MULTIMODAL APPROACH TO THE TREATMENT OF ESOPHAGEAL CANCER
1Department of Abdominal Oncology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russian Federation
2Department of Thoracic Oncology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences,, Tomsk, Russian Federation
3Department of Oncology, Siberian State Medical University, Tomsk, Russian Federation
Objective: To study the effectiveness and tolerability of preoperative chemotherapy (CHT) in combination with radical surgery in patients with esophageal squamous cell carcinoma (ESCC) II-III stages
Methods: The results of the combined and surgical treatment of 43 patients with ESCC II-III stages are presented. The main group consisted of 22 patients who were assigned two courses of CHT before surgery (gemcitabine/cisplatin), followed by a radical surgery. The control group included 21 patients who received only surgical treatment.
Results: Preoperative CHT in one (4.5±4.6%) patient gave a complete regression of the tumor, incomplete regression was in ten (45.5±11.1%) and stabilization is established in nine (40.9±10.9%) patients. The therapy had satisfactory tolerability and low toxicity, most patients observed the restoration of a full enteral nutrition. Postoperative complications in both groups of observations developed in 18.2±8.6% and 23.8±9.5% respectively (p>0.05). Preoperative CHT in the combined treatment of ESCC II-III stages has significantly improved two-year relapse-free and overall survival (80,9±8,7% and 85,7±7,8%) compared to the control group (35.0±10.6% and 55.0±11.1%) (p<0.05).
Conclusion: The multimodal approach in the treatment of patients in II-III stages ESCC has pronounced damaging effect on the tumor and allows to significantly increase two-year relapse-free and overall survival rate compared to patients who have undergone only surgical treatment.
Keywords: Esophageal squamous cell carcinoma, combined treatment, preoperative chemotherapy, short-term and long-term results.
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.
- Zhang Y. Epidemiology of esophageal cancer. World J Gastroenterol. 2013;19:5598-606
- Kaprin AD, Starinskiy VV, Petrova GV. Sostoyanie onkologicheskoy pomoshchi naseleniyu Rossii v 2017 godu [The state of cancer care to the population of Russia in 2017]. Moscow, RF: RIIS FIAN; 2018. 69 p.
- Dvoretskiy SYu. Sovremennaya strategiya lecheniya raka pishchevoda [Modern esophageal cancer treatment strategy]. Vestnik khirurgii. 2016;17(4):102-7.
- Klevebro F, Lindblad M, Johansson J, Lundell L, Nilsson M. Outcome of neoadjuvant therapies for cancer of the oesophagus or gastro-oesophageal junction based on a national data registry. Br J Surg. 2016;103(13):1864-73.
- Napier KJ, Scheerer M, Misra S. Esophageal cancer: a review of epidemiology, pathogenesis, staging workup and treatment modalities. World J Gastrointest Oncol. 2014;6(5):112-20.
- Kuwano H, Nishimura Y, Oyama T, Kato H, Kitagawa Y, Kusano M, et al. Guidelines for diagnosis and treatment of carcinoma of the esophagus April 2012 edited by the Japan Esophageal Society. Esophagus. 2015;12(1):1-30.
- Scheer RV, Fakiris AJ, Johnstone PA. Quantifying the benefit of a pathologic complete response after neoadjuvant chemoradiotherapy in the treatment of esophageal cancer. Int J Radiat Oncol Biol Phys. 2011;80(4):996-1001.
- Levchenko EV, Kanaev SV, Tyuryaeva EI, Dvoretskiy SYu, Shcherbakov AM, Komarov IV, i dr. Rezul’taty kompleksnogo lecheniya bol’nykh rakom grudnogo otdela pishchevoda [Results of complex treatment of patients with cancer of the thoracic part of esophagus]. Voprosy onkologii. 2016;62(2):302-9.
- Duan X, Yu Z. Neoadjuvant chemoradiotherapy combined with operation vs. operation alone for resectable esophageal cancer: Meta-analysis on randomized controlled trials. Zhonghua Wei Chang Wai Ke Za Zhi. 2017;20(7):809-15.
- Zhang YS, Gao BR, Wang HJ, Su YF, Yang YZ, Zhang JH, at al. Comparison of anastomotic leakage and stricture formation following layered and stapler oesophagogastric anastomosis for cancer: a prospective randomized controlled trial. J Int Med Res. 2010;38(1):227-33.
