secondary. Adult. Aged. Aged, 80 and over. Carcinoma, Large Cell / drug therapy. Carcinoma, Large Cell / radiotherapy. Carcinoma, Large Cell / secondary. Carcinoma, Squamous Cell / drug therapy. Carcinoma, Squamous Cell / radiotherapy. Carcinoma, Squamous Cell / secondary. Cisplatin / administration & dosage. Combined Modality Therapy. Deoxycytidine / administration & dosage. Deoxycytidine / analogs & derivatives. Dose Fractionation. Feasibility Studies. Female. Follow-Up Studies. Humans. Male. Middle Aged. Neoplasm Staging. Prognosis. Survival Rate. Treatment Outcome

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  • (PMID = 19875976.001).
  • [ISSN] 1556-1380
  • [Journal-full-title] Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
  • [ISO-abbreviation] J Thorac Oncol
  • [Language] eng
  • [Publication-type] Clinical Trial, Phase II; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0W860991D6 / Deoxycytidine; B76N6SBZ8R / gemcitabine; Q20Q21Q62J / Cisplatin
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22. Ruol A, Castoro C, Portale G, Cavallin F, Sileni VC, Cagol M, Alfieri R, Corti L, Boso C, Zaninotto G, Peracchia A, Ancona E: Trends in management and prognosis for esophageal cancer surgery: twenty-five years of experience at a single institution. Arch Surg; 2009 Mar;144(3):247-54; discussion 254
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  • [Title] Trends in management and prognosis for esophageal cancer surgery: twenty-five years of experience at a single institution.
  • OBJECTIVE: To investigate trends in results of esophagectomies to treat esophageal cancer at a single high-volume institution during the past 25 years.
  • PATIENTS AND METHODS: Patients with cancer of the thoracic esophagus or esophagogastric junction seen from 1980 through 2004 were included (N = 3493).
  • Three time periods were defined: 1980-1987, 1988-1995, and 1996-2004.
  • MAIN OUTCOME MEASURES: Clinical presentation, tumor characteristics, and morbidity, mortality, and survival rates among patients with esophageal cancer undergoing esophagectomy.
  • RESULTS: The ratio of squamous cell carcinoma to adenocarcinoma decreased from 3.3 to 1.7 (P <.001) during the study period, in parallel with an increase in the number of patients with tumors in the lower esophagus/esophagogastric junction.
  • An increasing proportion of patients who underwent resection received neoadjuvant treatment (chemotherapy/chemoradiotherapy), and 1978 patients underwent esophagectomy.
  • In addition, an increasing proportion of patients had early-stage tumor in the resected specimen.
  • Pathological tumor stage, completeness of the resection, time period, sex, tumor histological type, and tumor location influenced the prognosis of patients with esophageal cancer undergoing esophagectomy.
  • CONCLUSIONS: A change in location and histological type of esophageal cancer has occurred during the past 25 years.
  • Earlier diagnosis, a multidisciplinary approach, and refinements in surgical technique and perioperative care have led to a significant reduction in postoperative mortality rate and improved long-term survival among patients with cancer of the thoracic esophagus or esophagogastric junction.
  • [MeSH-major] Adenocarcinoma / surgery. Carcinoma, Squamous Cell / surgery. Esophageal Neoplasms / surgery. Esophagectomy / trends. Esophagogastric Junction

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  • (PMID = 19289664.001).
  • [ISSN] 1538-3644
  • [Journal-full-title] Archives of surgery (Chicago, Ill. : 1960)
  • [ISO-abbreviation] Arch Surg
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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23. Bains MS, Stojadinovic A, Minsky B, Rusch V, Turnbull A, Korst R, Ginsberg R, Kelsen DP, Ilson DH: A phase II trial of preoperative combined-modality therapy for localized esophageal carcinoma: initial results. J Thorac Cardiovasc Surg; 2002 Aug;124(2):270-7
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  • [Title] A phase II trial of preoperative combined-modality therapy for localized esophageal carcinoma: initial results.
