Norio Aoyama

Surgery Plus Chemotherapy Compared With Surgery Alone for Localized Squamous Cell Carcinoma of the Thoracic Esophagus: A Japan Clinical Oncology Group Study—JCOG9204

PURPOSE We performed a multicenter randomized controlled trial to determine whether postoperative adjuvant chemotherapy improves outcome in patients with esophageal squamous cell carcinoma undergoing radical surgery. PATIENTS AND METHODS Patients undergoing transthoracic esophagectomy with lymphadenectomy between July 1992 and January 1997 at 17 institutions were randomly assigned to receive surgery alone or surgery plus chemotherapy including two courses of cisplatin (80 mg/m2 of body-surface area x 1 day) and fluorouracil (800 mg/m2 x 5 days) within 2 months after surgery. Adaptive stratification factors were institution and lymph node status (pN0 versus pN1). The primary end point was disease-free survival. RESULTS Of the 242 patients, 122 were assigned to surgery alone, and 120 to surgery plus chemotherapy. In the surgery plus chemotherapy group, 91 patients (75%) received both full courses of chemotherapy; grade 3 or 4 hematologic or nonhematologic toxicities were limited. The 5-year disease-free survival rate was 45% with surgery alone, and 55% with surgery plus chemotherapy (one-sided log-rank, P =.037). The 5-year overall survival rate was 52% and 61%, respectively (P =.13). Risk reduction by postoperative chemotherapy was remarkable in the subgroup with lymph node metastasis. CONCLUSION Postoperative adjuvant chemotherapy with cisplatin and fluorouracil is better able to prevent relapse in patients with esophageal cancer than surgery alone.

Amelanotic malignant melanoma of the esophagus: report of a patient with recurrence successfully treated with chemoendocrine therapy

We report a case of primary amelanotic malignant melanoma of the esophagus, an extremely rare disease. A 58-year-old man was diagnosed as having middle esophageal cancer with lymph node metastasis, which was classified as esophageal cancer, Stage III:T3N1M0, by International Union Against Cancer (UICC) criteria. Preoperative chemotherapy was performed, but the response assessment was no change (NC). The patient underwent a subtotal esophagectomy via right thoracotomy and laparotomy. Reconstruction was performed by pulling up the stomach via the retrosternal route; the site of anastomosis was the neck. Adjuvant chemotherapy consisted of five courses of dacarbazine (DITC), nimustine (ACNU), vincristine (VCR), and interferon-β. Eleven months after the surgery, computed tomography (CT) demonstrated recurrence in the upper mediastinum. The patient received chemoendocrine therapy, consisting of the first planned course of DITC, ACNU, and cisplatin (CDDP), given intravenously; and tamoxifen (TAM), given orally. Subsequently with a modified regimen of this therapy he attained a complete response (CR). In general, the prognosis of esophageal malignant melanoma is very poor. Although our patient had a recurrence, he is alive 4 years and 5 months after the surgery and 3 years and 6 months after the recurrence. The chemoendocrine therapy probably contributed to this outcome.

Prognosis of patients with advanced carcinoma of the esophagus with complete response to chemotherapy and/or radiation therapy: a questionnaire survey in Japan

AbstractBackground. We estimated the survival of patients with advanced carcinoma of the esophagus in Japan who achieved complete response (CR) with chemotherapy and/or radiation therapy. Methods. A questionnaire was designed for patients with cancer of the esophagus with pretreatment stage II–IV (excluding organ metastasis [M1]), who were treated with chemotherapy and/or radiation therapy and achieved either a clinical CR continuing for more than 1 year, or a pathological CR in surgical specimens. All patients were treated between January 1, 1990, and December 31, 1997, in Japan. Results. Of the 169 eligible patients for whom adequate data were available, 106 patients with continuing clinical CR were defined as group A and 63 with pathological CR as group B. The overall survival rates at 5 years were 62.4% in group A and 64.8% in group B. In each of groups A and B, there was no significant difference in overall survival among subgroups of patients classified by initial pretreatment clinical stage. In group A, the survival rate of patients with concurrent chemotherapy and radiation therapy was significantly better than the rates for patients with chemotherapy alone or radiotherapy alone. In group A, the frequency of first failure at the local site of esophageal carcinoma was 7.7%. Of the 12 patients in group B (19%) who died less than 1 year postoperatively, 6 died of postoperative complications. Conclusion. The effect of CR to chemotherapy and/or radiation therapy for carcinoma of the esophagus on survival was marked. In patients with esophageal carcinoma who achieve CR, the prognosis may be independent of the initial pretreatment stage. Local failure in group A patients remains a problem, however.

Evaluation of the quality of life after surgical treatment for thoracic esophageal cancer

BackgroundSurgical treatment for thoracic esophageal cancer is highly invasive. The importance of evaluating the postoperative quality of life (QOL) is beginning to be recognized.MethodsWe reviewed the QOL of 46 patients who had undergone thoracolaparotomy for thoracic esophageal cancer using questionnaires (a questionnaire prepared at our department and the scale of health-related QOL [sf36v-2]) and respiratory function tests.Results(1) Results of the sf36v-2: there was no significant difference other than score of bodily pain (BP) and score of role, physical (RP). (2) Results of our questionnaire: (2-1) activity: the activity level recovered nearly to the preoperative level in 70% of the patients after a mean of 10.4 months post-esophagectomy. (2-2) Wounds: none of the patients complained of chronic pain or inconvenience in daily living. (2-3) Eating: the mean quantity of food per meal was about 2/3 of the quantity before surgery. Seventeen patients felt some problems concerning the passage of food through the site of anastomosis. A mean weight loss of about 7 kg was observed after surgery compared with the preoperative level. (3) Results of respiratory function tests: significant differences were observed in % vital capacity and % maximum ventilation volume but not in forced expiratory volume in 1 second compared with the preoperative levels (P < 0.01).ConclusionsThe postoperative QOL of patients who underwent esophagectomy was maintained at a satisfactory level. Their respiratory function was slightly reduced compared with the preoperative level, but their daily activities were similar to those of healthy people, and their eating problems were tolerable.

