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Pathology & Oncology Research

, Volume 16, Issue 2, pp 193–200 | Cite as

Chemo-radiotherapy in Locally Advanced Squamous Cell Oesophageal Cancer—are Upper Third Tumours more Responsive?

  • Andras Papp
  • Laszlo Cseke
  • Robert Farkas
  • Gabor Pavlovics
  • Gabor Horvath
  • Gabor Varga
  • Andras Szigeti
  • Szabolcs Bellyei
  • Sandor Marton
  • Laszlo Poto
  • Katalin Kalmar
  • Andras Vereczkei
  • Eva Pozsgai
  • Ors Peter Horvath
Article

Abstract

Before neoadjuvant therapy was widely applied, the prognosis of oesophageal cancer had been considered dependent on the location of the tumor, i.e. upper third cancers had had the worst prognosis. The aim of this retrolective study was to prove the efficiency of the neoadjuvant treatment, and to compare the response of esophageal cancer in different locations. Between January 1998 and September 2005, 102 patients with locally advanced squamous cell oesophageal cancer received preoperative chemo-radiotherapy. In 40 cases the tumor was located in the upper third and in 62 cases in the middle third of the oesophagus. After a four-week-long treatment free period restaging was carried out and patients considered resectable were submitted to surgery. From 40 patients with upper third oesophageal cancer 28 underwent oesophageal resection or pharyngo-laryngectomy. Thiry-five percent a complete histopathological remission was observed. From 62 patients with middle third oesophageal cancer 43 underwent oesophageal resection. Histological examination of the resected specimens documented complete response only in three patients. The median survival and the R0 resection rate were similar in the two groups. Although the resection rate, perioperative morbidity, mortality and the median survival were similar in the two groups, a significantly higher rate of complete response (p < 0,05) was observed in patients with upper third oesophageal cancer compared to patients with middle third oesophageal cancer. It seems that upper third oesophageal cancer has superior sensitivity to multimodal treatment therefore our results may support that upper third location is not an unfavorable prognostic factor any more.

Keywords

Complete response Locally advanced tumor Neoadjuvant therapy Squamous cell oesophageal cancer 

