Tomoyoshi Suzuki

Osteoplastic bone metastasis in esophageal squamous cell cancer : report of a case

This report presents a case of esophageal squamous cell cancer with osteoplastic bone metastasis. A 58-year-old male patient underwent multimodality treatment for esophageal cancer. Sclerotic changes resembling bone metastasis from prostate cancer were detected in the 4th thoracic and the 5th lumber vertebral body soon after the adjuvant chemoradiotherapy. Systemic examinations revealed no primary cancer as a cause of osteoplastic bone metastasis and no esophageal cancer recurrence. A needle biopsy revealed metastases of esophageal squamous cell cancer with osteoplastic changes. Multiple sclerotic changes were detected in the systemic bones at that time, and new carcinomatous bilateral pleural effusion developed. The drastic systemic progression of the cancer caused the rapid deterioration of the patient’s general condition.

Argon plasma coagulation for local recurrence of squamous cell carcinoma of the esophagus after endoscopic mucosal resection: technique and outcome

BackgroundIt is difficult to undergo a second endoscopic mucosal resection (EMR) for local cancer recurrence because ulcer scars caused by the previous EMR are frequently located near the tumor. The main objective of this study was to evaluate whether argon plasma coagulation (APC) is an effective and safe modality for treating early esophageal cancer recurrence untreatable by EMR.MethodsWe reviewed the experience of this clinic in the administration of EMR for the treatment of mucosal esophageal cancer in 249 patients with 276 lesions (142, m1; 98, m2; 36, m3) between December 1989 and March 2005. A local recurrence of the disease after the EMR was detected in 24 cases (9.6%). Seventeen patients were treated with APC. An argon gas flow of 2 l/min was used at a power setting of 60 W. The follow-up period of the 17 patients ranged from 13 to 87 months (median, 68 months).ResultsThe depth of tumor invasion, estimated by endoscopy, was mucosal in all patients. Seventy-three sessions (mean, 4.3 sessions/person; range, 1–12 sessions) were performed. All lesions were easily irradiated. No serious complications such as bleeding, perforation, or stenosis occurred. Complete local control was achieved in 16 of the 17 patients, but the remaining patient required further surgery. Death occurred in 3 cases. Two patients died as a result of other disease, and 1 patient died of other carcinomas, but no patient died of esophageal carcinoma.ConclusionAPC is a safe and effective method for the treatment of local recurrence of squamous cell carcinoma of the esophagus after an EMR.

The current status of recurrent and residual treatment after an esophagectomy: what method of treatment should be performed and how?

AimThis study investigated the present status of patients with recurrent and residual disease after an esophagectomy, and examined the ideal clinical course and method for patients with recurrent or residual esophageal cancer.Patients and methodsSeventy-five patients who developed recurrence between April 2005 and May 2009, and 14 patients who showed macroscopic residual tumors following tumor resection, were included in this study. At the same time, the staging of the recurrent or residual tumors was determined and analyzed.ResultsSeventy-two patients received first-line treatment, and the response rate was 61.1%. Second-line treatment was administered for 50 patients, and most selected chemotherapy. The response rate was 36.0% and the response rate to chemotherapy was 23.3%. Third-line, fourth-line, fifth-line, and sixth-line treatment was performed for 28, 13, 9, and 5 patients, respectively, and the response rate was 30.8%, 15.4%, 22.2%, and 25.0%, respectively. Additional treatments were not administered because of the patients’ requests as a result of their poor performance status and tumor progression. No significant difference was observed in survival between patients with recurrent and residual tumors, nor among the number of the treatment methods administered. There was no significant difference in survival among stage III, IVa, and IVb patients, although the stage III patients achieved better clinical responses to the first-line treatment.ConclusionsAggressive additional treatments should be performed early after operations for residual tumors. Control of distant metastasis is considered the primary issue in recurrent and residual treatment. Therefore, the establishment of effective chemotherapeutic agents and molecular targeting agents or combination therapy is necessary. In addition, further surgery should be pursued aggressively in cases in which tumor progression can be controlled. Continued treatment did not necessarily prolong survival; thus, physicians must respect the patient’s wish to continue the treatment and select suitable treatments that do not compromise the patient’s quality of life.