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1. Wu Z, Ma JY, Yang JJ, Zhao YF, Zhang SF: Primary small cell carcinoma of esophagus: report of 9 cases and review of literature. World J Gastroenterol; 2004 Dec 15;10(24):3680-2
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Primary small cell carcinoma of esophagus: report of 9 cases and review of literature.
  • AIM: To analyze the clinical manifestations, pathological features and treatment of primary small cell carcinoma (SCC) of the esophagus and to review the literature on this entity.
  • METHODS: The records of 9 patients with primary esophageal small cell carcinoma were examined and the demographic data, presenting symptoms, methods of tumor diagnosis, and types of treatment given, response to treatment, pathologic findings, and clinical outcome were reviewed.
  • In 5 cases the tumors were located in the mid-esophagus, 3 cases in the lower third of the esophagus and 1 case in the upper third.
  • The average length of esophageal involvement was 5 cm.
  • They underwent radical resection, regional lymph node clearance and esophageal-stomach anastomosis in thorax or at neck.
  • Two patients had a stage IIa disease, five had a stage IIb disease, and the other two had a stage III disease of International Union Contrele Cancer (UICC).
  • All of them were histologically and immunohistochemically confirmed SCC of esophagus.
  • They received adjuvant systemic chemotherapy and local radiation therapy after discharge.
  • During follow-up, three patients developed multiple liver, brain, lung and bone metastases and died between 5 and 18 mo after the diagnosis.
  • Three patients developed widespread metastasis disease and died between 18 and 37 mo after the diagnosis.
  • There was no local tumor recurrence in these 6 patients.
  • CONCLUSION: Primary small cell carcinoma of the esophagus is a rare but very malignant tumor.
  • Radical resection combined with chemotherapy and radiotherapy is helpful in limited stage cases.
  • [MeSH-major] Carcinoma, Small Cell / pathology. Esophageal Neoplasms / pathology
  • [MeSH-minor] Aged. Female. Humans. Male. Middle Aged. Neoplasm Staging

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  • (PMID = 15534932.001).
  • [ISSN] 1007-9327
  • [Journal-full-title] World journal of gastroenterology
  • [ISO-abbreviation] World J. Gastroenterol.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] China
  • [Number-of-references] 18
  • [Other-IDs] NLM/ PMC4612018
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2. Yendamuri S, Swisher SG, Correa AM, Hofstetter W, Ajani JA, Francis A, Maru D, Mehran RJ, Rice DC, Roth JA, Walsh GL, Vaporciyan AA: Esophageal tumor length is independently associated with long-term survival. Cancer; 2009 Feb 1;115(3):508-16
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  • [Title] Esophageal tumor length is independently associated with long-term survival.
  • BACKGROUND: Esophageal cancer staging uses tumor depth as the sole criterion for assessment of the primary tumor (pT).
  • To the authors' knowledge the impact of esophageal tumor length on long-term outcome and the esophageal cancer staging system has not been fully evaluated in the current era.
  • METHODS: All esophageal cancer patients (n = 209) undergoing surgery from 1995 to 2005 who did not receive preoperative chemotherapy or radiotherapy were reviewed.
  • Maximum esophageal tumor length along a craniocaudal axis was determined pathologically after surgical resection.
  • Univariate and multivariate analyses were used to assess the impact of esophageal tumor length (< or = 3 cm vs >3 cm) on long-term survival.
  • RESULTS: Esophageal tumor length was closely associated with long-term survival (hazards ratio [HR] of 6.14 [95% confidence interval (95% CI), 4.1-9.25]; 5-year survival: < or = 3 cm = 68%, >3 cm = 10% [P < .001]).
  • Multivariate Cox regression analyses demonstrated tumor length (HR of 2.13 [95% CI, 1.26-3.63]) was found to be a significant independent predictor of long-term survival even when controlled for sex, age, tumor location, histology, margin positivity, surgical procedure, and current pTNM criteria.
  • The incorporation of tumor length in pTNM staging significantly improves the ability to predict the long-term survival of patients (5-year survival for patients with tumors < or = 3 cm and stages I, IIA, IIB, and III disease = 86%, 62%, 49%, and 22%, respectively; survival for patients with tumors measuring >3 cm and stages I, IIA, IIB, and III disease = 27%, 22%, 0%, and 8%, respectively [P < .1]).
  • CONCLUSIONS: Esophageal tumor length is an independent predictor of long-term survival in the current era and should be considered for incorporation into the current esophageal cancer staging system to better predict long-term survival and identify high-risk patients for postoperative therapy.
  • [MeSH-major] Esophageal Neoplasms / mortality. Esophageal Neoplasms / pathology. Neoplasm Staging / methods

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  • [Copyright] (c) 2008 American Cancer Society.
  • (PMID = 19117343.001).
  • [ISSN] 0008-543X
  • [Journal-full-title] Cancer
  • [ISO-abbreviation] Cancer
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
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3. Wang KK: Detection and staging of esophageal cancers. Curr Opin Gastroenterol; 2004 Jul;20(4):381-5
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Detection and staging of esophageal cancers.
  • PURPOSE OF REVIEW: Technology for detection and staging of esophageal cancer has made significant strides advances in the past 2 years.
  • These advances have led to the enhanced selection of appropriate treatments for esophageal cancer.
  • Cancers that are discovered at an early stage can be treated with endoscopic therapy, whereas advanced cancers are primarily treated with chemotherapy and radiation.
  • RECENT FINDINGS: Detection of esophageal cancer can be enhanced by two major mechanisms: one is by enhancing the lesion, which has typically been done using vital dyes and the other is by changing the method of imaging of the lesion, which has been accomplished by the use of several technologies including fluorescence and optical coherence tomography.
  • Neither of these techniques has been proven, but some investigators have been able to use them to enhance cancer detection.
  • Similar technologies have been applied to staging esophageal cancer.
  • The use of positron emission tomography has been the most recent development that may have application for advanced cancer.
  • The most significant development for staging early cancers is mucosal resection.
  • Finally, by using mucosal resection techniques, the depth of tumor invasion can be established by histology, which allows gastroenterologists to treat early cancers with greater confidence regarding rates of metastatic disease.
  • SUMMARY: Early detection of esophageal cancer can be enhanced by the use of vital dyes for mucosal staining, but the advancement of novel optical diagnostic strategies may be more suitable for clinical use.
  • The primary advantage of these new staging methods is to clearly identify early stage cancer that potentially can be treated without traditional surgical resection techniques.
  • More advanced cancers can be staged with positron emission tomography, but definitive studies demonstrating its role are still lacking.

