• Asian Pacific Journal of Cancer Prevention
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• 제15권5호
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• pp.1943-1948
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• 2014

Purpose: The prevalence of weight loss in esophageal carcinoma patients is high and associated with impairment of physical function, increased psychological distress and low quality of life. It is not known which factors may contribute to weight loss in patients with esophageal carcinoma during radiotherapy in China. The objective of this study was to identify the associated demographic and clinical factors influencing weight loss. Methods: We evaluated 159 esophageal carcinoma patients between August 2010 and August 2013 in a crosssectional, descriptive study. Patient characteristics, tumor and treatment details, psychological status, adverse effects, and dietary intake were evaluated at baseline and during radiotherapy. A multivariate logistic regression analyss was performed to identify the potential factors leading to weight loss. Results: 64 (40.3%) patients had weight loss ${\geq}5%$ during radiotherapy. According to logistic regression analysis, depression, esophagitis, and loss of appetite were adverse factors linked to weight loss. Dietary counseling, early stage disease and total energy intake ${\geq}1441.3$ (kcal/d) were protective factors. Conclusions It was found that dietary counseling, TNM stage, total energy intake, depression, esophagitis, and loss of appetite were the most important factors for weight loss. The results underline the importance of maintaining energy intake and providing dietary advice in EC patients during RT. At the same time, by identifying associated factors, medical staff can provide appropriate medical care to reduce weight loss. Further studies should determine the effect of these factors on weight loss and propose a predictive model.

• Asian Pacific Journal of Cancer Prevention
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• 제14권3호
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• pp.1677-1680
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• 2013

Background: Areas of Iran have among the highest incidences of esophageal cancer in the world. Definitive chemo-radiotherapy (DCRT) is used for locally advanced esophageal cancer and for inoperable tumors asan alternative to surgical treatment. Materials and Methods: This retrospective study was conducted in North-West Iran 2006-2011, including 267 consecutive patients with non-metastatic esophageal cancer. Eligible inoperable patients were treated with DCRT or definitive radiotherapy (DRT) alone. Radiotherapy (RT) was delivered at 1.8-2 Gy/day for five consecutive days in a given week. Chemotherapy (CT) consisted of cisplatin and 5-fluorouracil. Results: The median survival was 12.7 months with 1, 3 and 5 year survival rates of 55%, 18% and 11%, respectively. On univariate analysis, relations with age at diagnosis (p=0.015), N-stage (p=0.04), total dose of RT (p=0.001), fraction (p<0.001), Gap status (p=0.025), chemotherapeutic regimens (P=0.027), and 5-Fu $Mg/m^2$ (P=0.004) were apparent. Comparing DCRT to DRT, there was a significant difference in survival. Multivariate analysis was performed for comparison between DCRT and DRT showed significant association with age group ${\geq}65$ to <65 (P=0.02; OR: 1.46), the total RT dose (Gy) ${\geq}50$ to <50 (P=0.01; OR: 0.65) and the fraction group ${\geq}25$ to <25 (P=<0.001; OR: 0.54). Conclusions: The survival rates of esophageal cancer treated with DCRT in North West of Iran is poor; therefore, early detection and improved treatment methods, with clinical trials are a high priority.

• Journal of Chest Surgery
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• 제53권4호
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• pp.184-190
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• 2020

Radiation therapy (RT) has improved patient outcomes, but treatment-related complication rates remain high. In the conventional 2-dimensional and 3-dimensional conformal RT (3D-CRT) era, there was little room for toxicity reduction because of the need to balance the estimated toxicity to organs at risk (OARs), derived from dose-volume histogram data for organs including the lung, heart, spinal cord, and liver, with the planning target volume (PTV) dose. Intensity-modulated RT (IMRT) is an advanced form of conformal RT that utilizes computer-controlled linear accelerators to deliver precise radiation doses to the PTV. The dosimetric advantages of IMRT enable better sparing of normal tissues and OARs than is possible with 3D-CRT. A major breakthrough in the treatment of esophageal cancer (EC), whether early or locally advanced, is the use of proton beam therapy (PBT). Protons deposit their highest dose of radiation at the tumor, while leaving none behind; the resulting effective dose reduction to healthy tissues and OARs considerably reduces acute and delayed RT-related toxicity. In recent studies, PBT has been found to alleviate severe lymphopenia resulting from combined chemo-radiation, opening up the possibility of reducing immune suppression, which might be associated with a poor prognosis in cases of locally advanced EC.

