Harushi Udagawa

A Phase II Trial of Chemoradiotherapy for Stage I Esophageal Squamous Cell Carcinoma: Japan Clinical Oncology Group Study (JCOG9708)

OBJECTIVE The study objective was to evaluate the efficacy and toxicity of chemoradiotherapy with 5-fluorouracil (5-FU) plus cisplatin in patients with Stage I esophageal squamous cell carcinoma (ESCC). The primary endpoint was proportion of complete response (%CR). METHODS Patients with Stage I (T1N0M0) ESCC, aged 20-75 years, without indication of endoscopic mucosal resection were eligible. Treatment consisted of cisplatin 70 mg/m(2) (day 1) and 5-FU 700 mg/m(2)/day (days 1-4) combined with 30 Gy radiotherapy (2 Gy/day, 5 days/week, days 1-21). The cycle was repeated twice with 1-week split. Salvage surgery was recommended for residual tumor or local recurrence. RESULTS From December 1997 to June 2000, 72 patients were enrolled. No ineligible patient or major protocol violation was observed. There were 63 CRs for %CR of 87.5% [95% confidence interval (CI): 77.6-94.1]. Six patients with residual tumor successfully underwent esophagectomy. There was no Grade 4 toxicity. Four-year survival proportion was 80.5% (95% CI: 71.3-89.7), and 4-year major relapse-free survival proportion was 68% (95% CI: 57.3-78.8) (mucosal recurrence removed by endoscopy was not counted as an event). CONCLUSIONS High CR proportion and survival proportion with mild toxicity suggest that this regimen could be considered as a candidate of new standard treatment to be compared with surgery in patients with Stage I ESCC.

Comprehensive Registry of Esophageal Cancer in Japan, 2003

We are very pleased to publish the Comprehensive Registry of Esophageal Cancer in Japan, 2003, and thank all the members of the Japan Esophageal Society who made great contributions in preparing this material. We would like to review the history of the registry of esophageal cancer cases in Japan. The Registration Committee for Esophageal Cancer, the Japan Esophageal Society, has annually registered cases of esophageal cancer since 1976 and published the first issue of the Comprehensive Registry of Esophageal Cancer in Japan in 1979. The Act for the Protection of Personal Information was promulgated in 2003, and began to be enforced in 2005. The purpose of this Act is to protect the rights and interests of individuals while taking into consideration the usefulness of personal information, keeping in mind the remarkable increase in the use of personal information arising from the development of today’s advanced information and communications society. The registry of esophageal cancer cases has required some adjustments to comply with the Acts. The new registration system has been discussed for several years and was finally completed in 2008. The most important point was These data were first issued on 1 March, 2011, as the Comprehensive Registry of Esophageal Cancer in Japan, 2003. Not all pages are reprinted here; however, the original table and figure numbers have been kept. The authors were at the time members of the Registration Committee for Esophageal Cancer, the Japan Esophageal Society, and made great contributions in preparing this material.

Comprehensive Registry of Esophageal Cancer in Japan, 2004

Japan was struck by the Great East Japan Earthquake, which resulted in almost twenty thousand deaths and missing persons, 1 year ago. We would like to express our heartfelt condolences and sympathies to all the people who have been affected by this disaster. We pray that the regions affected will recover as soon as possible and that the physicians working diligently in the affected areas remain in good health and spirits. We deeply appreciate the cooperation of many physicians with the registry of esophageal cancer cases; nevertheless, the recovery from the Great East Japan Earthquake is ongoing. The Comprehensive Registry of Esophageal Cancer in Japan, 2004, was finally published here, despite some delay. The registry of esophageal cancer cases has required some adjustments to comply with the Act for the Protection of Personal Information, which was promulgated in 2003 and began to be enforced in 2005. The most important point was ‘‘anonymity in an unlinkable fashion’’ using encryption with a hash function. The new registration These data were first made available on June 1, 2004, as the Comprehensive Registry of Esophageal Cancer in Japan, 2004. Not all the pages are reprinted here; however, the original table and figure numbers have been maintained.