  • OBJECTIVE: We sought to evaluate treatment response to a novel combined-modality treatment regimen for localized esophageal carcinoma.
  • METHODS: Localized esophageal carcinoma was confirmed with endoscopic ultrasonography, computed tomography, and positron emission tomography before induction therapy.
  • This therapy consisted of combined cisplatin/paclitaxel (cisplatin, 75 mg/m(2); paclitaxel, 175 mg/m(2); 2 cycles, 3-hour infusion) for weeks 1 and 4, combined cisplatin (30 mg. m(-2).
  • wk(-1), 96-hour infusion) with concurrent radiation (external beam, 1.8 Gy/d; total, 50.4 Gy) for weeks 7 to 12, and esophagectomy for week 16 after restaging confirmed resectability.
  • RESULTS: Forty-one patients (36 men) with adenocarcinoma (n = 25) or squamous cell carcinoma (n = 16) were enrolled.
  • Thirty-six patients completed treatment, of whom 34 (85%) had locally advanced disease of clinical stage T3-4 N0-1.
  • Symptoms resolved or improved in 35 (92%) of 38 patients after induction chemotherapy.
  • Fourteen (35%) and 10 (24%) patients experienced grade III/IV myelosuppression during induction chemotherapy and chemoradiation, respectively.
  • Two (5%) had grade III and none had grade IV esophagitis during chemoradiation.
  • Only 2 (5%) patients required enteral feeding-tube support during therapy.
  • CONCLUSION: This regimen of induction concurrent chemoradiation followed by surgical intervention for esophageal carcinoma produces rapid dysphagia relief with initial chemotherapy, has a high overall response rate, and has acceptable toxicity levels.
  • [MeSH-major] Adenocarcinoma / therapy. Carcinoma, Squamous Cell / therapy. Esophageal Neoplasms / therapy
  • [MeSH-minor] Adult. Aged. Antineoplastic Combined Chemotherapy Protocols. Cisplatin / administration & dosage. Combined Modality Therapy. Diagnostic Imaging. Female. Humans. Male. Middle Aged. Paclitaxel / administration & dosage. Treatment Outcome

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  • (PMID = 12167786.001).
  • [ISSN] 0022-5223
  • [Journal-full-title] The Journal of thoracic and cardiovascular surgery
  • [ISO-abbreviation] J. Thorac. Cardiovasc. Surg.
  • [Language] eng
  • [Grant] United States / NCPDCID CDC HHS / CI / NCI U01 166913
  • [Publication-type] Clinical Trial; Clinical Trial, Phase II; Journal Article; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] United States
  • [Chemical-registry-number] P88XT4IS4D / Paclitaxel; Q20Q21Q62J / Cisplatin
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24. Kolh P, Honore P, Degauque C, Gielen J, Gerard P, Jacquet N: Early stage results after oesophageal resection for malignancy - colon interposition vs. gastric pull-up. Eur J Cardiothorac Surg; 2000 Sep;18(3):293-300
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  • [Title] Early stage results after oesophageal resection for malignancy - colon interposition vs. gastric pull-up.
  • METHODS: From January 1990 to December 1998, 130 patients underwent oesophageal resection for malignancy.
  • Indications were squamous cell carcinoma in 69 patients and adenocarcinoma in 61.
  • Preoperatively 30 patients (eight in stage IIB, 18 in stage III, and four in stage IV) received radiochemotherapy.
  • There were 84 subtotal oesophagectomies, with anastomosis in the neck in 44 patients and at the thoracic inlet in 40, and 46 distal oesophageal resections.
  • The incidence of postoperative pulmonary complications was 70% (21/30 patients) in the subgroup who received preoperative radiochemotherapy, as compared to 11% (5/44 patients) in the subgroup of comparable staging, but without preoperative treatment (P<0.001).
  • Our results suggest that preoperative neoadjuvant treatment significantly increases postoperative pulmonary complications.
