Search

Background: Prehabilitation during neoadjuvant therapy has the potential to improve clinical outcomes. However, information on its global dissemination status is limited. This Japanese nationwide survey investigated the implementation status of and barriers to prehabilitation during neoadjuvant chemotherapy (NAC) for patients with locally advanced esophageal cancer in hospitals. Methods: This multicenter nationwide survey was conducted by post. The eligible facilities were 155 Japanese hospitals that had been certified within the last 10 years as authorized institutes for board-certified esophageal surgeons by the Japan Esophageal Society. We administered an original questionnaire to investigate the current status of prehabilitation during NAC. Results: The response rate was 75% (117/155 facilities). Forty-six facilities (39%) provided prehabilitation during NAC. The most frequently selected reasons for not providing or providing insufficient prehabilitation were lack of human resources, issues with the reimbursement of medical fees, difficulty in providing continuous prehabilitation during repeated inpatient and outpatient care, the lack of established standard prehabilitation programs, challenges in providing multidisciplinary prehabilitation, and difficulty in managing physical symptoms. Conclusion: We observed that the implementation rate of prehabilitation during NAC was low. Critical reasons were not only the lack of medical resources but also the lack of evidence-based standard prehabilitation programs during NAC and the lack of evidence for how to continuously deliver prehabilitation during NAC to patients with physical symptoms. [ABSTRACT FROM AUTHOR]

Background: As esophageal gastrointestinal stromal tumors (GISTs) are very rare, their clinicopathological features remain obscure. We conducted a nationwide survey to clarify the characteristics of these tumors and to establish a consensus on their diagnosis and treatment. Methods: The clinicopathological information of patients with esophageal GISTs who underwent treatment between January 2010 and June 2016 at the accredited institutions by the Japan Esophageal Society was collected via a questionnaire method and analyzed statistically. Results: Fifty-one patients (29 men and 22 women; median age, 68 years) were recruited from 31 institutions. Diagnosis was triggered most frequently during screening and other disease scrutiny. Symptoms were seen only in 17 patients: highest in 11 patients with dysphagia. Thirty-five patients underwent surgery alone; 15 patients, surgery with imatinib therapy; and one patient, endoscopic resection. The tumors preferentially occurred in the lower and middle parts of the thoracic esophagus, with a median size of 36.5 mm. Neoadjuvant and adjuvant imatinib therapies were performed in seven and eight patients, respectively. Administration of imatinib 400 mg/day was the standard regimen. Postoperative follow-up observations were conducted mostly via computed tomography (CT) scans every 3 or 6 months until 5 years after surgery. The tumors recurred in ten patients within 5 years postoperatively (high risk, 38.5%; intermediate risk, 20%; low risk, 0%; very low risk, 0%; three cases of relapse with an unknown risk assessment). A patient with a high-risk GIST died from the tumor 54 months after surgery. Conclusions: This nationwide survey revealed the current status of esophageal GISTs in Japan and provided important information for making a consensus on the treatment and follow-up method. [ABSTRACT FROM AUTHOR]

Background: n our previous nationwide survey report on esophageal perforation, we proposed the existence of cases with idiopathic esophageal perforation at a certain rate. Aims: To elucidate the clinical characteristics of idiopathic esophageal perforation, we performed a comparative analysis between cases with idiopathic type and post-emetic type esophageal perforation. Methods: This study enrolled 139 patients with esophageal perforation (post-emetic type: idiopathic type = 115:24) as the subjects of nationwide survey on esophageal perforation. We conducted detailed studies on chief complaints, inflammatory responses, initial diagnosis, location and situation of the perforation site, time to therapeutic intervention, and prognosis between the two groups. Results: Compared with post-emetic type, cases of idiopathic type tended to exhibit rear-side perforation (p = 0.052) and significantly less presented chest pain (p = 0.002). Consequently, cases of idiopathic type significantly missed to diagnose as esophageal perforation compared with post-emetic type (p = 0.042). With regard to inflammatory response, cases of post-emetic type experienced hyperthermia compared with idiopathic type (p = 0.033). On the other hand, cases of idiopathic type exhibited significantly higher level of C-reactive protein than post-emetic type (p = 0.004). In addition, it took longer time until starting treatment in the cases of idiopathic type (p < 0.0001) and the cases of idiopathic type showed significantly worse prognosis than the cases of post-emetic type (p = 0.009). Conclusion: This study first focused on the characteristics of idiopathic esophageal perforation that have been included in so-called Boerhaave's syndrome. The pathophysiology of the idiopathic type should be separately understood from post-emetic type, because the diagnostic and prognostic features largely differ. [ABSTRACT FROM AUTHOR]

Background: There has been no definitive evidence of chemoradiotherapy being superior to radiotherapy alone in patients aged 80 years or older. The purpose of the present study was to evaluate the results of radiotherapy and chemoradiotherapy in patients aged 80 years or older with esophageal cancer in the Japanese Nationwide Cancer Database. Methods: A total of 358 patients aged 80 years or older who were treated with radiotherapy alone or with chemoradiotherapy for esophageal cancer between 2009 and 2011 were enrolled. Results: The 5-year overall survival (OS) rates in patients with cStages 0–I, II, III and IV were 40.9%, 24.7%, 12.2% and 4.9%, respectively. The 5-year cause-specific survival (CSS) rates in patients aged 80 years or older with cStages 0–I, cStage II, cStage III and cStage IV were 73.5%, 41.4%, 25.3% and 7.4%, respectively. In patients treated with radiotherapy alone, the 5-year OS rates for patients with cStages 0–I, II, III and IV were 36.5%, 12.0%, 5.4% and 0%, respectively. In patients treated with chemoradiotherapy, the 5-year OS rates for patients with cStages 0–I, II, III and IV were 45.0%, 36.1%, 16.4% and 7.1%, respectively. In multivariate analysis, chemoradiotherapy, early stage and squamous cell carcinoma were significantly favorable prognostic factors for OS in patients aged 80 years or older (p < 0.001, p < 0.001 and p = 0.0323, respectively). We were unable to evaluate toxicities, because of lack of information in the registry. Conclusion: Concurrent chemotherapy with radiotherapy for esophageal cancer in patients aged 80 years or older is a significantly favorable prognostic factor for OS. However, chemoradiotherapy should be carefully selected in elderly patients. [ABSTRACT FROM AUTHOR]