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  • (PMID = 15703669.001).
  • [ISSN] 0267-1379
  • [Journal-full-title] Current opinion in gastroenterology
  • [ISO-abbreviation] Curr. Opin. Gastroenterol.
  • [Language] ENG
  • [Grant] United States / NCI NIH HHS / CA / R01 CA085992; United States / NCI NIH HHS / CA / R01 CA097048; United States / NCI NIH HHS / CA / R01 CA097048-01
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Other-IDs] NLM/ NIHMS86218; NLM/ PMC2664739
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4. Vu C, Tsang S, Doig L, Meenan J: The preferred choice for radial endosonographic staging of esophageal cancer: standard echoendoscope or nonoptic esophagoprobe? Surg Endosc; 2007 Sep;21(9):1617-22
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  • [Title] The preferred choice for radial endosonographic staging of esophageal cancer: standard echoendoscope or nonoptic esophagoprobe?
  • BACKGROUND: The nonoptic esophagoprobe has been reported to be comparable to the standard echoendoscope in esophageal cancer staging, with a superior advantage of traversing more stenotic tumors because of its smaller diameter.
  • The aim of this study was to see whether its use in a general population of esophageal cancer patients confers any significant clinical benefit.
  • METHODS: Five hundred seventy-seven consecutive patients referred for initial locoregional staging of esophageal cancer were analyzed retrospectively.
  • RESULTS: Complete staging (95.2% vs 77.5%; p < 0.001) was significantly higher in the esophagoprobe group compared with that of the standard echoendoscope group (315 and 262 patients, respectively).
  • In 146 patients with histopathologic verification without prior chemotherapy or radiotherapy, the esophagoprobe was comparable in T-staging accuracy to the standard echoendoscope in those with traversable tumors (89.2% vs. 82.8%; p = 0.213).
  • However, the presence of a nontraversable stricture significantly decreased standard echoendoscope T-staging accuracy compared with a traversable stricture (33.3% vs. 82.8%, respectively; p < 0.001).
  • The esophagoprobe also picked more advanced tumors and distal nodes.
  • CONCLUSIONS: The esophagoprobe is more accurate than the standard echoendoscope in the T staging of esophageal cancer because of its higher likelihood of traversing tumor stenosis.
  • It can potentially reduce the necessity for dilation in stenotic tumors by four to five times.
  • We propose using the esophagoprobe as the first choice for radial endoscopic ultrasound staging of esophageal cancer.
  • [MeSH-major] Endosonography. Esophageal Neoplasms / diagnostic imaging. Esophagoscopes
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Female. Humans. Male. Middle Aged. Neoplasm Staging

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  • (PMID = 17342557.001).
  • [ISSN] 1432-2218
  • [Journal-full-title] Surgical endoscopy
  • [ISO-abbreviation] Surg Endosc
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] Germany
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5. Puri V, Meyers BF: Utility of positron emission tomography in the mediastinum: moving beyond lung and esophageal cancer staging. Thorac Surg Clin; 2009 Feb;19(1):7-15
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  • [Title] Utility of positron emission tomography in the mediastinum: moving beyond lung and esophageal cancer staging.
  • PET is the standard of care in staging and follow-up of mediastinal lymphoma and in follow-up of metastatic seminomas after chemotherapy.
  • Mycobacterial/fungal infections, sarcoidosis, and brown fat can mimic malignant findings on PET in the mediastinum.
  • [MeSH-major] Mediastinum / radionuclide imaging. Positron-Emission Tomography. Thoracic Neoplasms / radionuclide imaging
  • [MeSH-minor] Fluorodeoxyglucose F18. Humans. Lymphoma / pathology. Lymphoma / radionuclide imaging. Neoplasm Staging. Parathyroid Neoplasms / pathology. Parathyroid Neoplasms / radionuclide imaging. Radiopharmaceuticals

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  • (PMID = 19288816.001).
  • [ISSN] 1547-4127
  • [Journal-full-title] Thoracic surgery clinics
  • [ISO-abbreviation] Thorac Surg Clin
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Radiopharmaceuticals; 0Z5B2CJX4D / Fluorodeoxyglucose F18
  • [Number-of-references] 34
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6. Krasna MJ, Jiao X: Use of minimally invasive surgery in staging esophageal cancer. J Laparoendosc Adv Surg Tech A; 2000 Jun;10(3):161-4
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Use of minimally invasive surgery in staging esophageal cancer.
  • Noninvasive staging of esophageal cancer (EC) is often inaccurate, and this fact has compromised clinical trials of treatment for EC.
  • Prognostic evaluation might allocate chemotherapy and radiation more appropriately.
  • Thoracoscopy and laparoscopy has recently shown promising results, and molecular analysis of the recovered tissue may further improve staging accuracy.
  • [MeSH-major] Esophageal Neoplasms / pathology. Laparoscopy. Thoracoscopy
  • [MeSH-minor] Endosonography. Humans. Neoplasm Staging / methods. Reverse Transcriptase Polymerase Chain Reaction