  • [MeSH-major] Adenocarcinoma / surgery. Carcinoma, Squamous Cell / surgery. Colon / transplantation. Esophageal Neoplasms / surgery. Esophagus / surgery. Stomach / surgery
  • [MeSH-minor] Anastomosis, Surgical / methods. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Esophagectomy. Female. Hospital Mortality. Humans. Male. Middle Aged. Palliative Care. Reoperation. Retrospective Studies. Stomach Neoplasms / drug therapy. Stomach Neoplasms / mortality. Stomach Neoplasms / radiotherapy. Stomach Neoplasms / surgery. Survival Rate. Treatment Outcome

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  • (PMID = 10973538.001).
  • [ISSN] 1010-7940
  • [Journal-full-title] European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
  • [ISO-abbreviation] Eur J Cardiothorac Surg
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] ENGLAND
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25. Knox JJ, Wong R, Visbal AL, Horgan AM, Guindi M, Hornby J, Xu W, Ringash J, Keshavjee S, Chen E, Haider M, Darling G: Phase 2 trial of preoperative irinotecan plus cisplatin and conformal radiotherapy, followed by surgery for esophageal cancer. Cancer; 2010 Sep 1;116(17):4023-32
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  • [Title] Phase 2 trial of preoperative irinotecan plus cisplatin and conformal radiotherapy, followed by surgery for esophageal cancer.
  • BACKGROUND: Esophagectomy for locally advanced esophageal cancer (LAEC) is associated with limited survival.
  • Trimodality therapy yields a small survival advantage, with cisplatin and 5-fluorouracil regimens most frequently studied.
  • METHODS: Patients with LAEC of the thoracic esophagus or gastroesophageal junction underwent chemotherapy with preoperative irinotecan (65 mg/m(2)) plus cisplatin (30 mg/m(2)) on Weeks 1, 2, 4, 5, 7, and 8 with concurrent conformal radiotherapy (40 grays [Gy]/20 fractions during Weeks 4-7) and external beam boost (10 Gy/5 fractions at Week 8).
  • Nineteen patients had American Joint Committee on Cancer stage II, 22 had stage III, and 11 had stage IVA disease.
  • Three patients withdrew from treatment due to toxicity.
  • There was 1 treatment-related death.
  • Median and 3-year overall survival for patients receiving trimodality therapy was 36 months and 51%, respectively.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Camptothecin / analogs & derivatives. Cisplatin / administration & dosage. Esophageal Neoplasms / therapy
  • [MeSH-minor] Adenocarcinoma / drug therapy. Adenocarcinoma / surgery. Adult. Aged. Carcinoma, Squamous Cell / drug therapy. Carcinoma, Squamous Cell / radiotherapy. Carcinoma, Squamous Cell / surgery. Combined Modality Therapy. Esophagectomy. Esophagogastric Junction. Female. Humans. Male. Middle Aged. Neoadjuvant Therapy. Radiotherapy, Conformal

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  • [Copyright] Cancer 2010. (c) 2010 American Cancer Society.
  • (PMID = 20533506.001).
  • [ISSN] 0008-543X
  • [Journal-full-title] Cancer
  • [ISO-abbreviation] Cancer
  • [Language] eng
  • [Publication-type] Clinical Trial, Phase II; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 7673326042 / irinotecan; Q20Q21Q62J / Cisplatin; XT3Z54Z28A / Camptothecin
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26. Wang H, Ryu J, Gandara D, Bold RJ, Urayama S, Tanaka M, Goldberg Z, Follette D, Narayan S, Lau D: A phase II study of paclitaxel, carboplatin, and radiation with or without surgery for esophageal cancer. J Thorac Oncol; 2007 Feb;2(2):153-7
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  • [Title] A phase II study of paclitaxel, carboplatin, and radiation with or without surgery for esophageal cancer.
  • BACKGROUND: Cisplatin-based chemoradiotherapy (CRT) has been a standard treatment for patients with locally advanced esophageal cancer.