Comprehensive Registry of Esophageal Cancer in Japan, 2002

We are very pleased to publish the Comprehensive Registry of Esophageal Cancer in Japan, 2002, we thank all the members of the Japan Esophageal Society who made great contributions in preparing this material. First of all, we describe the history of the registry of esophageal cancer cases in Japan. The Registration Committee for Esophageal Cancer of the Japan Esophageal Society, has registered cases of esophageal cancer since 1976 and published the fi rst issue of the Comprehensive Registry of Esophageal Cancer in Japan in 1979. The Act for the Protection of Personal Information was promulgated in 2003, and began to be enforced in 2005. The purpose of this Act is to protect the rights and interests of individuals while taking into consideration the usefulness of personal information, keeping in mind the remarkable increase in the use of personal information arising from the development of today’s advanced information and communications society. The registry of esophageal cancer cases has required some improvements to comply with the Acts. The new registration system has been considered for several years and was fi nally completed in 2008. The most important point was “anonymity in an unlinkable fashion” using encryption with a “hash function”. Finally, the registry resumed registering cases of esophageal cancer that had been treated in 2001. We briefl y summarized the Comprehensive Registry of Esophageal Cancer in Japan, 2002. A total of 4281 cases were registered from 222 institutions in Japan. As for the histologic type of cancer according to biopsy specimens, squamous cell carcinoma and adenocarcinoma accounted for 92.9% and 2.4%, respectively. Regarding clinical results, the 5-year survival rates of patients treated using endoscopic mucosal resection, concurrent chemoradiotherapy, radiotherapy alone, chemotherapy alone, or esophagectomy were 87.7%, 22.9%, 15.1%, 1.7%, and 44.1%, respectively. Concerning the approach used to perform an esophagectomy, 16.5% of the cases were performed endoscopically, that is, thoracoscopically, laparoscopically, or mediastinoscopically. Regarding the reconstruction route, the retrosternal, the posterior mediastinal and the intrathoracic route were used in 35.4%, 32.4% and 17.9% of cases, respectively. The percentage of operative deaths occurring within 30 days or less after operation and the percentage of postoperative hospital deaths occurring 31 days or more after operation were 1.2% (25 out of 2028 cases) and 2.0% (41 out of 2028 cases), respectively. We hope that this Comprehensive Registry of Esophageal Cancer in Japan for 2002 helps to improve all aspects of the diagnosis and treatment of esophageal cancer.

Efficacy of lymph node dissection by node zones according to tumor location for esophageal squamous cell carcinoma

BackgroundThe extent of node dissection in esophageal cancer surgery is usually estimated by the number of resected nodes, irrespective of the area of dissection. The efficacy of lymph node dissection by area was evaluated according to the location of the primary tumor.MethodsThe study group comprised the 3827 patients who underwent R0 esophagectomy with three-field lymph node dissection for squamous cell carcinoma, registered in a nationwide registry in Japan. The areas of lymph node were classified into zones according to AJCC Staging Manual. The Efficacy Index (EI) calculating the frequency and patient survival of metastases to each zone was investigated according to tumor location.ResultsThe EI was high in supraclavicular and upper mediastinal zones in patients with upper esophageal tumors, highest in upper mediastinal zone followed by supraclavicular and perigastric zones in patients with middle esophageal tumors, and highest in perigastric zone followed by upper and lower mediastinal zones in patients with lower esophageal tumors. In patients with middle and lower esophageal cT1 tumors, the EIs of upper mediastinal and perigastric zones were higher than middle and lower mediastinal zones.ConclusionThe EIs of each zone were differed by tumor location. The extent of lymph node dissection should be estimated by the dissected zones and modified by the tumor location. Supraclavicular dissection is indispensable for patients with upper esophageal tumors, and recommended for patients with middle esophageal tumors. Upper mediastinal dissection is recommended for all patients with thoracic esophageal squamous cell carcinoma, irrespective of the location.