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  • (PMID = 10883994.001).
  • [ISSN] 1092-6429
  • [Journal-full-title] Journal of laparoendoscopic & advanced surgical techniques. Part A
  • [ISO-abbreviation] J Laparoendosc Adv Surg Tech A
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't; Review
  • [Publication-country] UNITED STATES
  • [Number-of-references] 24
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7. Gananadha S, Hazebroek EJ, Leibman S, Berry H, Osgood L, Shon IH, Pavlakis N, Marx G, Smith GS: The utility of FDG-PET in the preoperative staging of esophageal cancer. Dis Esophagus; 2008;21(5):389-94
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] The utility of FDG-PET in the preoperative staging of esophageal cancer.
  • Accurate staging of esophageal cancer is important when determining which patients will potentially benefit from curative surgery.
  • The aim of this study was to evaluate the incremental effect of 2-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) when used in addition to standard staging modalities.
  • Patients referred to two surgeons in an Australian metropolitan teaching hospital with esophageal or esophago-gastric junction malignancy between May 2002 and December 2006 were included.
  • Patients who had undergone prereferral treatment with chemotherapy or radiotherapy were excluded.
  • Patients undergoing resection for gastrointestinal stromal tumors or high-grade dysplasia within Barrett's esophagus were also excluded.
  • Pretreatment staging included routine CT scan and selective endoscopic ultrasound (EUS).
  • The addition of FDG-PET to routine preoperative staging resulted in the exclusion from surgery of 19 (25%) patients who prior to the introduction of FDG-PET would have undergone attempted resection.

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  • (PMID = 19125791.001).
  • [ISSN] 1442-2050
  • [Journal-full-title] Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
  • [ISO-abbreviation] Dis. Esophagus
  • [Language] ENG
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0Z5B2CJX4D / Fluorodeoxyglucose F18
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8. Dave UR, Williams AD, Wilson JA, Amin Z, Gilderdale DJ, Larkman DJ, Thursz MR, Taylor-Robinson SD, deSouza NM: Esophageal cancer staging with endoscopic MR imaging: pilot study. Radiology; 2004 Jan;230(1):281-6
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Esophageal cancer staging with endoscopic MR imaging: pilot study.
  • The authors defined esophageal anatomy and evaluated esophageal cancer staging in a pilot group by comparing endoscopic magnetic resonance (MR) imaging results with pathologic and endoscopic ultrasonographic (US) results when available.
  • A porcine esophagus, one volunteer, and 23 patients suspected of having esophageal cancer were imaged at 0.5 T.
  • Eight of these patients underwent esophagectomy (one after chemotherapy, which invalidated comparison with MR imaging; another did not undergo lymphadenectomy) and one underwent laparoscopy and nodal staging only; eight underwent US.
  • When verified with pathologic staging, endoscopic MR imaging was accurate in six of seven patients (T stage) and five of six patients (N stage; nodal areas too obscured by artifact for comparison in one case).
  • [MeSH-major] Esophageal Neoplasms / pathology. Esophagoscopy. Magnetic Resonance Imaging
  • [MeSH-minor] Adult. Aged. Animals. Equipment Design. Esophagoscopes. Female. Humans. In Vitro Techniques. Male. Middle Aged. Neoplasm Staging. Pilot Projects. Swine

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  • [Copyright] Copyright RSNA, 2004
  • (PMID = 14645876.001).
  • [ISSN] 0033-8419
  • [Journal-full-title] Radiology
  • [ISO-abbreviation] Radiology
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
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9. Hofstetter W, Correa AM, Bekele N, Ajani JA, Phan A, Komaki RR, Liao Z, Maru D, Wu TT, Mehran RJ, Rice DC, Roth JA, Vaporciyan AA, Walsh GL, Francis A, Blackmon S, Swisher SG: Proposed modification of nodal status in AJCC esophageal cancer staging system. Ann Thorac Surg; 2007 Aug;84(2):365-73; discussion 374-5
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Proposed modification of nodal status in AJCC esophageal cancer staging system.
  • BACKGROUND: The current American Joint Committee on Cancer (AJCC) esophageal cancer staging for nodal status is difficult to interpret and is based solely on lymph node location relative to the primary tumor's esophageal location.
  • We reviewed our esophageal experience to propose an improved nodal staging system.
  • METHODS: In all, 1,027 patients with resected esophageal cancer from 1970 to 2005 were reviewed.
  • The impact of location, number of involved lymph nodes, and use of preoperative chemotherapy or radiation therapy, or both, was assessed.
  • We propose a modified nodal staging system that designates celiac nodes as regional and includes number of involved nodes: pN0, no nodes (3 years = 63%, n = 496); pN1-regional, 1 to 3 nodes (3 years = 32%, n = 292); pN2-regional, more than 3 nodes (3 years = 14%, n = 222); pN3-nonregional node (3 years = 0%, n = 17 [p < 0.0001]).
  • This modified nodal staging system better predicts survival than the current AJCC nodal staging system in which survival for pN1 (3 years = 24%) and pM1a (3 years = 23%) do not differ (p = 0.67).
  • The use of induction before surgical resection did not alter the predictive effect of the new nodal staging system.
  • [MeSH-major] Esophageal Neoplasms / pathology. Lymph Nodes / pathology. Neoplasm Staging / methods

