Search

In the open, comparative, non-randomized and prospective study conducted from 2007 to 2014 there were included 83 patients who received combined treatment for thoracic esophageal cancer. For a comparative analysis there was used a retrospective control group of 51 patients with esophageal cancer who had undergone surgery alone from 1999 to 2014. Complex treatment of patients with advanced forms of thoracic esophageal cancer included argon-plasma recanalization of the lumen of the esophagus followed by neoadjuvant chemoradiotherapy in two versions. One group of patients (29) received external beam radiotherapy, prescription dose of 40-45 Gy, the other group of patients (54) received intraluminal brachytherapy, 3 sessions of 7 Gy, prescription dose of 21 Gy. All patients synchronously with radiotherapy there were performed two cycles of polychemotherapy on PF scheme. A month after the neoadjuvant treatment there was carried out resection of the esophagus with simultaneous plastics by gastric stem. Complete local tumor regression was achieved in 34,7% of patients in group with intraluminal brachytherapy and 30% in the group with external beam radiotherapy. Long-term results could be traced in 90.8% of patients. Using chemoradiotherapy on preoperative stage we managed to increase disease-free and overall survival of patients with an increase of median of progression-free survival - 27 against 12 months and overall survival - 29 against 14 months in comparison with surgery alone.

To control dysphagia 202 patients with a verified esophageal cancer of stage cT1-4N0-2M0-1 underwent intraluminal brachytherapy with neoadjuvant chemoradiotherapy in the process of combined radiation/chemoradiation therapy and palliative treatment. Duration of event-free period in the group of patients, operated after neoadjuvant chemoradiotherapy was 10,1 ± 2,7 months, after intraluminal brachytherapy at combined radiation/chemoradiation therapy was 6,2 ± 2,6 months and at palliative brachytherapy--4,5 ± 2,0 months. Frequency of complete clinical regressions was 16,7% after neoadjuvant chemoradiotherapy, 19,3% after brachytherapy in the frames of radiation/chemoradiation therapy for esophageal cancer, 15,7% as a result of palliative intraluminal brachytherapy. Complete morphological tumor regression after neoadjuvant chemoradiotherapy using intraluminal brachytherapy was registered in 23,1% patients.

It was evaluated mini-invasive endovideosurgical technologies using in complex treatment of esophagus cancer. The investigation included 28 patients with thoracic esophagus cancer. Age of patients operated in terms from April 2012 to December 2013 was from 42 to 74 years (mean 61.7 ± 8.7 years). Only surgical treatment was used in 10 patients. Neoadjuvant chemotherapy and radiotherapy were performed in 18 patients. Hybrid mini-invasive esophagectomy (laparoscopic stomach mobilization and right-side thoracotomy) were used in 14 cases. The frequency of postoperative complications was 35.5%. Mini-invasive endovideosurgical esophagectomy was done in 14 patients. The frequency of postoperative complications was 57.1%. There were not deaths. Our experience demonstrates good results of mini-invasive technologies using in treatment of patients with esophagus cancer. Endovideosurgical methods permit to perform adequate volume of surgery in case of oncological diseases.

During the period from April 2012 to December 2014 54 patients aged 29-76 years, 36 (66.6%) males and 18 (33.4%) females, with esophageal cancer underwent minimally invasive esophagectomy as final phase of treatment. Squamous cell carcinoma was diagnosed in 50 patients and adenocarcinoma identified in 4 patients. The disease was staged as follows: IA--5 (9.3%) patients, IB--11 (20.4%) patients, IIA-- (16,.%) cases, III -- (3,.%) cases, IIII --8 (33,.%), IIII -- (14,8%), III -- (1,.%). 37 (68,.%) patients had surgery after induction chemoradiation therapy. Of 54 surgical interventions there were 20 hybrid and 34 minimally invasive operations. 19 (35,.%) patients developed complications, postoperative mortality was 2 (3,.)%. Minimally invasive esophagectomy meets basic oncological principles and leads to tolerable short-term results.

For treatment of cancer of the thoracic esophagus, the method of neoadjuvant chemoradiotherapy (CRT) with a use of intraluminal brachytherapy (BT) was performed. The study included 51 patients (mean age 56.9 ± 4.3 years). The length of the primary tumor up to 6 cm was determined in 18 patients, more than 6 cm--33 patients. CRT included three BT sessions (7Gy X 3; q7d) and two cycles of chemotherapy (PF; q28d). After CRT in 30 (62.4%) patients there was marked a complete or partial radiological tumor regression. In 40-45 days after CRT surgery performed. Subtotal resection of esophagus of the Lewis type was performed in 29 cases, transtracheal ex- tirpation of the esophagus--in 2, minimally invasive esopha- gectomy--in 17 cases. Postoperative complications occurred in 22 (44%) patients; one patient died (2%). In 11 (23%) patients morphological investigation revealed a complete regression of the primary tumor. Thus, a use of intraluminal BT in combination with chemotherapy in many cases promoted reducing the size of the primary tumor of the esophagus, which was an effective factor in improving surgical results.

