[A case of basaloid cell carcinoma of the anal canal in which complete response was obtained by chemoradiation therapy].

The patient was a 69-year-old woman with a chief complaint of melena, who had a palpable firm mass and tenderness on digital rectal examination. Colonoscopy (CS) showed a depressed hemorrhagic lesion 2cm in diameter on the left anterior wall of the anal canal near the dentate line. Biopsy examination yielded a diagnosis of basaloid cell carcinoma. On the basis of a diagnosis of clinical stage I (T1N0M0) anal canal cancer, chemoradiotherapy was performed. After treatment, no tumor cells were detected on biopsy. Basaloid cell carcinoma, accounting for about 1.6% of anal canal cancers, is rare. Only 4 among 62 reported cases (including our patient) received chemoradiation therapy.

Chemoradiotherapy with and without esophagectomy for advanced esophageal cancer.

BACKGROUND/AIMS: To evaluate the impact of surgery on survival after chemoradiotherapy, we analyzed the long-term outcome of patients with advanced esophageal cancer. METHODOLOGY: Data on 92 consecutive patients with T3 or T4 esophageal cancer who were initially treated by chemoradiotherapy were reviewed retrospectively. Of 82 patients who completed the planned schedule, 35 patients underwent esophagectomy (CRT+E Group) and 47 patients received definitive chemoradiotherapy (CRT Group). RESULTS: A response to chemoradiotherapy was obtained in 71% of all 92 patients. The 1- and 3-year survival rates in the patients with T3M0 were 87 and 44 percent respectively, while these in the patients with T4 and/or M1(Lymph) disease were 47 and 20 percent. Although there was no difference in overall survival between the CRT+E Group and the CRT Group, the survival of responders in the CRT+E Group was significantly higher than that of those in the CRT Group (P=0.0448). The locoregional recurrence rate of responders in the CRT Group was higher than that in the CRT+E Group. Multivariate analysis showed that the independent prognostic factors were response, M(Lymph), and esophagectomy. CONCLUSIONS: Although this study was retrospective and nonrandomized, esophagectomy after chemoradiotherapy might improve the survival of responders for locoregional control.

Salvage esophagectomy after definitive chemotherapy and radiotherapy for advanced esophageal cancer.

BACKGROUND: Although local recurrence of advanced esophageal cancer is frequent after definitive chemoradiotherapy (CRT), the clinical benefit of salvage esophagectomy has not been elucidated. METHODS: We reviewed 27 patients with squamous-cell cancer who underwent esophagectomy after definitive CRT (> or = 50 Gy) (salvage group) and 28 patients who underwent planned esophagectomy after neoadjuvant CRT (30 to 45 Gy) (neoadjuvant group). RESULTS: The preoperative albumin level and vital capacity were significantly lower in the salvage group than in the neoadjuvant group. Two patients (7.4%) from the salvage group who underwent extended esophagectomy with three-field lymphadenectomy died of postoperative complications, but no deaths occurred after less-invasive surgery. There was no difference of overall postoperative survival between the salvage and neoadjuvant groups. CONCLUSIONS: The outcome of salvage esophagectomy after definitive CRT was similar to that of planned esophagectomy after neoadjuvant CRT. Less-invasive procedures might be better for salvage esophagectomy because of the high operative risk.

Concomitant analysis of p16/INK4, cyclin D1, and retinoblastoma protein expression in esophageal squamous cell carcinoma.