  • We conducted a phase II clinical trial of concurrent paclitaxel, carboplatin, and radiation with or without surgery as an alternative to the standard cisplatin-based CRT for localized and metastatic esophageal cancer.
  • METHODS: Fifty patients with esophageal cancer were enrolled: 16 patients with stage II, eight patients with stage III, and 26 patients with stage IV disease.
  • Two thirds (67%) of patients had adenocarcinoma and one third (33%) with squamous histology.
  • Patients with resectable disease were treated with paclitaxel 30 mg/m, twice weekly for 10 doses, carboplatin AUC (area under the curve) 1.5 weekly for five doses; and concurrent radiation, 1.8 Gy/day, for a total of 45 Gy, followed by esophagectomy.
  • Without surgery, patients received an additional dose each of paclitaxel and carboplatin with concurrent radiation for a total of 50.4 Gy, followed by two consolidation cycles of paclitaxel (200 mg/m) and carboplatin (AUC 6).
  • RESULTS: During CRT, common stage III/IV toxicities included nausea/emesis (19%), esophagitis (9%), and neutropenia (4%).
  • For consolidation chemotherapy, neutropenia (23%), neuropathy (8%) and nausea/emesis (4%) were the most common stage III/IV side effects.
  • With a median follow-up of 32 months, the median survival was 12 months for patients with metastatic disease, 44 months for localized disease treated with esophagectomy, and >44 months for localized disease treated with definitive CRT.
  • CONCLUSIONS: The regimen of paclitaxel, carboplatin, and radiation with or without surgery is well tolerated with promising efficacy for patients with esophageal cancer.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / administration & dosage. Esophageal Neoplasms / drug therapy. Esophageal Neoplasms / radiotherapy
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Carboplatin / administration & dosage. Combined Modality Therapy. Female. Humans. Male. Middle Aged. Paclitaxel / administration & dosage

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  • (PMID = 17410032.001).
  • [ISSN] 1556-1380
  • [Journal-full-title] Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
  • [ISO-abbreviation] J Thorac Oncol
  • [Language] eng
  • [Publication-type] Clinical Trial, Phase II; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] BG3F62OND5 / Carboplatin; P88XT4IS4D / Paclitaxel
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27. Low DE, Kunz S, Schembre D, Otero H, Malpass T, Hsi A, Song G, Hinke R, Kozarek RA: Esophagectomy--it's not just about mortality anymore: standardized perioperative clinical pathways improve outcomes in patients with esophageal cancer. J Gastrointest Surg; 2007 Nov;11(11):1395-402; discussion 1402
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  • [Title] Esophagectomy--it's not just about mortality anymore: standardized perioperative clinical pathways improve outcomes in patients with esophageal cancer.
  • BACKGROUND: Esophageal resection (ER) remains the standard therapy for early esophageal cancer; however, because of concerns regarding high levels of morbidity and mortality reported in analyses of national databases, many patients are relegated to less effective endoscopic or chemotherapeutic approaches.
  • All aspects of work-up and treatment were guided by an evolving standardized perioperative clinical pathway.
  • RESULTS: Three hundred forty consecutive patients, mean age of 64 (33-90), underwent ER for Barrett's esophagus (17) or invasive cancer stages I-87, II-133, III-94, IV-9.
  • One hundred thirty-nine (41%) had neoadjuvant therapy.
  • Sixty-three percent were American Society of Anesthesiologists class III or IV, and five different operative approaches were used.
  • No significant differences were seen in length of stay, operative time, blood loss, or complications in patients receiving neoadjuvant therapy.
  • For stages I, II, and III, patients between 1998-2004 Kaplan-Meier 5-year cumulative survival was 92.4, 57.1, and 34.5%, respectively.
  • CONCLUSIONS: Surgical treatment of esophageal cancer can be done with moderate morbidity and very low mortality, and the expectation of improved levels of survival, especially in early-stage patients.