• Radiation Oncology Journal
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• 제13권1호
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• pp.27-31
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• 1995

Purpose : This study was done to evaluate preliminarily the role of intraluminal brachytherapy in the radiation treatment of non-metastatic esophageal cancer, Materials and Methods: We analyzed follow-up result of 21 patients treated at the dept. of therapeutic radiology in Gyeongsang national university hospital between April, 1989 and August, 1992. All patients received neoadjuvant chemotherapy(5-FU, Cispl-atin). Fifteen Patients were treated with external beam alone, and in remaining 6 patients, the external beam radiotherapy followed by intraluminal brachytherapy was done. Results : Among 21 patients, 7 patients showed complete tumor regression after completion of radiotherapy. But 2 of these complete responder recurred at the site of primary disease, so ultimate local control rate was $23.8\%$(5/21). Local control rate according to radiation treatment modality was $6.7\%$(1/15) in patients treaed with external irradiation only, and $66.7\%$ in patients treated with combined external irradiation and intraluminal brachytherapy. The 2 year NED survival rate was $6.6.\%$ in the former and $66.7\%$ in the latter. Conclusion: Although there should be consideration about case selection for addition of intraluminal brachytherapy intraluminal brachytherapy may be considerded as one of the method to enhance the local control probability of esophageal cancer.

• 대한방사선기술학회지:방사선기술과학
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• 제38권4호
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• pp.463-475
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• 2015

본 논문은 상당히 진행된 중위 식도암의 동시항암화학 방사선치료에 대한 분석의 것이다. 사용한 항암제는 전통적으로 사용되어온 시스플라틴, 5-플루오로우라실에, 도쎄탁실을 추가 시행하였다. 과거 식도암의 방사선치료에서는 총 선량 50.4 Gy/28회를 처방하였다. 하지만 현대의 방사선치료기술의 비약적인 발전으로, 호흡동조치료와 세기변조방사선치료를 적용하여, 정상조직의 손상을 최대한 감소시키면서 총 선량을 50.4 Gy이상으로 증가시키는 것이 가능하다. 이에 우리는, 도쎄탁실, 시스플라틴, 5-플루오로우라실 이라는 새로운 3제 병합요법(DCF-R)에 추가하여, 4DCT 모의시뮬레이션을 기반으로 한 호흡동조 세기변조방사선치료(gated-IGRT) 총 선량 70.2 Gy/39회를 동시에 시도하였으며, 치료기간 동안, 그리고 치료 종료 후 임상적으로 환자에게 위중한 합병증 및 부작용 발생은 관찰되지 않았다. 또한 생존율 향상을 이루어 냈다. 이를 바탕으로, 식도암의 새로운 치료방법을 제안한다.

• Journal of Chest Surgery
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• 제41권2호
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• pp.253-259
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• 2008

