p D O P Q he goal of this evidence-based review was to examine the clinical practice of the gastroenterologist in the anagement of patients with esophageal carcinoma. The ethods for this review were to search and review the iterature available on MEDLINE and PREMEDLINE on he topics of esophageal neoplasm, esophageal cancer, nd Barrett’s esophagus from 1968 to 2004. Bibliograhies of significant reports were also reviewed to ensure hat the pertinent literature was reviewed. Recommenations are graded as to the level of evidence available on scale of I–V. Level I evidence is the presence of at least ne prospective, randomized, controlled trial, level II vidence is based on well-designed cohort or case-conrolled studies, level III evidence is based on case series or awed clinical trials, level IV evidence is based on opinons of respected authorities or expert committees, and evel V evidence is insufficient evidence to form any pinions.

https://www.gastrojournal.org/article/S0016-5085(05)00606-2/pdf

American Gastroenterological Association Technical Review on the Role of the Gastroenterologist in the Management of Esophageal Carcinoma

Purpose: With the aim of improving the results of treatment of esophageal cancer, we designed this multi-institutional, randomized trial to establish the optimal irradiation method in radical radiation therapy for esophageal cancer by clinically evaluating external irradiation alone and in combination with intraluminal brachytherapy. Methods and Materials: The study population consisted of patients with squamous cell carcinoma who were expected to be successfully treated with radical radiation therapy. The patients who could be given intraluminal brachytherapy at the end of external irradiation of 60 Gy were stratified into 2 groups. Patients assigned to receive external irradiation alone received boost irradiation of 10 Gy/week on a schedule similar to the previous one, and with the same or smaller irradiation field. Intraluminal brachytherapy was performed, as a rule, with the reference dose point set at a depth of 5 mm of the esophageal submucosa, and a total of 10 Gy was irradiated at a daily dose of 5 Gy, on a once-weekly schedule with low-dose-rate or high-dose-rate brachytherapy equipment. Results: A total of 103 patients were registered, 94 of whom were analyzable, with 8 ineligible, and 1 for whom complete information was unavailable. The overall cumulative survival rate was 20.3% at 5 years. The cause-specific survival rate was 31.8% at 5 years. The cause-specific survival rate at 5 years was 27% in the external irradiation alone group and 38% in intraluminal brachytherapy combined group. There was no significant difference between the 2 groups ( p = 0.385). However, in the patients with 5 cm or less tumor length, the cause-specific survival rate was 64% at 5 years in the intraluminal brachytherapy combined group, which showed a significant improvement over 31.5% in the external irradiation alone group ( p = 0.025). In the patients with Stage T1 and T2 disease, cause-specific survival rates tended to be better in the intraluminal brachytherapy combined group than in the external irradiation alone group ( p = 0.088). In the patients with more than 5 cm tumor length or Stage T3–4 disease, there were no significant differences between the two groups by treatment methods ( p = 0.290). The incidence of early and late complications did not differ according to whether intraluminal brachytherapy was used. Conclusion: For the purpose of establishing the usefulness of intraluminal brachytherapy, further prospective randomized studies are necessary to evaluate the efficacy in tumors with short length and those with shallow invasion, or to assess the usefulness of intraluminal brachytherapy, as additional irradiation in large advanced tumors have been shown to have disappeared by diagnostic imaging after chemoradiotherapy with 60 Gy/6w external irradiation.

Multi-institutional randomized trial of external radiotherapy with and without intraluminal brachytherapy for esophageal cancer in japan

EMR Combined With Chemoradiotherapy: A Novel Treatment for Superficial Esophageal Squamous-Cell Carcinoma

BACKGROUND

Photodynamic therapy (PDT) is a new local, endoscopically controlled therapeutic concept based on the selective sensitization of malignant and precancerous lesions prior to light-induced tissue destruction. 5-aminolevulinic acid (5-ALA) appears to be a promising alternative photosensitizer with a high mucosa specificity without phototoxic side effects on the skin. The authors report on their experiences with this new form of PDT in 27 patients.



