Your browser doesn't support javascript.
loading
Towards an Organ-Sparing Approach for Locally Advanced Esophageal Cancer.
van der Wilk, Berend Jan; Eyck, Ben M; Spaander, Manon C W; Valkema, Roelf; Lagarde, Sjoerd M; Wijnhoven, Bas P L; van Lanschot, J Jan B.
Affiliation
  • van der Wilk BJ; Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands, b.vanderwilk@erasmusmc.nl.
  • Eyck BM; Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
  • Spaander MCW; Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
  • Valkema R; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
  • Lagarde SM; Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
  • Wijnhoven BPL; Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
  • van Lanschot JJB; Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Dig Surg ; 36(6): 462-469, 2019.
Article de En | MEDLINE | ID: mdl-30227434
ABSTRACT

BACKGROUND:

Active surveillance after neoadjuvant therapies has emerged among several malignancies. During active surveillance, frequent assessments are performed to detect residual disease and surgery is only reserved for those patients in whom residual disease is proven or highly suspected without distant metastases. After neoadjuvant chemoradiotherapy (nCRT), nearly one-third of esophageal cancer patients achieve a pathologically complete response (pCR). Both patients that achieve a pCR and patients that harbor subclinical disseminated disease after nCRT could benefit from an active surveillance strategy.

SUMMARY:

Esophagectomy is still the cornerstone of treatment in patients with esophageal cancer. Non-surgical treatment via definitive chemoradiotherapy (dCRT) is currently reserved only for patients not eligible for esophagectomy. Since salvage esophagectomy after dCRT (50-60 Gy) results in increased complications, morbidity and mortality compared to surgery after nCRT (41.4 Gy), the latter seems preferable in the setting of active surveillance. Clinical response evaluations can detect substantial (i.e., tumor regression grade [TRG] 3-4) tumors after nCRT with a sensitivity of 90%, minimizing the risk of development of non-resectable recurrences. Current scarce and retrospective literature suggests that active surveillance following nCRT might not jeopardize overall survival and postponed surgery could be performed safely. Key Message Before an active surveillance approach could be considered standard treatment, results of phase III randomized trials should be awaited.
Sujet(s)
Mots clés

Texte intégral: 1 Collection: 01-internacional Base de données: MEDLINE Sujet principal: Tumeurs de l'oesophage / Oesophagectomie / Traitement néoadjuvant / Observation (surveillance clinique) / Traitements préservant les organes Type d'étude: Clinical_trials Limites: Humans Langue: En Journal: Dig Surg Sujet du journal: GASTROENTEROLOGIA Année: 2019 Type de document: Article

Texte intégral: 1 Collection: 01-internacional Base de données: MEDLINE Sujet principal: Tumeurs de l'oesophage / Oesophagectomie / Traitement néoadjuvant / Observation (surveillance clinique) / Traitements préservant les organes Type d'étude: Clinical_trials Limites: Humans Langue: En Journal: Dig Surg Sujet du journal: GASTROENTEROLOGIA Année: 2019 Type de document: Article
...