| International Session (Symposium) 3 (1) (JSGS・JSGE・JSH) |
| Fri. November 2nd 9:00 - 10:30 Room 9: Portopia Hotel Main Building Kairaku 3 |
| Current research in esophageal cancer | |||
| C S Pramesh | |||
| Tata Memorial Centre | |||
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| Esophageal cancer is the eighth most common cancer worldwide, with remarkably high contribution of Asia to the world's total incidence and mortality. With the highest age standardized incidence rates of any continent (7.7 per 100 000), and the densest population in the world, Asia represents 75% of the world's burden of esophageal cancer. The biological behavior of squamous and adenocarcinoma of the esophagus is quite different. While adenocarcinomas have a propensity for distant metastases, ESCC has a predilection for locoregional spread and therefore, the challenges in management are unique. There are several ongoing trials evaluating several aspects of management of esophageal cancer - two clear examples of unanswered questions in ESCC are the choice of neoadjuvant therapy and the role of radical lymphadenectomy Neoadjuvant treatment is now well-established in the overall management of localized operable esophageal cancer. However, there is controversy on which of the two strategies - neoadjuvant chemotherapy (NACT) or neoadjuvant chemoradiation (NACRT) is optimal. While it is acknowledged that response rates are better with neoadjuvant chemoradiation compared to neoadjuvant chemotherapy, the exact differences in survival, if any, between these two strategies is unknown. There are several new trials evaluating these two strategies - the neo AEGIS, ESOPEC, NeXT (JCOG 1109) and the Tata Memorial Centre trial - while the former two deal with adenocarcinomas, the latter two compares these strategies in squamous cell cancer. The role of radical lymphadenectomy is a longstanding controversy dating more than two decades. The impact of the radical lymphadenectomy is likely to be more pronounced in ESCC than adenocarcinoma due to the selective lymph nodal spread rather than distant metastases, which are seen more commonly in adenocarcinomas. While radical three field lymphadenectomy is the standard of care in several Asian countries including Japan, two-field lymph node dissection is followed in most western countries. These two issues may also be inter-related: a neoadjuvant strategy of NACTRT may have much higher perioperative morbidity and mortality if radical lymphadenectomy is combined with it. In my talk, I summarize the current global research on esophageal cancer and briefly describe our own institutional research initiatives. |
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