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  • (PMID = 17643602.001).
  • [ISSN] 1552-6259
  • [Journal-full-title] The Annals of thoracic surgery
  • [ISO-abbreviation] Ann. Thorac. Surg.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Netherlands
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10. D'Amico TA: Molecular biologic staging of esophageal cancer. Thorac Surg Clin; 2006 Nov;16(4):317-27
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Molecular biologic staging of esophageal cancer.
  • The molecular biology of esophageal cancer is characterized by a series of genetic mutations that occur throughout the progression from normal squamous epithelium to carcinoma.
  • Analysis of molecular biologic factors that are important in tumorigenesis may be used in clinical applications: establishing diagnosis, assessing prognosis, and assigning therapy.
  • The development of molecular biologic substaging of patients with CLE may potentially identify patients with elevated malignant potential and expedite therapy.
  • The ability of molecular markers to predict resistance to chemotherapy and radiation therapy represents an important potential advantage, with two possible applications.
  • The molecular biology of esophageal cancer requires further study.
  • The molecular events and factors that are involved may be important in the diagnosis, staging, and treatment of esophageal cancer, in addition to the description of tumorigenesis.
  • [MeSH-major] Esophageal Neoplasms / pathology
  • [MeSH-minor] Adenocarcinoma / pathology. Biomarkers, Tumor. Cell Transformation, Neoplastic / pathology. Drug Resistance, Neoplasm. Humans. Neoplasm Metastasis. Neoplasm Staging. Prognosis. Risk Factors

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  • (PMID = 17240819.001).
  • [ISSN] 1547-4127
  • [Journal-full-title] Thoracic surgery clinics
  • [ISO-abbreviation] Thorac Surg Clin
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Biomarkers, Tumor
  • [Number-of-references] 97
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11. Krasna MJ, Jiao X: Thoracoscopic and laparoscopic staging for esophageal cancer. Semin Thorac Cardiovasc Surg; 2000 Jul;12(3):186-94
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  • [Title] Thoracoscopic and laparoscopic staging for esophageal cancer.
  • Accurate pretreatment staging for patients with esophageal cancer (EC) is becoming increasingly important in the evaluation and comparison of different treatment modalities.
  • Noninvasive staging methods are imperfect in detecting lymph node metastasis in patients with EC.
  • Surgical staging with the thoracoscopic/laparoscopic (Ts/Ls) technique may provide accurate staging information that is useful for evaluating and comparing the results of clinical trials of preoperative chemotherapy and radiotherapy.
  • It can be used to confirm or exclude suspicious distant metastasis found by other staging methods.
  • Pretreatment (lymph node) biopsies obtained by Ts/Ls staging allow further molecular biologic analysis to detect occult lymph node metastasis for more accurate lymph node staging.
  • Since 1992, we have used Ts/Ls staging for EC in 111 patients.
  • We found that Ts/Ls is a promising method for staging lymph nodes in EC patients.
  • A recent study showed that pretreatment surgical lymph node staging can predict response and survival for EC patients receiving trimodality treatment (ie, radiation, chemotherapy, and surgery).
  • The information obtained with surgical staging now offers us the opportunity to optimize therapy to specific patient groups based on the extent of disease at the time of initial presentation.
  • Nevertheless, unlike the practice of mediastinoscopy in lung cancer patients, Ts/Ls staging in EC patients remains an academic interest rather than a clinical practice.
  • The concept of accurate pretreatment staging of EC remains to be realized and accepted in the clinical community.
  • [MeSH-major] Esophageal Neoplasms / pathology. Laparoscopy. Lymph Node Excision / methods. Thoracoscopy
  • [MeSH-minor] Biopsy. Clinical Trials as Topic. Humans. Lymph Nodes / pathology. Lymphatic Metastasis / diagnosis. Maryland. Neoplasm Staging / methods

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  • (PMID = 11052185.001).
  • [ISSN] 1043-0679
  • [Journal-full-title] Seminars in thoracic and cardiovascular surgery
  • [ISO-abbreviation] Semin. Thorac. Cardiovasc. Surg.
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] UNITED STATES
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12. Fink W, Zimpfer A, Ugurel S: Mucosal metastases in malignant melanoma. Onkologie; 2003 Jun;26(3):249-51
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  • [Title] Mucosal metastases in malignant melanoma.
  • BACKGROUND: We present the case of a patient with malignant melanoma stage IV according to the American Joint Committee on Cancer (AJCC) classification and an unusual pattern of metastasis to the mucosa of the esophagus, the stomach, the bladder and the palatine tonsil.
  • CASE REPORT: A 38-year-old male patient with metastatic malignant melanoma of stage III (AJCC) was admitted for initiation of adjuvant therapy.
  • Two cycles of dacarbazine (DTIC) chemotherapy were performed during which the patient developed cutaneous metastases, dyspepsia, and mild hematemesis.
  • Gastroscopy revealed bleeding from mucosal metastases of the esophagus and stomach.
  • A few weeks later the patient developed macroscopic hematuria.
  • [MeSH-major] Esophageal Neoplasms / secondary. Melanoma / secondary. Skin Neoplasms / pathology. Stomach Neoplasms / secondary. Tonsillar Neoplasms / secondary. Urinary Bladder Neoplasms / secondary
  • [MeSH-minor] Adult. Combined Modality Therapy. Diagnosis, Differential. Gastric Mucosa / pathology. Humans. Male. Mucous Membrane / pathology. Neoplasm Staging. Tomography, Emission-Computed


