DISCUSSION
Esophageal cancer is the eighth most common cancer and sixth most common cause of death from cancer worldwide. . Neoadjuvant chemoradiotherapy has recently become the focus of interest in an effort to prolong survival and reduce recurrence rates in patients with esophageal cancer.
The objective of this study is to determine National cancer institute experience about the role of preoperative chemoradiotherapy followed by esophagectomy for esophageal and gastro-esophageal carcinomas and its pathological outcome, resectability and the survival rate.
Patients ' age distribution for esophageal and gastro-esophageal junction carcinoma showed a peak from 51-60 years in our study. This distribution is comparable to the 2 peaks incidence …show more content…
Data for both types, esophageal cancer is clearly more prevalent in males than in females. Depending on the geographical region, male: female ratios of 2:1 to 4:1 are obtained for SCC (Crew and Neugut 2004) .This male predominance is even higher for AC, especially in the Western countries. In the US, a male: female ratio of as high as 7:1 was achieved in the period 1993-2002 (Holmes and Vaughan, 2007).
Unfortunately, Most of the patients presented to NCI were diagnosed with locally advanced tumors, only 23 % were operable cases, similar to literature, Only about 20% of esophageal cancer patients have operable localized disease (stages 0, 1 and II)( Bosset et al 1997) and only the minority of patients are considered suitable for resection (Pye et al 2001,Central Statistics Office 2001). Contrary to the well-known synergistic effects of smoking and alcohol consumption on the risk increase of esophageal cancer known in the literature where risk is five times higher among cigarette smokers than nonsmokers (Launoy et al. 1997). Smoking history was only found in 22% of patients while alcohol consumption was absent in all the studied …show more content…
FDG-PET signals have been used to identify patients who do not respond to neoadjuvant treatment and should be offered alternative treatment options. Higher glucose uptake – as measured by FDG-PET – seems to correlate with a better chance for responding to neoadjuvant therapy (Javeri et al. 2009; Lordick et al. 2007; Rizk et al. 2009).
Computed tomography was the main method used for assessment of the chemotherapy response in the study group which did not give us accurate data about response the inoperable cases were assessed before surgery showing regressive course in 33.3% by CT, 50% stationary course and 16% progressive. The CT low sensitivity in contrast to PET was responsible for the inaccurate response assessment in the inoperable cases.
• Treatment outcomes
The most common type of surgery was Ivor lewis by 50%. Type of surgery was chosen depend upon the site of tumor, not on tumor pathology or neoadjuvant treatment.
Western and Eastern counties adopt different surgical approaches; Ivor-Lewis type surgery with two-field LN dissection is preferred in the West, while three-field LN dissection is the treatment of choice in the East, especially in Japan (Nishihira et al
Esophageal cancer is the eighth most common cancer and sixth most common cause of death from cancer worldwide. . Neoadjuvant chemoradiotherapy has recently become the focus of interest in an effort to prolong survival and reduce recurrence rates in patients with esophageal cancer.
The objective of this study is to determine National cancer institute experience about the role of preoperative chemoradiotherapy followed by esophagectomy for esophageal and gastro-esophageal carcinomas and its pathological outcome, resectability and the survival rate.
Patients ' age distribution for esophageal and gastro-esophageal junction carcinoma showed a peak from 51-60 years in our study. This distribution is comparable to the 2 peaks incidence …show more content…
Data for both types, esophageal cancer is clearly more prevalent in males than in females. Depending on the geographical region, male: female ratios of 2:1 to 4:1 are obtained for SCC (Crew and Neugut 2004) .This male predominance is even higher for AC, especially in the Western countries. In the US, a male: female ratio of as high as 7:1 was achieved in the period 1993-2002 (Holmes and Vaughan, 2007).
Unfortunately, Most of the patients presented to NCI were diagnosed with locally advanced tumors, only 23 % were operable cases, similar to literature, Only about 20% of esophageal cancer patients have operable localized disease (stages 0, 1 and II)( Bosset et al 1997) and only the minority of patients are considered suitable for resection (Pye et al 2001,Central Statistics Office 2001). Contrary to the well-known synergistic effects of smoking and alcohol consumption on the risk increase of esophageal cancer known in the literature where risk is five times higher among cigarette smokers than nonsmokers (Launoy et al. 1997). Smoking history was only found in 22% of patients while alcohol consumption was absent in all the studied …show more content…
FDG-PET signals have been used to identify patients who do not respond to neoadjuvant treatment and should be offered alternative treatment options. Higher glucose uptake – as measured by FDG-PET – seems to correlate with a better chance for responding to neoadjuvant therapy (Javeri et al. 2009; Lordick et al. 2007; Rizk et al. 2009).
Computed tomography was the main method used for assessment of the chemotherapy response in the study group which did not give us accurate data about response the inoperable cases were assessed before surgery showing regressive course in 33.3% by CT, 50% stationary course and 16% progressive. The CT low sensitivity in contrast to PET was responsible for the inaccurate response assessment in the inoperable cases.
• Treatment outcomes
The most common type of surgery was Ivor lewis by 50%. Type of surgery was chosen depend upon the site of tumor, not on tumor pathology or neoadjuvant treatment.
Western and Eastern counties adopt different surgical approaches; Ivor-Lewis type surgery with two-field LN dissection is preferred in the West, while three-field LN dissection is the treatment of choice in the East, especially in Japan (Nishihira et al