Henner M. Schmidt

Molecular Markers for the Prediction of Minor Response to Neoadjuvant Chemoradiation in Esophageal Cancer: Results of the Prospective Cologne Esophageal Response Prediction (CERP) Study.

Objective: The aim of this study was to evaluate the predictive value of a single or combination of biomarker(s) for histopathologic non-response to neoadjuvant chemoradiation in esophageal cancer. Summary of Background Data: Patients without response to neoadjuvant chemoradiation for esophageal cancer have no prognostic benefits, but experience time delays and risk side effects. Methods: Inclusion criteria for this prospective diagnostic study were patients with cT3,Nx,M0, esophageal squamous cell or adenocarcinoma and planned neoadjuvant chemoradiation (5- fluorouracil, cisplatin, 40Gy) followed by 2-field transthoracic esophagectomy. From pretherapeutic endoscopic tumor biopsies, ERCC1 rs11615 single-nucleotide polymorphism (ERCC1-SNP) and a combination of gene expression marker mRNA (ERCC1, DPYD, ERBB2) were analyzed. ERCC1-SNP was subdifferentiated into homozygous C-allele (CC) and T-allele (TT), and heterozygous C/T carriers. The primary endpoint was the prediction of histopathological minor response (≥10% vital tumor cells in the primary tumor) relative to marker levels. Results: From 2009 until 2013, 320 patients were screened, and 85 patients (SCC n = 29, AC n = 56) were included in the study. Forty-one patients (48%) had major response with 3-year survival rate (3-YSR) of 57% compared with 44 patients with minor response and 3-YSR of 25% (P = 0.001). Patients with ERCC1-SNP CC (n = 8) and TT (n = 37) had similar rates of minor response of 70% and 75%, and a positive predictive value (PPV) of 71% [95% confidence interval (CI 56%–84%)]. PPV increased to 89% (95% CI 73%–96%) when ERCC1-SNP was combined with mRNA markers. Conclusion: ERCC1-SNP in combination with mRNA ERCC1, DPYD, and ERBB2 from pretherapeutic endoscopic biopsies can predict minor response to chemoradiation, as a basis for individualized therapy of advanced esophageal cancer.

Ivor Lewis Esophagectomy

In August 1944, the Welsh surgeon Ivor Lewis (1895–1982) described a two-staged esophagectomy, including a laparotomy followed by a right-sided thoracotomy, and an immediate intrathoracic gastroesophageal anastomosis. Because this approach advocated immediate rather than delayed reconstruction and also involved two standardized incisions, the Ivor Lewis procedure gained immediate popularity and is now the most commonly utilized approach for esophageal resection worldwide. The evolution of surgical technology has led to the description of hybrid, total, minimally invasive, and robotic approaches.

Esophageal Cancer: Surgical Treatment

Treatment approaches varies according to the stage of esophageal cancer and the majority of patients present with advanced disease. Despite being a challenging surgical procedure, historically associated with high morbidity and mortality, esophagectomy remains a central treatment component in patients with early-stage and loco regional esophageal cancer. This chapter describes the indications for esophagectomy, with an emphasis of the technical aspects of the surgical approaches available, common post-operative complications and outcomes following esophagectomy.

Esophageal Cancer: Evaluation

In recent years esophageal adenocarcinoma incidence increased rapidly and esophageal cancer is now the seventh leading cause of all cancer-related deaths. Over the last decades treatment approaches for esophageal cancer have evolved, with esophagectomy remaining a central component in the curative treatment of resectable esophageal cancer. Esophagectomy is a demanding procedure and with the availability of a wide variety of treatment regimes, accurate staging and evaluation became even more important. The management of patients is determined by patients physiology as well as tumor histology, location and clinical stage. This chapter describes a complete evaluation of esophageal cancer patients, including physiologic work-up, clinical staging modalities and treatment decision making.

Surgical Versus Endoscopic Management for Esophageal Perforations

Esophageal perforations remains a challenging clinical problem and is associated with a high mortality rate. Since the introduction of conservative and endoscopic therapies treatment has been increasingly diversified. In this chapter the currently available surgical and endoscopic treatment strategies are introduced and discussed against the background of the most recent literature. The published experiences of esophageal perforations are limited and typically reported from single centers. Timely initial assessment and diagnosis as well as providing a tailored approach for each patient are critically importance to achieve best outcomes. Best evidence currently suggests that this is best provided in high-volume centers where a multidisciplinary team with expertise in esophageal surgery, interventional radiology and endoscopy is available.

Effect of a multidisciplinary cancer conference for thoracic malignancies on patient care management.

112 Background: Treatment of thoracic cancers frequently involve multiple subspecialties thus treatment decisions are typically best facilitated in multidisciplinary tumor boards (MTB). This approach should facilitate and improve treatment decision making, standardize staging and therapeutic decisions and improve outcomes. In this study we analyze the evolution in staging and treatment decision making associated with presentation at MTB. Methods: Retrospective review of all patients with lung or esophageal cancer presented at our weekly MTB from June 1, 2010 to September 30, 2012. All providers submitting patients to tumor board recorded their current treatment plan prior to presentation. The physician’s plan was then compared to the tumor board’s final recommendation. Changes made were graded according to degree of magnitude as minor, moderate or major change. Minor changes included changes in diagnostic imaging. Moderate changes involved modifications in the type of invasive staging or biopsy procedures...