13. Boone J, Livestro DP, Elias SG, Borel Rinkes IH, van Hillegersberg R: International survey on esophageal cancer: part II staging and neoadjuvant therapy. Dis Esophagus; 2009;22(3):203-10
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  • [Title] International survey on esophageal cancer: part II staging and neoadjuvant therapy.
  • Neoadjuvant therapy could improve outcome by increasing the number of radical resections and by controlling metastatic disease.
  • The purposes of this study were to gain insight into the current worldwide practice of staging modalities and neoadjuvant therapy in esophageal cancer, and to detect intercontinental differences.
  • Surgeons with particular interest in esophageal surgery, including members of the International Society for Diseases of the Esophagus, the European Society of Esophagology - Group d'Etude EuropĂ©en des Maladies de l'Oesophage, and the OESO, were invited to participate in an online questionnaire.
  • Questions were asked regarding staging modalities, neoadjuvant therapy, and response evaluation applied in esophageal cancer patients.
  • Esophagogastroscopy with biopsy and computed tomography (CT) scanning were routinely performed by 98% of responders for diagnosing and staging esophageal cancer, while endoscopic ultrasound (EUS) and barium esophagography were routinely applied by 58% and 51%, respectively.
  • Neoadjuvant therapy is routinely administered by 33% and occasionally by 63% of responders.
  • Of the responders that administer identical neoadjuvant regimens to esophageal adenocarcinoma (AC) and squamous cell carcinoma, 54% favor chemoradiotherapy.
  • For AC, chemotherapy is preferred by 31% of the responders that administer neoadjuvant therapy, whereas for squamous cell carcinoma, the majority of responders (38%) prefer chemoradiotherapy.
  • Response to neoadjuvant therapy is predominantly assessed by CT scanning of the chest and abdomen (86%).
  • Substantial differences in applied staging modalities and neoadjuvant regimens were detected between surgeons from different continents.
  • In conclusion, currently the most commonly applied diagnostic modalities for staging and restaging esophageal cancer are CT scanning of the chest and abdomen, gastroscopy, barium esophagography and EUS.
  • Neoadjuvant therapy is routinely applied by one third of the responders.
  • Intercontinental differences have been detected in the diagnostic modalities applied in esophageal cancer staging and in the administration of neoadjuvant therapy.

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  • (PMID = 19191855.001).
  • [ISSN] 1442-2050
  • [Journal-full-title] Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
  • [ISO-abbreviation] Dis. Esophagus
  • [Language] ENG
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Contrast Media; 25BB7EKE2E / Barium Sulfate
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14. Bruzzi JF, Munden RF, Truong MT, Marom EM, Sabloff BS, Gladish GW, Iyer RB, Pan TS, Macapinlac HA, Erasmus JJ: PET/CT of esophageal cancer: its role in clinical management. Radiographics; 2007 Nov-Dec;27(6):1635-52
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  • [Title] PET/CT of esophageal cancer: its role in clinical management.
  • Positron emission tomography (PET)/computed tomography (CT) has important utility and limitations in the initial staging of esophageal cancer, evaluation of response to neoadjuvant therapy, and detection of recurrent malignancy.
  • Esophageal cancer is often treated by using a combined modality approach (chemotherapy, radiation therapy, and esophagectomy); correct integration of PET/CT into the conventional work-up of esophageal cancer requires a multidisciplinary approach that combines the information from PET/CT with results of clinical assessment, diagnostic CT, endoscopic gastroduodenoscopy, and endoscopic ultrasonography.
  • PET/CT has limited utility in T staging of esophageal cancer and relatively limited utility in detection of dissemination to locoregional lymph nodes.
  • However, PET/CT allows detection of metastatic disease that may not be identifiable with other methods.
  • PET/CT is not sufficiently reliable in the individual patient for determination of treatment response in the primary tumor.
  • Interpretation of PET/CT results is optimized by understanding the diagnostic limitations and pitfalls that may be encountered, together with knowledge of the natural history of esophageal cancer and the staging and treatment options available.
  • [MeSH-major] Adenocarcinoma / diagnosis. Esophageal Neoplasms / diagnosis. Positron-Emission Tomography / methods. Tomography, X-Ray Computed / methods
  • [MeSH-minor] Artifacts. Brain Neoplasms / secondary. Colonic Neoplasms / secondary. False Positive Reactions. Humans. Lymphatic Metastasis. Neoplasm Invasiveness. Neoplasm Staging. Sensitivity and Specificity

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  • [Copyright] RSNA, 2007
  • (PMID = 18025508.001).
  • [ISSN] 1527-1323
  • [Journal-full-title] Radiographics : a review publication of the Radiological Society of North America, Inc
  • [ISO-abbreviation] Radiographics
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 66
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15. Lightdale CJ, Kulkarni KG: Role of endoscopic ultrasonography in the staging and follow-up of esophageal cancer. J Clin Oncol; 2005 Jul 10;23(20):4483-9
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  • [Title] Role of endoscopic ultrasonography in the staging and follow-up of esophageal cancer.
  • PURPOSE: To evaluate the role of endoscopic ultrasonography (EUS) in the initial staging and follow-up of esophageal cancer on the basis of a review of the published literature.
  • METHODS: Articles published from 1985 to 2005 were searched and reviewed using the following keywords: "esophageal cancer staging," "endoscopic ultrasound," and "endoscopic ultrasonography."
  • RESULTS: For initial anatomic staging, EUS results have consistently shown more than 80% accuracy compared with surgical pathology for depth of tumor invasion (T).
  • Accuracy increased with higher stage, and was >90% for T3 cancer.
  • EUS results have shown accuracy in the range of 75% for initial staging of regional lymph nodes (N).
  • EUS has been invariably more accurate than computed tomography for T and N staging.
  • EUS is limited for staging distant metastases (M), and therefore EUS is usually performed after a body imaging modality such as computed tomography or positron emission tomography.
  • Pathologic staging can be achieved at EUS using fine-needle aspiration (FNA) to obtain cytology from suspect Ns.
  • EUS is inaccurate for staging after radiation and chemotherapy because of inability to distinguish inflammation and fibrosis from residual cancer, but a more than 50% decrease in tumor cross-sectional area or diameter has been found to correlate with treatment response.
  • CONCLUSION: EUS has a central role in the initial anatomic staging of esophageal cancer because of its high accuracy in determining the extent of locoregional disease.
  • EUS is inaccurate for staging after radiation therapy and chemotherapy, but can be useful in assessing treatment response.
  • [MeSH-major] Endosonography / methods. Esophageal Neoplasms
  • [MeSH-minor] Humans. Neoadjuvant Therapy. Neoplasm Staging / methods. Reproducibility of Results