METHODS

Twenty-seven patients (6 females and 21 males; ages 47–79 years) with histologically proven high grade dysplasia (n = 9) and early carcinoma (normal endoultrasonography or classified as uT1N0M0; n = 19; 1 patient had 2 lesions) of the esophagus were included in this study. Approximately 4–6 hours after oral ingestion of 5-ALA in a dosage of 60 mg/kg of body weight, laser light irradiation was conducted with a dye laser system with a wavelength of 635 nanometers at a light dose of 150 J/cm2.



RESULTS

The length of the segment of the esophagus with severe dysplasia or carcinoma of the mucosa varied between 0.5–9.0 cm (mean length, 2.5 cm). High grade dysplasia was eradicated in all patients. In addition, 19 mucosal tumors in 18 patients were treated successfully in 10 of 19 cases with an average of 1.7 treatment sessions and a mean follow-up of 16.9 months (range, 3–37 months). Method-related morbidity and mortality were not observed.



CONCLUSIONS

Severe dysplasia and superficial (≤2 mm) mucosal carcinoma of the esophagus can be ablated completely by 5-ALA-PDT. PDT with 5-ALA has few side effects and might offer an alternative to esophagectomy or radiochemotherapy. Cancer 1999;86:1921–8. © 1999 American Cancer Society.

https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/%28SICI%291097-0142%2819991115%2986%3A10%3C1921%3A%3AAID-CNCR7%3E3.0.CO%3B2-N

Photodynamic destruction of high grade dysplasia and early carcinoma of the esophagus after the oral administration of 5-aminolevulinic acid.

OBJECTIVE The standard treatment for submucosal esophageal cancer is esophagectomy or chemoradiotherapy (CRT). However, these treatment modalities could deteriorate the general condition and quality of life of the patients who are intolerant to invasive therapy. It is therefore important and beneficial to develop less invasive treatment protocols for these patients. METHODS The study included 43 patients who were clinically suspected of mucosa or submucosal esophageal cancer but underwent endoscopic submucosal dissection (ESD) as a primary treatment, due to the patients' poor performance statuses and/or preferences for less invasive therapy. According to the pathological findings and patient's general condition, whether the patient underwent additional treatments or remained hospitalized without additional treatments was thereafter decided for each patient. We retrospectively analyzed the outcomes of these patients. RESULTS Fifteen patients underwent additional surgery, 11 patients underwent CRT/radiation therapy (RT) and 17 patients were followed without additional treatments. During the 3-year follow-up period, the relapse-free survival rates in the patients who received or did not receive additional treatments were 88% and 64%, respectively (95% confidence interval, 0.45-0.76, p=0.04). The relapse-free and overall survival rates in the patients with additional treatments were equivalent or superior to those described in previous reports of the standard treatments. Preceding ESD contributed to reduce the local relapse significantly to approximately 3.5% and additional CRT-related toxicities. CONCLUSION Preceding ESD is very effective for the local control of cancer, and useful for histologically confirming the high-risk factors of relapse, such as ≥submucosal layer 2 (SM2) invasion and lymphovascular involvements. ESD with additional therapy may be a promising strategy for optimizing the selection of therapy depending on the patient's general condition.

Endoscopic Submucosal Dissection (ESD) with Additional Therapy for Superficial Esophageal Cancer with Submucosal Invasion.

PURPOSE: To assess the effectiveness of definitive radiation therapy in patients with superficial esophageal cancer. MATERIALS AND METHODS: Method of irradiation, local control rate, survival rate, and complications were assessed in 105 patients (89 men, 16 women; age range, 50-88 years) with superficial esophageal cancer treated with definitive radiation therapy at 15 hospitals in 1981-1990. RESULTS: All lesions were confirmed to be squamous cell carcinoma. The overall 5-year survival rate was 38.7%; the 5-year disease-specific survival rate was 71.0%. The 2-year local control rate was 83.0%. Late complications occurred in 16 patients. The prevalence of complications was relatively high in the group treated with intraluminal radiation therapy. CONCLUSION: Local control and survival rates in patients treated with radiation therapy were excellent, especially in the group treated with external and intraluminal radiation therapy; however, the optimal dose and optimal combination of external and intraluminal ...

Superficial esophageal cancer: multicenter analysis of results of definitive radiation therapy in Japan

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Superficial esophageal cancer: multicenter analysis of results of definitive radiation therapy in Japan