Postoperative complications in patients of esophageal cancer after neoadjuvant chemotherapy

We examined the effects of neoadjuvant chemotherapy on surgery by evaluating postoperative complications in 50 patients who had undergone neoadjuvant chemotherapy (Group A) and in 108 patients who had undergone surgery without neoadjuvant chemotherapy (Group B). Toxicity of grade 3 by chemotherapy were WBC in 3 patients (6%), alopecia in 3 patients (6%), and anorexia in 22 patients (44%). There were 4 patients with anastomotic leakage (8%) (all in minor), 5 patients with infection of wound (10%), 6 patients with arrhythmia (12%), no patients with postoperative bleeding, 2 patients with respiratory complications (4%), and no patients who died due to complications in Group A. In Group B, there were 13 patients with anastomotic leakage (13%) (all in minor), 12 patients with infection of the wound (11%), 11 patients with arrhythmia (10%), 2 patients with postoperative bleeding (2%), 8 patients with respiratory complications (7%), and 2 patients who died due to complications (2%). There was no significant difference in the incidence of postoperative complications between the patients who had undergone surgery after neoadjuvant chemotherapy, such as CDDP + 5FU therapy and FAP therapy, and the patients who had undergone surgery without neoadjuvant chemotherapy, in patients who had been diagnosed as being able to undergo relative non-curative resection or better, who had Ccr 60 ml/min or more and no severe complication, and whose stomach could be used for reconstruction of the esophagus, on the condition that surgery would be performed on NC patients at the end of first-course treatment.

The Development of “Through-Bougie Esophageal Prosthesis Intubation” and Its Evolution to an “Extinctive Type”

There are two basic techniques for esophageal prosthesis intubation: Pulsion and traction. The pulsion technique is superior to the traction technique in that there are fewer associated complications. Also, there is less invasion to the patient. Even so, with pulsion, general anesthesia is sometimes necessary, in cases of highly advanced stricture, to pass a prosthesis with or without the support of esophagoscopy or an introducer. With some cases of highly advanced stricture, it is necessary to use a general anesthesia, to be able to pass the prosthesis through.

The Concomitant Effects of Cis-diamminedichloroplatinum and Caffein on the Proliferation and Chromosomal Changes.

ヒト胃癌細胞株STKM-1を用いてCis-diamminedichloroplatinum (以下CDDP) とカフェイソとの併用抗腫瘍効果と染色体におよぼす影響について検討した.CDDP (2μg/ml) 3時間接触で57%の増殖率であったが, CDDP接触後カフェイソ1mM持続接触にて23%に, 2mMにて9.3%に低下し, 抗腫瘍効果の増強が認められた.CDDP (2μg/ml) 処理後の染色体におけるgap/breakの出現頻度は1.816±1.509/Cell, exchangeの出現頻度は0.184±0-565/Ce11であった.CDDP処理直後からカフェイン1mMを24時間接触させるとgap/breakの出現頻度は4-206±3.162/Cell, exchangeは0.760±0.938/Cellと増加した.CDDP処理後24, 48時間後にカフェインを接触させても同様の結果が得られた.以上より, カフェインはDNA修復阻害作用を有し, 胃癌に対する化学療法において, CDDPとの併用で抗腫瘍効果の増強が期待された.

Effects and Limitation of Endoscopic Incisional Dilatation on Castrointestinal Anastomotic Strictures.

消化管吻合部狭窄の治療法として, 内視鏡的切開およびブジーによる拡大術の適応と限界について検討した.吻合部狭窄35例 (瘢痕性26例, 癌性9例) を対象とした.瘢痕性狭窄の長さによる狭窄解除率をみると, 2cm未満14/15 (93.3%), 2cm以上3cm未満8/9 (88.9%), 3cm以上0/2 (0%) であった.一方, 癌性狭窄は0/9 (0%) と効果不良であった.効果不良例13例 (瘢痕性4例, 癌性9例) の内, 癌性3例を除く10例に他の治療を加えた.3例 (瘢痕性1例, 癌性2例) に手術, 7例 (瘢痕性3例, 癌性4例) に食道ブジー挿管術を施行した.手術では, 狭窄が解除出来たのは1例のみで他は試験開腹および合併症死におわった.食道ブジー挿管術は7例全例狭窄を解除でき退院可能であった.皮膚管瘢痕性狭窄1例のみ皮膚瘻孔を形成し手術を要した.食道ブジー挿管術は難治性吻合部狭窄の非観血的治療法として有用であった.

Diagnosis and surgical treatment for multiple primary cancer of the esophagus and the stomach.

同時性に発生した食道胃重複癌切除症例7例を対象とし, その診断, 手術および治療成績について検討した.術前に7例中5例が食道, 胃病変ともに正しく診断されたが, 特に鑑別診断上重要と思われたのは食道癌の胃壁内転移であった.手術々式はリンパ節郭清を考慮し, 胸部食道病変に対しては胸部食道全摘が, 胃病変に対しては病巣がAまたはMに存在する場合, あるいはCに存在し進行癌と考えられる場合には胃全摘術が, Cに存在し早期癌と考えられる場合には噴門側切除が行われた. しかし, 治療成績は不良で7例中5例が術後1年以内に死亡した. また, 2例が術後肺合併症で死亡した点から手術適応の決定は慎重にすべきと思われた.