Background: In definitive chemoradiotherapy (CRTx) for esophageal cancer, a radiotherapy (RT) dose of 50.4 Gy in 28 fractions has been the standard in many countries, while 60 Gy in 30 fractions has been frequently used in Japan. To clarify the optimal RT dose in CRTx for esophageal cancer, we compared clinical outcomes with the two doses using data from the Comprehensive Registry of Esophageal Cancer in Japan by the Japan Esophageal Society (JES). Methods: Of the patients enrolled in the registry for 2015–2017 surveys (patients treated between 2009 and 2011), 996 patients who received definitive CRTx with 50.4 Gy or 60 Gy for thoracic esophageal cancer were eligible for analysis. Results: The complete response (CR) rates in the 50.4 Gy and 60 Gy groups were 49.1% and 46.4%, respectively (p = 0.5851). The 5-year overall survival (OS) rates in the 50.4 Gy group and 60 Gy group for stages I, II/III and IV were 64.2% and 57.2%, 35.0% and 27.0%, and 18.0% and 15.3%, respectively. Since no significant difference was found between the two groups, the 50.4 Gy group was not inferior to the 60 Gy group with regard to OS. Conclusions: The analysis revealed that the 50.4 Gy group had a non-inferior outcome in comparison with the 60 Gy group for stages I, II/III and IV thoracic esophageal cancer. These results were obtained from a large database for the first time in Japan. [ABSTRACT FROM AUTHOR]

Background: Although esophagectomy is the standard treatment for resectable esophageal cancer, chemoradiotherapy or radiotherapy alone is also selected for some cases. However, there have been very few detailed studies conducted on a large scale on the efficacy of these treatments in Japan. Methods: Of the patients enrolled in the Comprehensive Registry of Esophageal Cancer in Japan by the Japan Esophageal Society for the 2015–2017 surveys (patients treated between 2009 and 2011), the data of 388 patients treated by definitive radiotherapy alone (RTx) and 1964 patients treated by definitive chemoradiotherapy (CRTx) were analyzed. Results: The median age of the patients was 78 years in the RTx group and 69 years in the CRTx group; thus, the proportion of elderly patients was significantly higher in the RTx group than in the CRTx group (p < 0.0001). With regard to the rates of treatment by the two modalities according to the depth of invasion, extent of lymph node metastasis, and disease stage, the treatment rate by CRTx increased more significantly than that by RTx as the disease progressed (p < 0.0001). With regard to the distribution of the total irradiation dose, 11.4% and 2.3% of patients in the RTx and CRTx groups, respectively, received a dose of 67 Gy or more; thus, the RTx group received significantly higher total irradiation doses (p < 0.0001). In the RTx group, the 5-year overall survival rate was 23.2%, and the rates in patients with cStage 0–I, II, III, and IV disease were 41.8%,18.5%, 9.3%, and 13.9%, respectively. In the patients of the RTx group showing complete response (CR), the 5-year overall survival rate was 46.6% and the rates in patients with cStage 0–I, II, III, and IV disease were 54.8%, 39.6%, 32.4%, and 38.9%, respectively. In the CRTx group, the 5-year overall survival rate was 30.6% and the rates in patients with cStage 0–I, II, III, and IV disease were 57.8%, 47.8%, 23.4%, and 13.0%, respectively. In the patients of the CRTx group showing CR, the 5-year overall survival rate was 59.2% and the rates in patients with cStage 0–I, II, III, and IV disease were 67.9%, 59.5%, 56.5%, and 39.6%, respectively. Conclusion: This study revealed the current status of treatment of esophageal cancer in Japan, and we think that we have been able to establish the grounds for explaining to patients with esophageal cancer and their families the treatment decisions made for them in daily clinical practice. [ABSTRACT FROM AUTHOR]

Background: Various options are available to treat cervical esophageal cancer (CEC), including primary resection, neo-adjuvant therapy followed by surgery, and definitive chemoradiotherapy (dCRT). However, whether neo-adjuvant therapy or dCRT can improve larynx preservation rates in patients with CEC is unclear. This study investigated results of CEC treatment in clinical practice by a nationwide survey in Japan. Patients and methods: We retrospectively investigated results of clinical practices for patients with resectable CEC treated between 2012 and 2014, using a mailed questionnaire as a nationwide survey to 308 institutions recognized by the Japan Esophageal Society and the Japan Broncho-Esophagological Society. Results: We registered 792 patients from 93 institutions, of whom 11.1 % underwent endoscopic resection, 46.0 % underwent surgery, and 39.2 % underwent dCRT. Among patients with CEC who were considered to be poor candidates for laryngeal preservation at initial diagnosis, 24.5 % of the 139 patients treated with neo-adjuvant therapy, and 47.3 % of the 226 patients treated with dCRT preserved their larynxes. Conclusions: This questionnaire survey revealed that multimodality treatment for CEC could decrease laryngectomy rates, especially among patients who were not considered to be laryngeal preservation candidates. These treatment strategies can lead to both laryngeal preservation and postoperative quality of life, and should become more widely used. [ABSTRACT FROM AUTHOR]