배경: 경부식도암은 흉부식도암에 비해 발생 빈도가 상대적으로 낮고 방사선치료나 항암 약물치료의 역할이 흉부식도암에서보다 상대적으로 높다. 따라서 경부식도암에 대한 수술적 치료의 역할이 흉부식도암에 비해 상대적으로 제한적이다. 저자들은 경부식도암에 대한 수술적 치료의 결과를 알아보기 위해 본 연구를 시행하였다. 대상 및 방법: 1989년 1월부터 2002년 12월까지 경부식도암(경흉부식도 암 포함 )으로 수술을 시행 받은 환자 43명의 결과를 후향적으로 분석하였다. 모든 환자에서 추적이 가능하였으며, 최종 추적일은 2004년 2월 28일이었다. 결과: 대상 환자의 평균 나이는 60세$(43{\sim}77)$였고, 남녀 비는 40:3이었다. 조직학적으로 편평상피세포암이 42명, 악성 흑색종이 1명이었다. 식도 재건 방법은 gastric pull-up 32명, 유리 공장 이식 7명, colon interposition 4명이었다. 전체 43명 중 31명(72%)의 환자에서 합병증이 발생하였고, 수술 사망자는 7명(16%)이었다. 수술 후 최종 병기는 I 3명, IIa 14 명, IIb 1명, III 19명, IVa 6명이었다. 수술 사망자를 제외한 36 명 중 16명(44%)에서 종양이 재발하였고, 수술 후 3년, 5년 생존율은 29.3% 와 20.9%이었다. 결론: 경부식도암에 대한 수술은 수술 사망률, 합병증 발생률, 재발률이 높고, 장기 생존율이 낮지만, 방사선치료나 항암약물치료 만으로는 연하곤란의 완전한 해소 및 종양의 완치가 어려우므로 수술이 포함되는 다방법 병합치료가 필요하다고 생각한다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권19호
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• pp.8475-8478
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• 2014

Purpose: This systematic analysis was conducted to evaluate the efficacy and safety of pemetrexed-based chemoradiotherapy in treating patients with locally advanced or metastatic esophageal cancer. Methods: Clinical studies evaluating the efficacy and safety of pemetrexed based regimens on response and safety for relevant patients were identified using a predefined search strategy. Pooled response rates (RRs) were calculated. Results: For pemetrexed-based regimens, 4 clinical studies including 47 patients with locally advanced or metastatic esophageal cancer were considered eligible for inclusion. Systematic analysis showed that, in all patients, the pooled RR was 51% (24/47). Major adverse effects of grade III/IV were esophagitis, neutropenia, thrombocytopenia, anemia anorexia, fatigue, diarrhea, dysphagia and vomiting. No treatment related death occurred with pemetrexed-based treatment. Conclusion: This systematic analysis suggests that pemetrexed based radiotherapy is associated with reasonable activity and good tolerability in treating patients with locally advanced or metastatic esophageal cancer.

• Radiation Oncology Journal
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• 제12권2호
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• pp.185-190
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• 1994

Purpose : Patients with esophageal cancer treated with surgery plus postoperative radiotherapy or radiation alone were retrospectively analyzed. Method : From August 1980 to June 1992, 93 patients who were treated with 30 Gy or more in the Department of Therapeutic Radiology were evaluated. Median age was 59 years. Ninety one were male and remaining 2 were female. Patients with stage II, III and IV disease were 25, 62 and 6 respectively. Thirteen of the tumor were located in upper one third, 56 in middle one third and 24 in lower one third. Forty three patients had tumors 5cm or less in size and remaining 50 had greater than 5cm. Of those 93 patients, 41 were treated with surgery plus postoperative radiotherapy and 52 with radiation alone. Dose of radiation ranged from 34 to 66.6 Gy. Follow up period was 12 to 61 months. Results : Stage of the tumor was the most important prognostic factor of the evaluated factors. Median survival for entire group of patients was 12 months. Median survival for patients treated with surgery plus postoperative radiotherapy and radiation alone were 15 and 10 months, respectively. There was no difference of 2 year survival. Median survival was 21 months for Stage II and 10 months for Stage m disease. In Stage II disease, that was 21 months for postoperative group and 17.5 months for radiation alone group. Five year survival were $27.5\%$ and $9\%$, respectively. Conclusion : This study showed that the result of surgery plus postoperative radiotherapy was not different from that of radiation alone despite of slightly longer median survival in postoperative group. Also stage of the disease was the most important prognostic factor.