BACKGROUND/AIMS: Cyclin D1 expression is one of the important biologic factors and its close association with p16/INK4 and retinoblastoma protein expression has been proven in patients with esophageal squamous cell carcinoma, however, the clinical implication of these associations is still unknown. The objective of this study is to clarify its clinical significance. METHODOLOGY: We studied p16, cyclin D1, and pRB expression using immunohistochemistry in the resected specimens of 156 patients who underwent curative esophagectomy. RESULTS: Alteration of p16 expression, positive cyclin D1 expression and loss of pRB expression were demonstrated in 108 (69%) patients, 47 (30%) patients, and 48 (31%) patients, respectively. An inverse correlation was found between p16 expression and pRB expression (P < 0.0001). Of 47 cyclin D1-positive tumors, 39 (83%) tumor exhibited alteration of p16 and 43 (92%) tumors were positive for pRB. Based on p16, cyclin D1, and pRB expression, 138 (88%) patients were divided into the following three groups: p16-/cyclin D1+/pRB+ (n = 44), p16+/cyclin D1-/pRB- (n = 38), p16-/cyclin D1-/pRB+ (n = 56). The three groups were the most influential prognostic factors in a Cox's proportional regression model. The p16-/cyclin D1+/pRB+ group had frequent hematogenous recurrence, while the other groups had frequent lymph node recurrence. CONCLUSIONS: Assessment of p16, cyclin D1, and pRB expression may be helpful for determining postoperative therapeutic strategies in patients with esophageal squamous cell carcinoma.

[Nedaplatin and 5-fluorouracil combined with radiotherapy for advanced esophageal cancer].

We conducted a pilot study of nedaplatin + 5-fluorouracil (5-FU) combined with radiotherapy for 29 patients with primary advanced (stage IV) esophageal cancer. A complete remission (CR) was obtained in 4 (14%) and a partial response in 13 patients (response rate: 59%). The median survival time and one-year survival rate were 238 days and 34.5%, respectively. Of the 29 patients, 24 (83%) completed the treatment schedule and toxicity of stomatitis and the like was infrequent. In conclusion, these results suggest that the efficacy of nedaplatin + 5-FU combined with radiotherapy might not differ from that of cisplatin + 5-FU combined with radiotherapy. Clearly, the usefulness of this combined therapy needs to be assessed in multicenter phase III trials.

[Radical surgery with mini-thoracolaparotomy for esophageal cancer].

In our institute, radical esophagectomy through mini-thoracolaparotomy has been performed as a less-invasive surgery for esophageal cancer since 1996. We describe the indications for and operative procedures of mini-thoracolaparotomy. Next we report the preliminary results of a prospective randomized trial that compared mini-thoracolaparotomy with conventional thoracolaparotomy in 30 patients without neoadjuvant therapy. There were no differences between the two groups in operative time, bleeding volume, and number of dissected lymph nodes. Thoracolaparotomy was effective in decreasing the quantity of morphinerequired in the ICU and shortening hospitalization after surgery. Thoracolaparotomy was effective in preventing a decrease in and early recovery of postoperative vital capacity. In clinical data on radical esophagectomy performed through a right thoracotomy and reconstruction with a stomach tube from 1996 to 2000, the 5-year survival rate of 63 patients in the thoracolaparotomy group (67.6%) did not differ from that of 124 patients in the conventional surgery group (49.9%).

Clinical implications of lymph node micrometastasis in patients with histologically node-negative (pN0) esophageal carcinoma.

BACKGROUND AND OBJECTIVES: Lymph node micrometastasis is frequently detected in resected specimens of esophageal squamous cell carcinoma (ESCC). The goal of this study was to evaluate the clinical implication of micrometastasis in patients with lymph node-negative (pN0) disease. METHODS: We examined the presence of micrometastasis in 2,511 lymph nodes from 53 patients with pN0 disease who underwent curative esophagectomy. All lymph nodes and the primary tumors were immunostained using an anticytokeratin antibody cocktail (AE1/AE3). RESULTS: Micrometastasis was detected in 18 lymph nodes (0.72%) from 14 patients (26.4%). Detection of micrometastasis was not associated with the depth of invasion or the differentiation or lymphatic invasion. Lymph nodes containing micrometastases were widely distributed, but the most frequently involved nodes were located along the lesser curvature of the stomach. Four patients with micrometastasis (29%) and the only two patients without micrometastasis (5%) had recurrence as lymph node metastases (P = 0.036). There were no significant differences in recurrence-free survival and disease-specific survival between patients with micrometastasis and patients without micrometastasis. CONCLUSIONS: These results show that micrometastasis might increase the risk of lymph node recurrence, but does not influence the survival of patients with pN0 ESCC.