Bosset JF, Gignoux M, Triboulet
JP, et al. Chemoradiotherapy followed by surgery compared with surgery
alone in squamous-cell cancer of the esophagus. N Engl J Med. 1997;337:161-167.
In patients with squamous-cell esophageal cancer,
preoperative chemoradiotherapy did not improve overall survival, but it
did prolong disease-free survival and survival free of local disease.
Walsh TN, Noonan N, Hollywood
D, et al. A comparison of multimodal therapy and surgery for esophageal
adenocarcinoma. N Engl J Med. 1996;335:462-467.
At one, two, and three years, 52%, 37%, and 32%,
respectively, of patients assigned to multimodal therapy were alive, compared
with 44%, 26%, and 6% of those assigned to surgery. The survival advantage
favoring multimodal therapy reached significance at three years.
Hiele M, DeLeyn P, Schurmans
P, et al. Relation between endoscopic ultrasound findings and outcome of
patients with tumors of the esophagus or esophagogastric junction. Gastrointest
Endosc. 1997;45:381-386.
Survival data of 86 patients who underwent endoscopic
ultrasound for staging of tumors of the esophagus or esophagogastric junction
were analyzed. Total accuracy for T staging amounted to 59%. Accuracy for
recognition of transmural growth was 82%. There was a good association
between endosonographic findings (EUS stage II, absence of lymph nodes)
and the possibility of complete resection. Incomplete resection was less
well predicted.
Riddell RH. Early detection
of neoplasia of the esophagus and gastroesophageal junction. Am J Gastroenterol.
1996;91:853-863.
Patients with intestinalized mucosa in the lower
esophagus should be considered for inclusion in a screening program for
the detection of dysplasia or carcinoma. Repeated screening may be necessary
to detect early invasive or preinvasive (dysplastic) tumors.
Price P, Hoskin PJ, Hutchinson
T, et al. What is the role of radiation-chemotherapy in the radical nonsurgical
management of carcinoma of the oesophagus? Br J Cancer. 1998;78:504-507.
The optimal radical nonsurgical management of carcinoma
of the esophagus has yet to be determined. The combination of high-dose
radiotherapy with chemotherapy is being explored, particularly in North
America. The Medical Research Council Upper GI Working Party has debated
the areas where there is scientific uncertainty and which clinical trials
may be appropriate to undertake in the United Kingdom.
Cameron AJ, Lomboy CT, Pera
M, et al. Adenocarcinoma of the esophagogastric junction and Barrett’s
esophagus. Gastroenterology. 1995;109:1541-1546.
Adenocarcinomas of the esophagogastric junction are
associated with short and long segments of Barrett’s esophagus. Larger
cancers probably overgrow and conceal the underlying specialized columnar
epithelium from which they arise.
Adam A, Ellul J, Watkinson
AF, et al. Palliation of inoperable esophageal carcinoma: a prospective
randomized trial of laser therapy and stent placement. Radiology. 1997;202:344-348.
Placement of metallic esophageal endoprostheses is
substantially better than endoscopic laser therapy for palliation of dysphagia
in patients with inoperable esophageal carcinoma. Use of uncovered and
plastic-covered metallic stents provides equal palliation in patients with
dysphagia.
Overholt BF, Panjehpour M.
Photodynamic therapy in Barrett’s esophagus: reduction of specialized mucosa,
ablation of dysplasia, and treatment of superficial esophageal cancer.
Semin Surg Oncol. 1995;11:372-376.
Twelve patients with Barrett’s esophagus and dysplasia
were treated with photodynamic therapy. Photodynamic therapy ablated dysplastic
mucosa and malignant mucosa in patients with superficial cancer. Healing
and partial replacement of Barrett’s mucosa with normal squamous epithelium
occurred in all patients, and complete replacement with squamous epithelium
was found in three patients.
Ellis FH Jr, Williamson WA,
Heatley GJ. Cancer of the esophagus and cardia: does age influence treatment
selection and surgical outcomes? J Am Coll Surg. 1998;187:345-351.
Age should not be a limiting factor in using an aggressive
surgical approach for the management of cancer of the esophagus or cardia
in patients aged 70 years or older. Such an approach can be performed as
safely as in younger patients, with comparable rates of palliation and
survival.
Natsugoe S, Yoshinaka H, Moringa
T, et al. Assessment of tumor invasion of the distal esophagus in carcinoma
of the cardia using endoscopic ultrasonography. Endoscopy. 1996;28:750-755.
EUS can provide the surgeon with additional information
on the extent of esophageal infiltration in patients with carcinoma of
the gastric cardia, and can therefore assist in the selection of the surgical
approach.