• Radiation Oncology Journal
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• 제26권1호
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• pp.17-23
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• 2008

목적: 최근 진행된 식도암의 치료는 병행항암방사선요법 후 수술을 시행하는 것이 가장 성적이 좋은 것으로 보고되고 있다. 그러나 병행치료의 발전에도 불구하고 여전히 많은 식도암 환자에서 병행치료가 어려워 방사선치료 단독으로 치료받게 된다. 이에 저자는 통상적인 외부방사선치료를 받은 식도암 환자의 치료성적과 예후인자를 알아 보고자 하였다. 대상 및 방법: 1998년 1월부터 2005년 12월까지 식도의 편평상피세포암으로 진단받고 40 Gy 이상 외부방사선조사를 받은 30명의 환자를 대상으로 분석하였다. 총방사선량은 $44{\sim}60Gy$(중간선량 57.2 Gy)이었으며 방사선치료 기간은 $36{\sim}115$일(중간방사선치료기간 45일)이었다. 13명(43.3%)의 환자는 당뇨, 고혈압, 결핵 등의 과거력이 있었으며 그중 4명의 환자에서 식도암 진단 전 3명이 위암, 1명이 하인두암으로 진단받고 치료받은 적이 있었다. 원발병소부위는 중흉부식도에 위치한 예가 19명(63.3%)으로 가장 많았고 상흉부식도 4명(13.3%), 하흉부식도 7명(23.3%)이었다. 원발병소의 길이는 $2{\sim}11cm$이었고, 중간 길이는 6 cm이었다. 진단당시 병기는 AJCC 병기로 병기 I이 2명(6.7%), 병기 II 4명(13.3%), 병기 III 19명(63.3%), 병기 IV 5명(16.7%)이었다. 결과: 전체 환자의 중간 생존기간은 8.3개월이었고 1년 생존율 33.3%, 2년 생존율 18.7%이었다. 치료종료 $1{\sim}3$개월째 치료결과를 판정하여 완전관해를 보인 환자가 6명(20%), 부분관해 21명(70%)이었다. 치료종료 $1{\sim}3$개월 후에 평가한 연하곤란증상은 29명(96.7%)의 환자에서 호전되었다. 치료성적에 영향을 미치는 예후인자에 대한 단변량 분석결과 연령, 종양의 길이, 병기, 치료 전 식사, 치료 목적, 치료에 따른 반응정도가 통계적인 유의성을 보였다. 다변량분석에서는 종양의 길이, 치료 목적, 치료에 따른 반응정도가 생존율에 영향을 미치는 인자로 확인되었다. 치료실패는 국소 실패가 28명, 전이가 4명이었다. 추적조사기간동안 2명의 환자에서 이차적인 암이 발생하여 과거력상 식도이외의 암이 있었던 환자를 포함하면 6명(20%)에서 다발성 암으로 진단받았다. 치료로 인한 부작용 중 식도협착이 발생한 예가 3명(10%), 방사선폐렴이 발생한 예가 2명(6.7%)이었다. 결론: 식도암에서 단독 방사선치료 결과는 병행치료에 비해 만족스럽지 못하지만 부작용이 많지 않아 연하곤란증상을 완화시키기 위한 목적으로 여전히 이용되고 있다. 진행된 식도암에서 항암제 혹은 항암제 이외의 적절한 병행치료를 시행하여 완전관해율을 높인다면 생존율의 향상을 얻을 수 있으리라 기대해 본다.

• Journal of Chest Surgery
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• 제53권4호
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• pp.160-167
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• 2020

Surgical resection is the mainstay of treatment for locally advanced esophageal cancer. Neoadjuvant therapy is recommended to improve survival, based on the results of several randomized trials and meta-analyses. However, controversy remains regarding how to combine surgery, radiotherapy, and chemotherapy. Moreover, in East Asia, the predominant histological type is esophageal squamous cell carcinoma, which has a different epidemiology and tumor biology from esophageal or gastroesophageal junctional adenocarcinoma. As such, the management of esophageal cancer in East Asia seems to be different from that in Western countries. Thus, this article reviews the current evidence on neoadjuvant therapy and considers the optimal combinations and ongoing strategies of multimodal therapy for esophageal squamous cell carcinoma.