[Squamous Cell Carcinoma of the Esophagus]

Overview

Journal Chirurg

Specialty General Surgery

Date 2011 Oct 18

PMID 22002703

Authors

K Ott

L Sisic

M Buchler

Affiliations

Soon will be listed here.

Abstract

The prognosis of locally advanced squamous cell carcinomas (SCC) of the esophagus after surgery only is poor. Therefore a definitive chemoradiotherapy (RCTx) was also discussed as the therapy of choice. Besides tumor biology, patient-related factors, such as alcohol and nicotine abuse increase the perioperative mortality and morbidity. Multimodal treatment can improve the outcome in comparison to surgery alone. A recently published meta-analysis confirmed that preoperative RCTx followed by surgery improves the prognosis compared to surgery alone in SCC of the esophagus. After chemotherapy this effect is less pronounced. Patients with a complete histopathological response (pCR) after preoperative RCTx have a 5-year survival rate of more than 55% and a low probability of local recurrence. However, a pCR cannot be predicted neither by negative biopsy nor by negative FDG-PET uptake after RCTx. Up to now FDG-PET has shown a low impact for response prediction or therapy modification in SCC of the esophagus in clinical studies. Responding patients should be transferred to surgery after preoperative treatment, because of a reduced perioperative morbidity and mortality and improved prognosis.

References

Swisher S, Hofstetter W, Wu T, Correa A, Ajani J, Komaki R . Proposed revision of the esophageal cancer staging system to accommodate pathologic response (pP) following preoperative chemoradiation (CRT). Ann Surg. 2005; 241(5):810-7. PMC: 1357136. DOI: 10.1097/01.sla.0000161983.82345.85. View

Kelsen D, Winter K, Gunderson L, Mortimer J, Estes N, Haller D . Long-term results of RTOG trial 8911 (USA Intergroup 113): a random assignment trial comparison of chemotherapy followed by surgery compared with surgery alone for esophageal cancer. J Clin Oncol. 2007; 25(24):3719-25. DOI: 10.1200/JCO.2006.10.4760. View

Bedenne L, Michel P, Bouche O, Milan C, Mariette C, Conroy T . Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol. 2007; 25(10):1160-8. DOI: 10.1200/JCO.2005.04.7118. View

McKenzie S, Mailey B, Artinyan A, Metchikian M, Shibata S, Kernstine K . Improved outcomes in the management of esophageal cancer with the addition of surgical resection to chemoradiation therapy. Ann Surg Oncol. 2010; 18(2):551-8. DOI: 10.1245/s10434-010-1314-7. View

Jin H, Zhu H, Ling T, Zhang H, Shi R . Neoadjuvant chemoradiotherapy for resectable esophageal carcinoma: a meta-analysis. World J Gastroenterol. 2009; 15(47):5983-91. PMC: 2795187. DOI: 10.3748/wjg.15.5983. View

Vallbohmer D, Holscher A, DeMeester S, DeMeester T, Salo J, Peters J . A multicenter study of survival after neoadjuvant radiotherapy/chemotherapy and esophagectomy for ypT0N0M0R0 esophageal cancer. Ann Surg. 2010; 252(5):744-9. DOI: 10.1097/SLA.0b013e3181fb8dde. View

Ott K, Weber W, Siewert J . The importance of PET in the diagnosis and response evaluation of esophageal cancer. Dis Esophagus. 2006; 19(6):433-42. DOI: 10.1111/j.1442-2050.2006.00617.x. View

Sjoquist K, Burmeister B, Smithers B, Zalcberg J, Simes R, Barbour A . Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol. 2011; 12(7):681-92. DOI: 10.1016/S1470-2045(11)70142-5. View

Siewert J, Ott K . Are squamous and adenocarcinomas of the esophagus the same disease?. Semin Radiat Oncol. 2006; 17(1):38-44. DOI: 10.1016/j.semradonc.2006.09.007. View

10.

Stahl M, Budach W, Meyer H, Cervantes A . Esophageal cancer: Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010; 21 Suppl 5:v46-9. DOI: 10.1093/annonc/mdq163. View

11.

Bartels H, Stein H, Siewert J . Preoperative risk analysis and postoperative mortality of oesophagectomy for resectable oesophageal cancer. Br J Surg. 1998; 85(6):840-4. DOI: 10.1046/j.1365-2168.1998.00663.x. View

12.

van Heijl M, Omloo J, van Berge Henegouwen M, Hoekstra O, Boellaard R, Bossuyt P . Fluorodeoxyglucose positron emission tomography for evaluating early response during neoadjuvant chemoradiotherapy in patients with potentially curable esophageal cancer. Ann Surg. 2011; 253(1):56-63. DOI: 10.1097/SLA.0b013e3181f66596. View

13.

Peyre C, Hagen J, DeMeester S, Altorki N, Ancona E, Griffin S . The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg. 2008; 248(4):549-56. DOI: 10.1097/SLA.0b013e318188c474. View

14.

Mandard A, Dalibard F, MANDARD J, Marnay J, Henry-Amar M, Petiot J . Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer. 1994; 73(11):2680-6. DOI: 10.1002/1097-0142(19940601)73:11<2680::aid-cncr2820731105>3.0.co;2-c. View

15.

Schneider P, Baldus S, Metzger R, Kocher M, Bongartz R, Bollschweiler E . Histomorphologic tumor regression and lymph node metastases determine prognosis following neoadjuvant radiochemotherapy for esophageal cancer: implications for response classification. Ann Surg. 2005; 242(5):684-92. PMC: 1409844. DOI: 10.1097/01.sla.0000186170.38348.7b. View

16.

Jost C, Binek J, Schuller J, Bauerfeind P, Metzger U, Werth B . Endosonographic radial tumor thickness after neoadjuvant chemoradiation therapy to predict response and survival in patients with locally advanced esophageal cancer: a prospective multicenter phase ll study by the Swiss Group for Clinical Cancer.... Gastrointest Endosc. 2010; 71(7):1114-21. DOI: 10.1016/j.gie.2009.12.015. View

17.

Meredith K, Weber J, Turaga K, Siegel E, McLoughlin J, Hoffe S . Pathologic response after neoadjuvant therapy is the major determinant of survival in patients with esophageal cancer. Ann Surg Oncol. 2010; 17(4):1159-67. DOI: 10.1245/s10434-009-0862-1. View

18.

Brucher B, Becker K, Lordick F, Fink U, Sarbia M, Stein H . The clinical impact of histopathologic response assessment by residual tumor cell quantification in esophageal squamous cell carcinomas. Cancer. 2006; 106(10):2119-27. DOI: 10.1002/cncr.21850. View

19.

Lee P, Port J, Paul S, Stiles B, Altorki N . Predictors of long-term survival after resection of esophageal carcinoma with nonregional nodal metastases. Ann Thorac Surg. 2009; 88(1):186-92. DOI: 10.1016/j.athoracsur.2009.03.079. View

20.

Miyata H, Yamasaki M, Takiguchi S, Nakajima K, Fujiwara Y, Konishi K . Prognostic value of endoscopic biopsy findings after induction chemoradiotherapy with and without surgery for esophageal cancer. Ann Surg. 2010; 253(2):279-84. DOI: 10.1097/SLA.0b013e318206824f. View