References

  1. 1.
    Lerut T, Coosemans W, Decker G, De Leyn P, Nafteux Ph, Van Raemdonck D (2001) Cancer of the esophagus and gastro-esophageal junction: potentially curative therapies Surg Oncol 10:113–122Google Scholar
  2. 2.
    Keighley MRB (2003) Gastrointestinal cancers in Europe. Aliment Pharmacol Ther 18(Suppl. 3):7–30CrossRefPubMedGoogle Scholar
  3. 3.
    Siewert JR, Stein HJ, Feith M, Bruecher BL, Bartels H, Fink U (2001) Histologic tumor type is an independent prognostic parameter in esophageal cancer: lessons from more than 1,000 consecutive resections at a single center in the Western world. Ann Surg. 234(3):360–367 discussion 368–9CrossRefPubMedGoogle Scholar
  4. 4.
    Law S, Kwong DL, Kwok KF, Wong KH, Chu KM, Sham JS, Wong J (2003) Improvement in treatment results and long-term survival of patients with esophageal cancer: impact of chemoradiation and change in treatment strategy. Ann Surg. 238(3):339–347 discussion 347–8PubMedGoogle Scholar
  5. 5.
    P. Sorrentino et al. (1988) Prognostic Significance of Tumor Stage and Lymph Node Involvement in Thoracic Esophageal Cancer. In: J.R. Siewert, A.H.Hölscher (ed) Diseases of the esophagus Springer-Verlag Berlin Heidelberg, pp:709–713,Google Scholar
  6. 6.
    Piessen G, Mariette C, Triboulet JP (2005) Cervical and upper-third thoracic oesophageal carcinoma: a single pathological entity? Ann Chir. 130(2):86–91CrossRefPubMedGoogle Scholar
  7. 7.
    Feinstein AR (1985) Clinical epidemiology. Saunders, PhiladelphiaGoogle Scholar
  8. 8.
    Horvath OP, Cseke L, Kalmar K, Varga G, Horvath G (2001) Larynx-preserving pharyngo-esophagectomy after chemoradiation in the treatment of cancer of the pharyngo-esophageal junction. Ann Thorac Surg. 72(6):2146–2147CrossRefPubMedGoogle Scholar
  9. 9.
    Pavlovics G, Cseke L, Papp A, Tizedes G, Tabar BA, Horvath PO (2006) Esophagus reconstruction with free jejunal transfer. Microsurgery 26(1):73–77CrossRefPubMedGoogle Scholar
  10. 10.
    Wong R, Malthaner R (2003) Combined chemotherapy and radiotherapy (without surgery) compared with radiotherapy alone in localised carcinoma of the esophagus (Cochrane Review), in the Cochrane Library, Issue 1. Oxford, Update SoftwerGoogle Scholar
  11. 11.
    Mariette C, Piessen G, Triboulet JP (2007) Therapeutic strategies in oesophageal carcinoma: role of surgery and other modalities. Lancet Oncol 8:545–553CrossRefPubMedGoogle Scholar
  12. 12.
    El Nakadi I, Van Laethem JL, Houben JJ, Gay F, Closset J, Van Houtte P, Danhier S, Limbosch JM, Lambilliotte JP, Gelin M (2002) Squamous cell carcinoma of the esophagus: multimodal therapy in locally advanced disease. World J Surg 26(1):72–78CrossRefPubMedGoogle Scholar
  13. 13.
    Meneu-Diaz JC, Blazquez LA, Vicente E, Nuno J, Quijano Y, Lopez-Hervas P, Devesa M, Fresneda V (2000) The role of multimodality therapy for resectable esophageal cancer. Am J Surg 179(6):508–513CrossRefPubMedGoogle Scholar
  14. 14.
    Bosset JF, Gignoux M, Triboulet JP, Tiret E, Mantion G, Elias D, Lozach P, Ollier JC, Pavy JJ, Mercier M, Sahmoud T (1997) Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med 337(3):161–167CrossRefPubMedGoogle Scholar
  15. 15.
    Visser BC, Venook AP, Patti MG (2003) Adjuvant and neoadjuvant therapy for esophageal cancer: a critical reappraisal. Surg Oncol 12(1):1–7CrossRefPubMedGoogle Scholar
  16. 16.
    Urschel JD, Vasan H (2003) A meta-analysis of randomized controlled trials that compared neoadjuvant chemoradiation and surgery to surgery alone for resectable esophageal cancer. Am J Surg 185(6):538–543CrossRefPubMedGoogle Scholar
  17. 17.
    Kaklamanos IG, Walker GR, Ferry K, Franceschi D (2003) Neoadjuvant treatment for resectable cancer of the esophagus and the gastroesophageal junction: a meta-analysis of randomized clinical trials. Ann Surg Oncol 10:754–761CrossRefPubMedGoogle Scholar
  18. 18.
    Greer SE, Goodney PP, Sutton JE, Birkmeyer JD (2005) Neoadjuvant chemoradiotherapy for esophageal carcinoma:a meta-analysis. Surgery 137:172–177CrossRefPubMedGoogle Scholar
  19. 19.
    Gebski V, Burmeister B, Smithers BM, Foo K, Zalcberg J, Simes J (2007) Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol 8:226–234CrossRefPubMedGoogle Scholar
  20. 20.
    Urba SG, Orringer MB, Turrisi A et al. (2001) Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 19:305–313PubMedGoogle Scholar
  21. 21.
    Berger AC, Farma J, Scott WJ et al. (2005) Complete response to neoadjuvant chemoradiotherapy in esophageal carcinoma is associated with significantly improved survival. J Clin Oncol 23:4330–4337CrossRefPubMedGoogle Scholar
  22. 22.
    Saito R, Suzuki H, Motoyama S, Sasaki S, Okuyama M, Ogawa J, Kitamura M (2000) A clinical study of surgical treatment of patients with carcinoma of the cervical esophagus extending to the thoracic esophagus. Jpn J Thorac Cardiovasc Surg 48(7):417–423PubMedGoogle Scholar
  23. 23.
    Peracchia A, Bonavina L, Botturi M, Pagani M, Via A, Saino G (2001) Current status of surgery for carcinoma of the hypopharynx and cervical esophagus. Dis Esoph 14:95–97CrossRefGoogle Scholar
  24. 24.
    Liebermann-Meffert DM, Luescher U, Neff U, Rüedi TP, Allgöwer M (1987) Esophagectomy without thoracotomy: is there a risk of intramediastinal bleeding? A study on blood supply of the esophagus. Ann Surg 206(2):184–192PubMedCrossRefGoogle Scholar
  25. 25.
    Stahl M, Stuschke M, Lehmann N, Meyer HJ, Walz MK, Seeber S, Klump B, Budach W, Teichmann R, Schmitt M, Schmitt G, Franke C, Wilke H (2005) Chemoradiation with and whitout surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol 23(10):2310–2317CrossRefPubMedGoogle Scholar
  26. 26.
    Bedenne L, Michel P, Bouche O et al. (2002) Randomised phase III trial in locally advanced esophageal cancer: Radiochemotherapy followed by surgery versus radiochemotherapy alone (FFCD 9102). Proc Am Soc Clin Oncol 21:130a abstr 519Google Scholar
  27. 27.
    Burmeister B, Dickie G, Smithers B, Hodge R, Morton K (2000) Thirty-four patients with carcinoma of the cervical esophagus treated with chemoradiation therapy. Arch Otolaryngol Head Neck Surg 126:205–208PubMedGoogle Scholar

Copyright information

© Arányi Lajos Foundation 2009

Authors and Affiliations

  • Andras Papp
    • 1
  • Laszlo Cseke
    • 1
  • Robert Farkas
    • 2
  • Gabor Pavlovics
    • 1
  • Gabor Horvath
    • 3
  • Gabor Varga
    • 1
  • Andras Szigeti
    • 2
  • Szabolcs Bellyei
    • 2
  • Sandor Marton
    • 4
  • Laszlo Poto
    • 5
  • Katalin Kalmar
    • 1
  • Andras Vereczkei
    • 1
  • Eva Pozsgai
    • 2
  • Ors Peter Horvath
    • 1
  1. 1.Department of Surgery, Medical FacultyUniversity of Pécs, HungaryPécsHungary
  2. 2.Department of Oncotherapy, Medical FacultyUniversity of Pécs, HungaryPécsHungary
  3. 3.Department of Radiation OncologyThe Johns Hopkins Medicine International, Tawam Medical CenterAbu DhabiUAE
  4. 4.Department of Anesthesia and Intensive Therapy, Medical FacultyUniversity of Pécs, HungaryPécsHungary
  5. 5.Institute of Bioanalysis, Medical FacultyUniversity of Pécs, HungaryPécsHungary

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