  • Standardized perioperative clinical pathways can provide the infrastructure for the treatment of these patients and should include increased efforts to minimize blood loss and transfusions, improve postoperative pain control and extubation rates, and facilitate early mobilization and discharge.
  • ER, as sole therapy or in combination with radiation/chemotherapy, should remain the standard of care in patients with early and locoregional esophageal cancer.
  • [MeSH-major] Adenocarcinoma / mortality. Adenocarcinoma / surgery. Carcinoma, Squamous Cell / mortality. Carcinoma, Squamous Cell / surgery. Critical Pathways. Esophageal Neoplasms / mortality. Esophageal Neoplasms / surgery. Esophagectomy
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Barrett Esophagus / surgery. Blood Loss, Surgical. Female. Humans. Length of Stay. Male. Middle Aged. Neoadjuvant Therapy. Neoplasm Staging. Prognosis. Treatment Outcome

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  • (PMID = 17763917.001).
  • [ISSN] 1091-255X
  • [Journal-full-title] Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
  • [ISO-abbreviation] J. Gastrointest. Surg.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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28. Maier A, Anegg U, Tomaselli F, Rehak P, Sankin O, Fell B, Renner H, Pinter H, Smolle-Jüttner FM, Friehs GB: Does hyperbaric oxygen enhance the effect of photodynamic therapy in patients with advanced esophageal carcinoma? A clinical pilot study. Endoscopy; 2000 Jan;32(1):42-8
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  • [Title] Does hyperbaric oxygen enhance the effect of photodynamic therapy in patients with advanced esophageal carcinoma? A clinical pilot study.
  • In a clinical pilot study we assessed the use of photodynamic therapy (PDT) under hyperbaric oxygen (HBO), compared with PDT under normobaric conditions, in patients with advanced esophageal carcinoma.
  • Of the patients, 14 (12 with stage III cancers, and two with stage IV cancers) were treated by PDT alone, and 17 patients (15 with stage III cancers, and two with stage IV cancers) received PDT under HBO at a level of 2 absolute atmospheric pressures (ATA).
  • RESULTS: Improvements regarding dysphagia and stenosis diameter were obtained in both treatment arms with no significant differences (P = 0.36 and 0.14, respectively).
  • No major treatment-related complication occurred, and the 30-day mortality rate was 0%.
  • CONCLUSIONS: Combined PDT/HBO represents a new approach in the treatment of esophageal cancer which, in this pilot study, appears to have enhanced the efficiency of PDT.
  • [MeSH-major] Adenocarcinoma / drug therapy. Carcinoma, Squamous Cell / drug therapy. Esophageal Neoplasms / drug therapy. Hematoporphyrin Photoradiation. Hyperbaric Oxygenation
  • [MeSH-minor] Aged. Aged, 80 and over. Esophagoscopy. Humans. Male. Middle Aged. Neoplasm Staging. Palliative Care. Pilot Projects. Treatment Outcome

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  • (PMID = 10691271.001).
  • [ISSN] 0013-726X
  • [Journal-full-title] Endoscopy
  • [ISO-abbreviation] Endoscopy
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] GERMANY
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29. Rice DC, Correa AM, Vaporciyan AA, Sodhi N, Smythe WR, Swisher SG, Walsh GL, Putnam JB Jr, Komaki R, Ajani JA, Roth JA: Preoperative chemoradiotherapy prior to esophagectomy in elderly patients is not associated with increased morbidity. Ann Thorac Surg; 2005 Feb;79(2):391-7; discussionn 391-7
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  • BACKGROUND: Preoperative chemotherapy and radiation therapy are often administered to patients with esophageal cancer.
  • Despite an aging population, little data exist regarding feasibility of preoperative therapy in elderly patients.
  • METHODS: Between January 1997 and December 2002, 312 consecutive patients underwent esophagectomy for esophageal cancer at our institution.
  • Outcomes of patients 70 years old, who underwent preoperative therapy (n = 35; group II), were compared with those of patients who did not (n = 39; group I) and with those of patients younger than 70 years old who received preoperative therapy (n = 165; group III).
