Kazuchika Ohno1, Motomi Nasu2, Hidetoshi Matsui3, Yoshifumi Baba4, Takushi Yasuda5, Jun Sakuma6, Kenichiro Ikeda7, Takashi Maruo8, Takumi Okuda9, Norihiko Narita10, Hisayuki Kato11, Taiji Kawasaki12, Hiroshi Sato13, Kunihiko Tokashiki14, Naoki Akisada15, Hajime Ishinaga16, Ken Akashi17, Kenji Okami18, Kosuke Murayama19, Soichiro Yamamoto20, Yuji Kumakura21, Kenro Kawada22, Akihiro Shiotani23,24, Takahiro Asakage25. 1. Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan. ohno.hns@tmd.ac.jp. 2. Department of Esophageal and Gastroenterological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan. 3. Department of Head and Neck Cancer, Hyogo Cancer Center, Akashi, Japan. 4. Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan. 5. Department of Surgery, School of Medicine, Kinki University, Osaka, Japan. 6. Department of Surgery, NTT Medical Center Tokyo, Tokyo, Japan. 7. Department of Otolaryngology, School of Medicine, Showa University, Tokyo, Japan. 8. Department of Otolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. 9. Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Miyazaki University, Miyazaki, Japan. 10. Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Fukui University, Fukui, Japan. 11. Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan. 12. Department of Otolaryngology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan. 13. Division of Digestive Surgery, Department of Surgery, International Medical Center, Saitama Medical University, Hidaka, Japan. 14. Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan. 15. Division of Head and Neck Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime, Japan. 16. Department of Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Tsu, Japan. 17. Department of Otolaryngology, Kameda Medical Center, Chiba, Japan. 18. Department of Otolaryngology, School of Medicine, Tokai University, Isehara, Japan. 19. Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo, Japan. 20. Department of Gastrointestinal Surgery, Tokai University Hachioji Hospital, Tokyo, Japan. 21. Department of Surgery, Fujioka General Hospital, Fujioka, Gunma, Japan. 22. Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan. 23. Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Saitama, Japan. 24. The Japan Broncho-Esophagological Society, Tokyo, Japan. 25. Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Abstract
BACKGROUND: Cervical esophageal cancer (CEC) carries a poor prognosis; however, due to its low incidence, optimal treatment for CEC remains to be established. The purpose of this study was to clarify the current status of treatment of CEC in Japan and obtain evidence for establishing the appropriate treatment method. PATIENTS AND METHODS: We asked specialist training facilities accredited by the Japanese Broncho-Esophageal Society to register data on CEC cases that received curative treatment from January 2009 to December 2014, and conducted a retrospective review of the clinical data of 302 cases registered from 27 facilities. RESULTS: In regard to the initial therapy, of the 302 patients, 33 had undergone endoscopic resection, 41 had undergone surgery, 67 had received induction chemotherapy (IC), and 143 had received chemoradiotherapy (CRT). There were no significant differences in the 5-year overall survival rates among the patient groups that had received surgery, IC or CRT as the initial treatment; advanced stage and recurrent nerve invasion were identified as independent poor prognostic factors. Among the patients who had received IC or CRT as laryngeal-preserving surgery was not indicated at the time of the initial diagnosis, the functional laryngeal preservation rate at the end of the observation period was 34.8%. CONCLUSION: Even in patients with advanced CEC, there is the possibility of preserving the larynx by adopting IC or CRT. However, if the laryngeal function cannot be preserved, there is a risk of complications from aspiration pneumonia, so that the choice of treatment should be made carefully.
BACKGROUND: Cervical esophageal cancer (CEC) carries a poor prognosis; however, due to its low incidence, optimal treatment for CEC remains to be established. The purpose of this study was to clarify the current status of treatment of CEC in Japan and obtain evidence for establishing the appropriate treatment method. PATIENTS AND METHODS: We asked specialist training facilities accredited by the Japanese Broncho-Esophageal Society to register data on CEC cases that received curative treatment from January 2009 to December 2014, and conducted a retrospective review of the clinical data of 302 cases registered from 27 facilities. RESULTS: In regard to the initial therapy, of the 302 patients, 33 had undergone endoscopic resection, 41 had undergone surgery, 67 had received induction chemotherapy (IC), and 143 had received chemoradiotherapy (CRT). There were no significant differences in the 5-year overall survival rates among the patient groups that had received surgery, IC or CRT as the initial treatment; advanced stage and recurrent nerve invasion were identified as independent poor prognostic factors. Among the patients who had received IC or CRT as laryngeal-preserving surgery was not indicated at the time of the initial diagnosis, the functional laryngeal preservation rate at the end of the observation period was 34.8%. CONCLUSION: Even in patients with advanced CEC, there is the possibility of preserving the larynx by adopting IC or CRT. However, if the laryngeal function cannot be preserved, there is a risk of complications from aspiration pneumonia, so that the choice of treatment should be made carefully.