Comprehensive Registry of Esophageal Cancer in Japan, 2008

We deeply appreciate the great contributions of many physicians in the registry of esophageal cancer cases. The Comprehensive Registry of Esophageal Cancer in Japan, 2008, was published here, despite some delay. The registry complies with the Act for the Protection of Personal Information. The encryption with a HASH function is used for ‘‘anonymity in an unlinkable fashion’’. We briefly summarized the Comprehensive Registry of Esophageal Cancer in Japan, 2008. Japanese Classification of Esophageal Cancer 10th and UICC TNM Classification 6th were used for cancer staging according to the subjected year. A total of 4925 cases were registered from 257 institutions in Japan. Tumor locations were cervical: 5.3 %, upper thoracic: 12.0 %, middle thoracic: 48.7 %, lower thoracic: 25.3 % and EG junction: 5.9 %. Superficial carcinomas (Tis, T1a, and T1b) were 35.3 %. As for the histologic type of biopsy specimens, squamous cell carcinoma and adenocarcinoma accounted for 89.3 % and 4.3 %, respectively. Regarding clinical results, the 5-year survival rates of patients treated using endoscopic mucosal resection, concurrent chemoradiotherapy, radiotherapy alone, chemotherapy alone, or esophagectomy were 85.7, 24.1, 23.4, 4.8, and 53.1 %, respectively. Esophagectomy was performed in 2657 cases. Concerning the approach used for These data were first made available on December 25, 2014, as the Comprehensive Registry of Esophageal Cancer in Japan, 2008. Not all the pages are reprinted here; however, the original table and figure numbers have been maintained.

Comprehensive Registry of Esophageal Cancer in Japan, 2001

The Registration Committee for Esophageal Cancer of the Japan Esophageal Society, has registered cases of esophageal cancer since 1976 and published the fi rst issue of the Comprehensive Registry of Esophageal Cancer in Japan in 1979. The Act for the Protection of Personal Information was promulgated in 2003, and began to be enforced in 2005. The purpose of this Act is to protect the rights and interests of individuals while taking into consideration the usefulness of personal information, keeping in mind the remarkable increase in the use of personal information arising from the development of today’s advanced information and communications society. The Registry of Esophageal Cancer Cases has required some adjustments to comply with these Acts. The new registration system has been considered for several years and was fi nally completed in 2008. The most important point was achieving unlinkable anonymity through hash function encryption. Finally, the registry resumed registering cases of esophageal cancer that had been treated in 2001. A brief summary follows: a total of 3940 cases were registered from 241 institutions in Japan. As for the histologic type of cancer according to biopsy specimens, squamous cell carcinoma and adenocarcinoma accounted for 91.7% and 2.3%, respectively. The 5-year survival rates of patients treated using endoscopic mucosal resection, concurrent chemoradiotherapy, radiotherapy alone, chemotherapy alone, or esophagectomy were 88.5%, 19.3%, 19.6%, 4.0%, and 42.6%, respectively. Regarding the approach used to perform esophagectomy, 14.3% of the cases were performed endoscopically, that is, thoracoscopically, laparoscopically, or mediastinoscopically. The percentage of operative deaths occurring within 30 days or less after operation and the percentage of postoperative hospital deaths occurring 31 days or more after operation were 2.8% and 3.2%, respectively. We hope that this Comprehensive Registry of Esophageal Cancer in Japan for 2001 helps to improve all aspects of the diagnosis and treatment of esophageal cancer.