  • The patients in group II were of more advanced clinical stage (p < 0.001).
  • Compared with group III, group II patients had higher rates of postoperative atrial arrhythmias (p = 0.013) and perioperative blood transfusions (p = 0.004).
  • CONCLUSIONS: Elderly patients receiving preoperative therapy for esophageal cancer do not have an increased incidence of major postoperative complications.
  • Elderly patients receiving preoperative therapy are more likely to develop postoperative atrial arrhythmias and require transfusion than younger patients.
  • [MeSH-major] Esophageal Neoplasms / epidemiology. Esophageal Neoplasms / surgery. Esophagectomy / methods. Premedication
  • [MeSH-minor] Adenocarcinoma / drug therapy. Adenocarcinoma / epidemiology. Adenocarcinoma / radiotherapy. Adenocarcinoma / surgery. Age Factors. Aged. Aged, 80 and over. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Awards and Prizes. Carcinoma, Squamous Cell / drug therapy. Carcinoma, Squamous Cell / epidemiology. Carcinoma, Squamous Cell / radiotherapy. Carcinoma, Squamous Cell / surgery. Cardiovascular Diseases / epidemiology. Chemotherapy, Adjuvant. Comorbidity. Diabetes Mellitus, Type 1 / epidemiology. Female. Follow-Up Studies. Humans. Length of Stay / statistics & numerical data. Male. Multivariate Analysis. Neoplasm Staging. Pulmonary Disease, Chronic Obstructive / epidemiology. Radiotherapy, Adjuvant. Renal Insufficiency / epidemiology. Retrospective Studies. Survival Rate

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  • (PMID = 15680801.001).
  • [ISSN] 1552-6259
  • [Journal-full-title] The Annals of thoracic surgery
  • [ISO-abbreviation] Ann. Thorac. Surg.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Netherlands
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30. Suntharalingam M, Moughan J, Coia LR, Krasna MJ, Kachnic L, Haller DG, Willett CG, John MJ, Minsky BD, Owen JB, 1996-1999 Patterns of Care Study: The national practice for patients receiving radiation therapy for carcinoma of the esophagus: results of the 1996-1999 Patterns of Care Study. Int J Radiat Oncol Biol Phys; 2003 Jul 15;56(4):981-7
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  • [Title] The national practice for patients receiving radiation therapy for carcinoma of the esophagus: results of the 1996-1999 Patterns of Care Study.
  • PURPOSE: A Patterns of Care Study (PCS) was conducted to evaluate the standards of practice for patients receiving radiation therapy for esophageal cancer from 1996 to 1999.
  • This study examined the evaluation and treatment schemes used during this time and compared these results to the PCS data obtained between 1992 and 1994 to identify any fundamental changes in national practice.
  • METHODS: A national survey was conducted using a two-stage cluster sampling technique.
  • Specific information was collected on 414 patients with esophageal cancer who received radiotherapy (RT) as part of definitive or adjuvant management at 59 institutions.
  • Eligibility criteria for case review included RT between 1996 and 1999, no evidence of distant metastasis (including CT evidence of either supraclavicular or celiac nodes >1 cm), squamous cell or adenocarcinoma histology, Karnofsky performance status >60, tumors in the thoracic esophagus with <2 cm extension into the stomach, and no prior malignancies within the last 5 years.
  • Statistical analysis was performed on the database using SUDAAN software to accurately reflect the type of sampling technique used by PCS.
  • For the purposes of comparison, the 1992-1994 PCS esophageal survey results were subjected to the same statistical procedures and tests.
  • A review of the histology revealed a nearly 50:50 split between squamous cell and adenocarcinoma.
  • Sixteen percent were clinical Stage I, 39% clinical Stage II, and 33% clinical Stage III according to the 1983 AJCC system.
  • Fifty-six percent of patients received concurrent chemoradiation as definitive treatment.