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  • (PMID = 16002838.001).
  • [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] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 64
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16. Siersema PD: Pathogenesis, diagnosis and therapeutic possibilities of esophageal cancer. Curr Opin Gastroenterol; 2007 Jul;23(4):456-61
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  • [Title] Pathogenesis, diagnosis and therapeutic possibilities of esophageal cancer.
  • PURPOSE OF REVIEW: This article reviews developments in pathogenesis, diagnosis and therapy of esophageal cancer published in 2006.
  • RECENT FINDINGS: Gene expression profiles in esophageal adenocarcinoma reveal information on its pathogenesis.
  • Evidence was presented that staging investigations for esophageal cancer should preferentially be performed in expert centers.
  • Early [F]fluorodeoxyglucose PET was shown to predict response to neoadjuvant chemotherapy.
  • A large randomized study demonstrated that peroperative chemotherapy improved survival in esophagogastric adenocarcinoma.
  • The current American Joint Committee on Cancer staging system probably needs revision in that the number of involved lymph nodes and extent of lymphadenectomy should be included.
  • Socioeconomic factors are involved in treatment decisions and outcome of esophageal cancer.
  • Chemotherapy and chemoradiotherapy are increasingly being used in the palliation of esophageal cancer.
  • SUMMARY: In 2006, microarray technology was introduced to elucidate the pathogenesis of esophageal cancer.
  • In addition, refinements in staging of esophageal cancer were proposed.
  • Finally, (chemo-)radiotherapy is increasingly being used in the neoadjuvant setting and for palliation of esophageal cancer.
  • [MeSH-major] Esophageal Neoplasms / diagnosis. Esophageal Neoplasms / therapy
  • [MeSH-minor] Esophagectomy. Esophagoscopy. Humans. Neoadjuvant Therapy. Neoplasm Staging. Palliative Care. Positron-Emission Tomography. Ultrasonography

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  • (PMID = 17545786.001).
  • [ISSN] 0267-1379
  • [Journal-full-title] Current opinion in gastroenterology
  • [ISO-abbreviation] Curr. Opin. Gastroenterol.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 20
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17. McDonough PB, Jones DR, Shen KR, Northup PG, Galysh RL, Hernandez A, White GE, Kahaleh M, Shami VM: Does FDG-PET add information to EUS and CT in the initial management of esophageal cancer? A prospective single center study. Am J Gastroenterol; 2008 Mar;103(3):570-4
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  • [Title] Does FDG-PET add information to EUS and CT in the initial management of esophageal cancer? A prospective single center study.
  • PURPOSE: There is no algorithm for the initial staging of esophageal cancer that is considered standard of care.
  • This prospective blinded study analyzes the utility of FDG-PET as an adjunct to EUS and CT for the management of patients with esophageal cancer.
  • METHODS: Between December 2003 and October 2006, patients diagnosed with esophageal carcinoma underwent EUS, CT, and FDG-PET at their initial evaluation.
  • Two thoracic surgeons were given staging EUS results and CT scan reports.
  • They were asked if the patient needed surgical resection, neoadjuvant chemotherapy followed by resection, or palliation.
  • The treatment decisions of each surgeon were compared to determine if PET altered clinical management.
  • Nineteen were treated with surgery, 25 with neoadjuvant chemotherapy and surgery, and 6 with palliative chemoradiation.
  • In the one case that the treatment decision differed, the EUS was incomplete.
  • The agreement on treatment strategy was 98% (kappa= 0.97, 95% CI 0.93-0.99).
  • CONCLUSION: This study shows that the addition of FDG-PET to EUS and CT offers little information to the initial treatment stratification of patients with esophageal cancer.
  • [MeSH-major] Endosonography. Esophageal Neoplasms / diagnosis. Fluorodeoxyglucose F18. Positron-Emission Tomography. Radiopharmaceuticals. Tomography, X-Ray Computed
  • [MeSH-minor] Adenocarcinoma / diagnosis. Adenocarcinoma / surgery. Adult. Aged. Aged, 80 and over. Carcinoma, Squamous Cell / diagnosis. Carcinoma, Squamous Cell / surgery. Esophagoscopy. False Positive Reactions. Female. Humans. Lymphatic Metastasis. Male. Middle Aged. Neoadjuvant Therapy. Palliative Care