Comprehensive Registry of Esophageal Cancer in Japan, 2000

I. Clinical Factors of Esophageal Cancer Patients treated in 2000 1. Institutions-registered cases in 2000 2. Patient Background Table 1) Age, gender and treatment Table 2) Area of patient’s residence and occupation Table 3) Familial history of carcinoma Table 4) Tumors in familial history of carcinoma Table 5) Reason and basis for diagnosis according to clinical T-category Table 6) Symptoms according to clinical T-category Table 7) Duble/multiple primary cancers Table 8) Double/multiple primary cancers and organs Table 13) Location of tumor Table 14) Longitudinal tumor length on esophagography Table 15) Endoscopic features Table 17) Depth of tumor invasion cT (clinical TNM-classifi cation) Table 18) Lymph node metastasis, cN; and organ metastasis, cM (clinical TNM-classifi cation) Table 19) Metastatic organs in cM1 cases (clinical TNM classifi cation) Table 20) Clinical stage (clinical TNM-classifi cation)

Supraclavicular node metastasis from thoracic esophageal carcinoma: A surgical series from a Japanese multi-institutional nationwide registry of esophageal cancer

OBJECTIVES In the present TNM classification, involvement of supraclavicular nodes is defined as distant metastases. However, the therapeutic value of supraclavicular node dissection remains controversial. The purpose of this study was to evaluate the survival benefit of dissection of metastases to the supraclavicular lymph nodes in patients with thoracic esophageal carcinoma by using a large nationwide registry of esophageal cancer maintained by the Japanese Esophageal Society. METHODS The study group comprised 1309 patients with thoracic esophageal carcinoma treated in 2001, 2002, and 2003, who underwent esophagectomy with 3-field dissection for curative intent, and in whom the locations of pathologic metastatic lymph nodes and outcome evaluations were available. RESULTS Of 1309 patients, 559 (42.7%) had no nodal metastases, 560 (42.8%) had at least 1 positive node but were supraclavicular node-negative, and 190 (14.5%) had supraclavicular node metastases. The 5-year survival was 73.7% for patients with N0, 40.4% for node-positive patients without supraclavicular node disease, and 24.1% for patients with supraclavicular node metastasis. In a multivariate analysis, male sex (P<.001), deeper T category (P<.001), and more positive nodes (P<.001) retained statistical significance as adverse prognostic factors for overall survival. Supraclavicular node metastasis was not significant (P=.062). CONCLUSIONS The survival benefit of dissection of metastases to the supraclavicular lymph nodes was indicated in patients with thoracic esophageal carcinoma. Supraclavicular nodes appear to be regional nodes similar to other regional nodes.

Comprehensive Registry of Esophageal Cancer in Japan, 2007

We deeply appreciate the great contributions of many physicians in the registry of esophageal cancer cases. The Comprehensive Registry of Esophageal Cancer in Japan, 2007, was published here, despite some delay. The registry complies with the Act for the Protection of Personal Information. The encryption with a HASH function is used for ‘‘anonymity in an unlinkable fashion’’. We briefly summarized the Comprehensive Registry of Esophageal Cancer in Japan, 2007. Japanese Classification of Esophageal Cancer 10th and UICC TNM Classification 6th were used for cancer staging according to the subjected year. A total of 5216 cases were registered from 257 institutions in Japan. Tumor locations were cervical: 4.4 %, upper thoracic: 12.7 %, middle thoracic: 49.5 %, lower thoracic: 25.1 % and EG junction: 5.9 %. Superficial carcinomas (Tis, T1a, and T1b) were 35.7 %. As for the histologic type of biopsy specimens, squamous cell carcinoma and adenocarcinoma accounted for 90.1 % and 3.9 %, respectively. Regarding clinical results, the 5-year survival rates of patients treated using endoscopic mucosal resection, concurrent chemoradiotherapy, radiotherapy alone, chemotherapy alone, or esophagectomy were 88.1, 25.1, 16.0, 9.4, and 52.8 %, respectively. Esophagectomy was performed in 2834 cases. Concerning the approach used for esophagectomy, 19.8 % of the cases were treated thoracoThese data were first made available on December 25, 2014, as the Comprehensive Registry of Esophageal Cancer in Japan, 2008. Not all the pages are reprinted here; however, the original table and figure numbers have been maintained.