  • Forty-six percent of patients with adenocarcinoma underwent trimodality therapy as compared to 19% with squamous cell carcinomas (p = 0.0002).
  • The median total dose of external RT was 50.4 Gy, and the median dose per fraction was 1.8 Gy.
  • The chemotherapy agents most commonly used included 5-fluorouracil (82%), cisplatin (67%), and paclitaxel (22%).
  • Paclitaxel was more commonly employed as part of a preoperative chemoradiation regimen than in the setting of definitive chemoradiation (46% vs. 12%, p = 0.03).
  • CONCLUSIONS: The Patterns of Care Survey confirms the use of concurrent chemoradiation as part of the national standards of practice for the management of esophageal cancer patients.
  • [MeSH-major] Adenocarcinoma / radiotherapy. Benchmarking. Carcinoma, Squamous Cell / radiotherapy. Esophageal Neoplasms / radiotherapy. Practice Patterns, Physicians'

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  • (PMID = 12829133.001).
  • [ISSN] 0360-3016
  • [Journal-full-title] International journal of radiation oncology, biology, physics
  • [ISO-abbreviation] Int. J. Radiat. Oncol. Biol. Phys.
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / CA65435
  • [Publication-type] Journal Article; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] United States
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31. Coia LR, Minsky BD, Berkey BA, John MJ, Haller D, Landry J, Pisansky TM, Willett CG, Hoffman JP, Owen JB, Hanks GE: Outcome of patients receiving radiation for cancer of the esophagus: results of the 1992-1994 Patterns of Care Study. J Clin Oncol; 2000 Feb;18(3):455-62
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  • PURPOSE: A Patterns of Care Study examined the records of patients with esophageal cancer (EC) treated with radiation in 1992 through 1994 to determine the national practice processes of care and outcomes and to compare the results with those of clinical trials.
  • PATIENTS AND METHODS: A national survey of 63 institutions was conducted using two-stage cluster sampling, and specific information was collected on 400 patients with squamous cell (62%) or adenocarcinoma (37%) of the thoracic esophagus who received radiation therapy (RT) as part of primary or adjuvant treatment.
  • Fifteen percent of patients had clinical stage (CS) I disease, 40% had CS II disease, and 30% had CS III disease.
  • Seventy-five percent of patients received chemotherapy; 84% of these received concurrent chemotherapy and radiation (CRT).
  • RESULTS: Significant variables for overall survival in multivariate analysis include the use of esophagectomy (risk ratio [RR] = 0.62), the use of chemotherapy (RR = 0.63), Karnofsky performance status (KPS) greater than 80 (RR = 0.61), CS I or II disease (RR = 0.66), and facility type (RR = 0.72).
  • Preoperative CRT resulted in a nonsignificantly higher 2-year survival rate compared with definitive CRT alone (63% v 39%; P =.11), whereas 2-year survival by planned treatment rather than treatment given was 47.7% for preoperative CRT and 35.4% for definitive CRT (P =.23).
  • Definitive CRT compared with definitive RT alone resulted in significantly higher 2-year survival (39% v 20.6%; P =.027) and lower 2-year local regional failure (30% v 57.9%; P =. 0031).
  • CONCLUSION: This study confirms the value of CRT in EC treatment.
  • [MeSH-major] Adenocarcinoma / radiotherapy. Carcinoma, Squamous Cell / radiotherapy. Esophageal Neoplasms / radiotherapy
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Clinical Trials as Topic. Cluster Analysis. Combined Modality Therapy. Female. Humans. Male. Middle Aged. Neoplasm Recurrence, Local / pathology. Survival Analysis. Treatment Outcome

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  • [CommentIn] J Clin Oncol. 2000 Feb;18(3):453-4 [10653859.001]
  • (PMID = 10653860.001).
  • [ISSN] 0732-183X
  • [Journal-full-title] Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • [ISO-abbreviation] J. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article; Multicenter Study
  • [Publication-country] United States
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