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Article: Current management of cervical esophageal cancer

TitleCurrent management of cervical esophageal cancer
Authors
Issue Date2011
PublisherSpringer New York LLC. The Journal's web site is located at http://link.springer.de/link/service/journals/00268/
Citation
World Journal Of Surgery, 2011, v. 35 n. 3, p. 600-607 How to Cite?
AbstractBackground: Pharyngo-laryngo-esophagectomy (PLE) has been regarded as a standard treatment for cervical esophageal cancer, but the morbidity and mortality rates associated with PLE are substantial. Chemoradiation (CTRT) is widely used to treat esophageal cancer; however, its role in managing cervical esophageal cancer has not been fully elucidated. It was hypothesized that up-front CTRT could be an effective alternative treatment option to PLE. The purpose of this study was to compare the outcomes of patients with cervical esophageal cancer treated with these two methods. Methods: Patients with cervical esophageal cancer from 1995 to 2008 were studied. Three main groups were identified: those treated with PLE, those managed with up-front concurrent chemoradiation, and those not suitable for either PLE or chemoradiation but to whom palliative treatment was offered. The demographics, management strategies, and outcomes of these patients were studied and analyzed. Results: A total of 107 patients were studied: 87 (81.3%) were men, and the median age was 64 years (range 17-92 years). There were 62 patients who underwent PLE as the primary treatment, 21 had up-front chemoradiation, and the others had palliative treatment. In the PLE group, curative resection was achieved in 37 (59.7%) patients, 20 of whom had either adjuvant chemoradiation or radiotherapy. The hospital mortality rate was 7.1%. In the chemoradiation group, 10 (47.6%) had tumor down-staging, 6 of whom achieved a clinically complete response. Among the 11 patients with poor response, 5 required salvage PLE for palliation. Chemoradiation-associated morbidities included oral mucositis, bilateral vocal cord palsy, esophageal stricture, carotid artery blowout, and permanent hypothyroidism and hypoparathyroidism. The median survival durations of patients in the PLE and chemoradiation groups were 20 and 25 months respectively (P = 0.39). Conclusions: Up-front chemoradiation can be an alternative therapeutic strategy to PLE. However, this method is not without drawbacks. A significant proportion also requires salvage surgery. Both PLE and chemoradiation have significant curative as well as palliative role in the management of cervical esophageal cancer and treatment should be individualized. © 2010 Société Internationale de Chirurgie.
Persistent Identifierhttp://hdl.handle.net/10722/142540
ISSN
2015 Impact Factor: 2.523
2015 SCImago Journal Rankings: 1.375
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorTong, DKHen_HK
dc.contributor.authorLaw, Sen_HK
dc.contributor.authorKwong, DLWen_HK
dc.contributor.authorWei, WIen_HK
dc.contributor.authorNg, RWMen_HK
dc.contributor.authorWong, KHen_HK
dc.date.accessioned2011-10-28T02:50:47Z-
dc.date.available2011-10-28T02:50:47Z-
dc.date.issued2011en_HK
dc.identifier.citationWorld Journal Of Surgery, 2011, v. 35 n. 3, p. 600-607en_HK
dc.identifier.issn0364-2313en_HK
dc.identifier.urihttp://hdl.handle.net/10722/142540-
dc.description.abstractBackground: Pharyngo-laryngo-esophagectomy (PLE) has been regarded as a standard treatment for cervical esophageal cancer, but the morbidity and mortality rates associated with PLE are substantial. Chemoradiation (CTRT) is widely used to treat esophageal cancer; however, its role in managing cervical esophageal cancer has not been fully elucidated. It was hypothesized that up-front CTRT could be an effective alternative treatment option to PLE. The purpose of this study was to compare the outcomes of patients with cervical esophageal cancer treated with these two methods. Methods: Patients with cervical esophageal cancer from 1995 to 2008 were studied. Three main groups were identified: those treated with PLE, those managed with up-front concurrent chemoradiation, and those not suitable for either PLE or chemoradiation but to whom palliative treatment was offered. The demographics, management strategies, and outcomes of these patients were studied and analyzed. Results: A total of 107 patients were studied: 87 (81.3%) were men, and the median age was 64 years (range 17-92 years). There were 62 patients who underwent PLE as the primary treatment, 21 had up-front chemoradiation, and the others had palliative treatment. In the PLE group, curative resection was achieved in 37 (59.7%) patients, 20 of whom had either adjuvant chemoradiation or radiotherapy. The hospital mortality rate was 7.1%. In the chemoradiation group, 10 (47.6%) had tumor down-staging, 6 of whom achieved a clinically complete response. Among the 11 patients with poor response, 5 required salvage PLE for palliation. Chemoradiation-associated morbidities included oral mucositis, bilateral vocal cord palsy, esophageal stricture, carotid artery blowout, and permanent hypothyroidism and hypoparathyroidism. The median survival durations of patients in the PLE and chemoradiation groups were 20 and 25 months respectively (P = 0.39). Conclusions: Up-front chemoradiation can be an alternative therapeutic strategy to PLE. However, this method is not without drawbacks. A significant proportion also requires salvage surgery. Both PLE and chemoradiation have significant curative as well as palliative role in the management of cervical esophageal cancer and treatment should be individualized. © 2010 Société Internationale de Chirurgie.en_HK
dc.languageengen_US
dc.publisherSpringer New York LLC. The Journal's web site is located at http://link.springer.de/link/service/journals/00268/en_HK
dc.relation.ispartofWorld Journal of Surgeryen_HK
dc.rightsThe original publication is available at www.springerlink.com-
dc.subject.meshAntineoplastic Combined Chemotherapy Protocols - therapeutic use-
dc.subject.meshCarcinoma, Squamous Cell - mortality - pathology - surgery - therapy-
dc.subject.meshEsophageal Neoplasms - mortality - pathology - surgery - therapy-
dc.subject.meshEsophagectomy - methods-
dc.subject.meshPalliative Care - methods-
dc.titleCurrent management of cervical esophageal canceren_HK
dc.typeArticleen_HK
dc.identifier.emailLaw, S: slaw@hku.hken_HK
dc.identifier.emailKwong, DLW: dlwkwong@hku.hken_HK
dc.identifier.emailWei, WI: hrmswwi@hku.hken_HK
dc.identifier.authorityLaw, S=rp00437en_HK
dc.identifier.authorityKwong, DLW=rp00414en_HK
dc.identifier.authorityWei, WI=rp00323en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1007/s00268-010-0876-7en_HK
dc.identifier.pmid21161656-
dc.identifier.scopuseid_2-s2.0-79952192203en_HK
dc.identifier.hkuros184630en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-79952192203&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume35en_HK
dc.identifier.issue3en_HK
dc.identifier.spage600en_HK
dc.identifier.epage607en_HK
dc.identifier.isiWOS:000286934700022-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridTong, DKH=8670837000en_HK
dc.identifier.scopusauthoridLaw, S=7202241293en_HK
dc.identifier.scopusauthoridKwong, DLW=15744231600en_HK
dc.identifier.scopusauthoridWei, WI=7403321552en_HK
dc.identifier.scopusauthoridNg, RWM=7102153861en_HK
dc.identifier.scopusauthoridWong, KH=36485841700en_HK
dc.identifier.citeulike8626966-

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