- Dengina NV. Sovremennye terapevticheskie vozmozhnosti pri rake pishchevoda [Modern therapeutic opportunities at cancer of the esophagus]. Prakticheskaya onkologiya. 2012;13(4):276-88.
- Ando N, Kato H, Igaki H, Shinoda M, Ozawa S, Shimizu H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19(1):68-74.
- Baba Y, Watanabe M, Yoshida N, Baba H. Neoadjuvant treatment for esophageal squamous cell carcinoma. World J Gastroint Oncol. 2014;6:121-8.
- Volkova EE, Vashakmadze LA, Khomyakov VM, Mamontov AS. Uskorennaya gospital’naya reabilitatsiya bol’nykh posle rasshirenno-kombinirovannykh operatsiy po povodu raka grudnogo otdela pishchevoda i kardii [Accelerated hospital rehabilitation of patients after advanced combined surgery for cancer of the thoracic part of esophagus and cardia]. Sibirskiy onkologicheskiy zhurnal. 2013;1:52-8.
- Yoshida N, Baba Y, Shigaki H, Harada K, Iwatsuki M, Sakamoto Y, at al. Risk factors of early recurrence within 6 months after esophagectomy following neoadjuvant chemotherapy for resectable advanced esophageal squamous cell carcinoma. Int J Clin Oncol. 2016;21(6):1071-8.
Urmonov Umidzhon Butabekovich
, Postgraduate Student in the Department of Abdominal Oncology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences SPIN code: 7150-7291
Dobrodeev Aleksey Yurievich
, Doctor of Medical Sciences, Leading Researcher in the Department of Abdominal Oncology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences SPIN code: 5510-4043; ORCID ID: 0000-0002-2748-0644
Afanasyev Sergey Gennadievich
, Doctor of Medical Sciences, Full Professor, Head of Abdominal Oncology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences SPIN code: 9206-3037; ORCID ID: 0000-0002-4701-0375
Avgustinovich Aleksandra Vladimirovna
, Researcher in the Department of Abdominal Oncology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences SPIN code: 2952-6119; Author ID: 558788
Rodionov Evgeniy Olegovich
, Candidate of Medical Sciences, Junior Researcher in the Department of Thoracic Oncology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences; Assistant of the Department of Oncology, Siberian State Medical University SPIN code: 7650-2129; Author ID: 805452
Conflict of interest: No conflict
Address for correspondence:
Urmonov Umidzhon Butabekovich
Postgraduate Student in the Department of Abdominal Oncology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
634009, Russian Federation, Tomsk, Kooperativniy per., 5
Tel.: +7 (953) 9137175
Materials on the topic:
- COMPLEX DIAGNOSIS OF CERVICAL INTRAEPITHELIAL NEOPLASIA IN THE REPUBLIC OF TAJIKISTAN
- MODERN METHODS OF LOCAL TREATMENT OF PATIENTS WITH UVEAL MELANOMA WITH LIVER METASTASES
- FIRST RESULTS OF TREATMENT OF CERVICAL INTRAEPITHELIAL NEOPLASIA IN THE REPUBLIC OF TAJIKISTAN
- INFLUENCE OF PLASTIC AND RECONSTRUCTIVE SURGERY ON THE QUALITY OF LIFE OF PATIENTS WITH LOCALLY ADVANCED HEAD AND NECK CANCER
- OUR EXPERIENCE OF IMMUNOHISTOCHEMICAL ASSAY IN BREAST CANCER
- EXPERIENCE OF MULTIVISCERAL RESECTIONS IN LOCALLY ADVANCED AND PRIMARY-MULTIPLE RECTAL CANCER
- COMBINED TREATMENT OF PATIENTS WITH NON-SMALL CELL LUNG CANCER WITH PERSONALIZED PRESCRIPTION OF ADJUVANT CHEMOTHERAPY
- ETHNIC PECULIARITIES OF DISTRIBUTION OF ACUTE MYELOBLASTIC LEUKAEMIA IN CHILDREN’S POPULATION IN KYRGYZSTAN
- INDICATORS OF ANTICOAGULATIVE ACTIVITY OF VASCULAR WALL DEPENDING ON STAGE OF BREAST CANCER
- EMERGENCY SURGERY TO ONCOLOGICAL PATIENTS