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  • (PMID = 17941963.001).
  • [ISSN] 0002-9270
  • [Journal-full-title] The American journal of gastroenterology
  • [ISO-abbreviation] Am. J. Gastroenterol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Radiopharmaceuticals; 0Z5B2CJX4D / Fluorodeoxyglucose F18
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18. Beseth BD, Bedford R, Isacoff WH, Holmes EC, Cameron RB: Endoscopic ultrasound does not accurately assess pathologic stage of esophageal cancer after neoadjuvant chemoradiotherapy. Am Surg; 2000 Sep;66(9):827-31
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  • [Title] Endoscopic ultrasound does not accurately assess pathologic stage of esophageal cancer after neoadjuvant chemoradiotherapy.
  • The accuracy of endoscopic ultrasound (EUS) for initial staging of esophageal cancer is widely accepted.
  • There is, however, considerable variability in the reported accuracy of EUS for restaging of esophageal neoplasms after neoadjuvant therapy.
  • From June 1995 through December 1999, we prospectively studied a series of 26 patients who underwent neoadjuvant treatment for esophageal cancer and were subsequently restaged by EUS before resection.
  • EUS correctly predicted tumor stage in seven of 26 patients for an overall accuracy of 27 per cent.
  • EUS overestimated the depth of tumor penetration in 18 patients (69%) and underestimated depth of penetration in one patient (4%).
  • EUS cannot distinguish tumor involvement of the esophageal wall and lymph nodes from the postinflammatory changes that characterize effective neoadjuvant treatment.
  • EUS is of limited utility in guiding clinical decision making after neoadjuvant therapy.
  • [MeSH-major] Endosonography. Esophageal Neoplasms / ultrasonography. Neoadjuvant Therapy
  • [MeSH-minor] Adenocarcinoma / drug therapy. Adenocarcinoma / pathology. Adenocarcinoma / radiotherapy. Adenocarcinoma / ultrasonography. Adult. Aged. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Carcinoma, Squamous Cell / drug therapy. Carcinoma, Squamous Cell / pathology. Carcinoma, Squamous Cell / radiotherapy. Carcinoma, Squamous Cell / ultrasonography. Decision Making. Esophagus / ultrasonography. Humans. Lymph Nodes / pathology. Lymph Nodes / ultrasonography. Male. Middle Aged. Neoplasm Invasiveness. Neoplasm Staging. Patient Care Planning. Prospective Studies. Radiotherapy Dosage. Remission Induction. Sensitivity and Specificity

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  • (PMID = 10993609.001).
  • [ISSN] 0003-1348
  • [Journal-full-title] The American surgeon
  • [ISO-abbreviation] Am Surg
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] UNITED STATES
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19. Takizawa K, Matsuda T, Kozu T, Eguchi T, Kato H, Nakanishi Y, Hijikata A, Saito D: Lymph node staging in esophageal squamous cell carcinoma: a comparative study of endoscopic ultrasonography versus computed tomography. J Gastroenterol Hepatol; 2009 Oct;24(10):1687-91
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  • [Title] Lymph node staging in esophageal squamous cell carcinoma: a comparative study of endoscopic ultrasonography versus computed tomography.
  • BACKGROUND AND AIM: Endoscopic ultrasonography (EUS) is established as a standard approach for locoregional staging of esophageal cancer.
  • However, only a few published studies have attempted to correlate the station of the abnormal lymph nodes detected by EUS with the definitive histology.
  • We compared EUS and computed tomography (CT) in the initial staging of esophageal squamous cell carcinoma.
  • METHODS: Consecutive patients with esophageal cancer undergoing EUS were evaluated.
  • RESULTS: A total of 365 consecutive patients underwent EUS and 159 patients underwent esophagectomy without neoadjuvant chemotherapy.
  • Therefore, both EUS and CT should be undertaken for routine examination prior to treatment of esophageal cancer.
  • [MeSH-major] Carcinoma, Squamous Cell / secondary. Endosonography. Esophageal Neoplasms / secondary. Lymph Nodes / radiography. Lymph Nodes / ultrasonography. Tomography, X-Ray Computed
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Esophagectomy. Female. Humans. Lymphatic Metastasis. Male. Middle Aged. Neoplasm Staging. Predictive Value of Tests. Retrospective Studies. Sensitivity and Specificity

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  • (PMID = 19788609.001).
  • [ISSN] 1440-1746
  • [Journal-full-title] Journal of gastroenterology and hepatology
  • [ISO-abbreviation] J. Gastroenterol. Hepatol.
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] Australia
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20. Nakahara T, Takagi Y, Takemasa K, Mitsui Y, Tsuyuki A, Shigematsu N, Kubo A: Dose-related fluorodeoxyglucose uptake in acute radiation-induced hepatitis. Eur J Gastroenterol Hepatol; 2008 Oct;20(10):1040-4
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  • Therapeutic assessment with fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) is sometimes problematic after radiation therapy.
  • A 50-year-old man underwent FDG PET for staging of esophageal cancer.
  • Chemoradiotherapy was delivered concurrently with a radiation field that expanded from the esophagus into the upper stomach to cover metastasis of the gastric wall.
  • The patient also underwent FDG PET 26 days and 4 months after chemoradiotherapy to evaluate the therapeutic effect.
  • Twenty-eight days after chemoradiotherapy, hematochemistry revealed elevated hepatic enzymes and postcontrast computed tomography showed band-like hypoattenuation in the liver with parenchymal swelling corresponding to the radiation field.
  • Follow-up PET 4 months after therapy showed no abnormal uptake in the liver.
  • [MeSH-major] Fluorodeoxyglucose F18 / pharmacokinetics. Hepatitis / etiology. Liver / metabolism. Positron-Emission Tomography / methods. Radiation Injuries / radionuclide imaging. Radiopharmaceuticals / pharmacokinetics
  • [MeSH-minor] Acute Disease. Antineoplastic Agents / therapeutic use. Combined Modality Therapy. Dose-Response Relationship, Radiation. Esophageal Neoplasms / drug therapy. Esophageal Neoplasms / metabolism. Esophageal Neoplasms / radiotherapy. Humans. Male. Middle Aged. Neoplasm Staging / methods. Taxoids / therapeutic use

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  • (PMID = 18787476.001).
  • [ISSN] 1473-5687
  • [Journal-full-title] European journal of gastroenterology & hepatology
  • [ISO-abbreviation] Eur J Gastroenterol Hepatol
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Radiopharmaceuticals; 0 / Taxoids; 0Z5B2CJX4D / Fluorodeoxyglucose F18; 15H5577CQD / docetaxel
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21. Jiao X, Sonett J, Gamliel Z, Doyle A, Schuetz J, Greenwald B, Suntharalingam M, Krasna MJ: Trimodality treatment versus surgery alone for esophageal cancer. A stratified analysis with minimally invasive pretreatment staging. J Cardiovasc Surg (Torino); 2002 Aug;43(4):531-7
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Trimodality treatment versus surgery alone for esophageal cancer. A stratified analysis with minimally invasive pretreatment staging.
  • BACKGROUND: Accurate pretreatment staging of esophageal cancer (EC) is important in the evaluation and comparison of results of different treatment modalities.
  • Few studies using minimally invasive staging techniques for this purpose have been reported.
  • We previously demonstrated the usefulness of the thoracoscopic/laparoscopic (Ts/Ls) technique in pretreatment staging of EC.
  • This study was conducted to evaluate the impact of trimodality based on pretreatment Ts/Ls staging diagnosis on EC.
  • Group A (44 patients) underwent pretreatment Ts/Ls staging and had trimodality treatment.
  • Preoperative therapy consisted of concurrent chemotherapy (5-FU + cisplatinum) and radiotherapy.
  • CONCLUSIONS: Pretreatment Ts/Ls staging can provide accurate staging information for EC patients.
  • Trimodality treatment was successful in local control for patients with squamous cell carcinoma.
  • Pretreatment lymph node status was the most important prognosticator regardless of treatment modality.
  • Pretreatment pathological staging should be included in the future clinical trials on multimodality treatments in EC patients.
  • [MeSH-major] Adenocarcinoma / therapy. Carcinoma, Squamous Cell / therapy. Esophageal Neoplasms / therapy
  • [MeSH-minor] Aged. Case-Control Studies. Combined Modality Therapy. Disease-Free Survival. Esophagus / pathology. Female. Humans. Male. Middle Aged. Multivariate Analysis. Neoplasm Recurrence, Local / epidemiology. Neoplasm Staging. Retrospective Studies

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  • (PMID = 12124569.001).
  • [ISSN] 0021-9509
  • [Journal-full-title] The Journal of cardiovascular surgery
  • [ISO-abbreviation] J Cardiovasc Surg (Torino)
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Italy
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22. McClave SA, Jones WF, Evans WB: Do physician attitudes and practices limit use of EUS in the staging and the treatment of esophageal carcinoma? Gastrointest Endosc; 2005 Jun;61(7):840-8
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Do physician attitudes and practices limit use of EUS in the staging and the treatment of esophageal carcinoma?
  • BACKGROUND: Although EUS provides superior local staging of esophageal carcinoma when compared with other tests, EUS seems to be underused by physicians.
  • We designed this prospective study to determine whether EUS is ordered in the evaluation of esophageal cancer and whether staging information obtained would change management.
  • METHODS: A total of 114 physicians were mailed a questionnaire that surveyed which tests are used in evaluating patients with esophageal cancer, the order in which they are requested, and their estimated cost.
  • Physicians were asked to estimate prognosis and to indicate which therapy would be used for each specific TNM cancer stage.
  • Only 47.3% of physicians would use EUS in the patient workup for esophageal cancer.
  • A significantly greater number of internists (78.9%, p = 0.055) would not order EUS, and 31.6% of internists would not use any staging data before referral to another physician for definitive management.
  • Physicians were accurate in their assessment of the prognosis for each cancer stage and the cost of each test.
  • Except for significantly greater use of chemotherapy by surgeons and oncologists for stage IIA than internists and gastroenterologists (36.6% vs. 3.1%, p = 0.0006), there were no differences between subspecialties with use of chemotherapy for all other stages or use of radiation therapy for any stage.
  • CONCLUSIONS: Clinicians have an adequate understanding of patient survival based on cancer stage and a reasonable appreciation of cost for diagnostic tests regarding esophageal carcinoma.
  • Specific data on cancer staging does impact treatment choices and management decisions.
  • EUS is grossly underused by clinicians for staging esophageal cancer.
  • Although internists may serve as gatekeepers, they fail to order EUS, order EUS only after less accurate tests, or fail to use staging data in management (especially referral) decisions.
  • The ultimate modality of treatment may be more related to the type of physician that the patient is referred to, instead of the specific cancer stage.
  • [MeSH-major] Attitude of Health Personnel. Carcinoma / diagnostic imaging. Endosonography / utilization. Esophageal Neoplasms / diagnostic imaging. Physicians. Practice Patterns, Physicians'
  • [MeSH-minor] Adenocarcinoma / pathology. Adenocarcinoma / therapy. Antineoplastic Agents / therapeutic use. Barium Sulfate. Carcinoma, Squamous Cell / pathology. Carcinoma, Squamous Cell / therapy. Contrast Media. Esophagoscopy. Gastroenterology. General Surgery. Humans. Internal Medicine. Medical Oncology. Neoplasm Staging. Patient Care Planning. Prognosis. Prospective Studies. Radiopharmaceuticals / therapeutic use. Tomography, X-Ray Computed

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  • (PMID = 15933685.001).
  • [ISSN] 0016-5107
  • [Journal-full-title] Gastrointestinal endoscopy
  • [ISO-abbreviation] Gastrointest. Endosc.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Contrast Media; 0 / Radiopharmaceuticals; 25BB7EKE2E / Barium Sulfate
  •  go-up   go-down






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