The locally advanced cancer of thoracic esophagus was treated by induction chemo-irradiation therapy (IHRT) with intraluminal medium dose-rate brachytherapy (IMBT). From July 2009 to February 2012 twenty five patients (mean age 54.3 +/- 1.3 years) were included in the study. The length of the primary tumor was up to 6 cm in 10 pts and more than 6 cm in 15 pts. Induction therapy consisted of three IMBT sessions (7 Gy X 3; q7d) and two cycles of chemotherapy (PF; q28d), 26-31 days later the surgery was performed. Subtotal resection of the esophagus type of I Lewis was performed in 23 pts, transtracheal extirpation of the esophagus was performed in 2 pts.In all the cases 3F lymphodissection was performed. After IHRT in 15 of 25 pts. was obtained complete or partial response, in 10 of 25 pts was obtained disease stabilization. Perioperative complications occurred in 17 (68%) patients receiving conservative treatment, one patient (4%) died of treatment complications. In 6 cases (24%) morphology had shown the complete regression of primary tumor. Thus, the combination of intraluminal medium dose-rate brachytherapy and chemotherapy lead to reduction of primary tumor local spread and can be an efficient factor in improving the results of surgical treatment.

This is an analysis of treatment results data for conservative (endosurgical and radiation therapy) treatment of patients with inoperable locally advanced esophageal cancer receiving therapy in 1990-2011. The original treatment tactics including recanalization of tumor-compressed esophageal lumen (argon plasma coagulation +/- high-frequency surgery or chemical tumor necrolysis) with consequent combined radiotherapy resulted in clinical response in 79,5% of cases, 89,3% of patients retained the possibility of enteral nutrition. One-year overall survival (OS) was 68,9% (58,8% in patients receiving combined radiotherapy), 2-year OS was 22,7% and 21,2% respectively.

Among 112 patients with inoperable esophageal cancer treated with high-dose intraluminal brachytherapy and distant irradiation, objective response was in 84.8%. Predominantly local complications were reported in 78.6%. Recurrences were detected in 63.5% during follow-up, with mean relapse-free period being 107 days. Mean survival time was 15.3 months (1-, 2- and 3-year survival--58.8; 22.3 and 12.9%, respectively) which was comparable to similar results of palliative esophagectomy for gastric cancer.

A comparative evaluation of the efficacy of combined radiotherapy (112 - group 1) carried out in conjunction with a battery of procedures of endoscopic surgery plus combined radiotherapy (76 - group 2) for inoperable cancer of the esophagus was conducted in 118 patients. Maximum local regression was reported in group 2 (77.6%) as compared with only 33.9% in group 1. Relatively longer relapse-free period (133 days) and lower residual growth incidence (44.6%) were in group 2, too, as compared with 107 days and 63.5% in group 1. Mean survival duration was nearly identical in both groups - ca.15 months. Similarly, survival rates in groups 2 and 1 were: 69.2 and 58.8% (year 1), 22.2 and 22.3% (year 2), and 11.3 and 12.9% (year 3), respectively. It was concluded that combinations of endoscopic surgery and combined radiotherapy for inoperable cancer of the esophagus improved immediate results and reduced the rates of residual tumor incidence. However, no significant differences in mean duration or rates of survival were observed.

Patients with inoperable cancer of the esophagus were followed up for 1-3 years after a course of palliative endoscopic destruction of tumor. Residual growth occurred in 88.1% with an average stabilization period of 47 days. Among the unfavorable prognostic factors were partial decomposition of tumor, squamous-cell pattern, size of more than 9 cm, circular extension through the esophagus and stage III stenosis. With the aid of newly-developed methods of outpatient endoscopic destruction, 94.2% could eat throughout their survival period. Mean survival time was 5.6 months or 7.3 months in metastasis-free cases.

Endoscopic surgery including chemical necrolysis, diathermy coagulation and excision, and argon-plasma was conducted in the course of two-stage palliative treatment of 31 patients with gastroesophageal cancer. A total of 273 procedures of tumor destruction were administered. Stenosis was either eliminated or significantly reduced in 28 (90.2%) on completion of stage I. Average stabilization duration was 44 days. During stage II, periodic destruction of tumor foci continued so that peroral feeding could be maintained for another 3 years. Mean survival was 8.7 months (one year--35%, two--20%, three--7.7%). Since no life-threatening complications were reported, our method may be recommended for out-patient hospital applications.

The immediate and 3-year results were evaluated of application of combined radiotherapy and/or endoscopic argon-plasma coagulation carried out for esophageal cancers 3 cm long or less in 39 patients. Recurrences were reported, in 31.4% ca. 4 months later. Joint use of the modalities was followed by an up to 5-months rise in relapse-free period. Mean survival time was 20.2 months, and it was significantly higher in radiation-treated patients without metastases. One-year survival was 96.6% in those without distant metastases, 2-year--72%, and 3-year--47.6%. Our data point to new vistas in application of our techniques, particularly, for short (up to 3 cm) inoperable esophageal cancers.

An experience with treatment of 21 patients with inoperable cancer of the esophagus allowed determination of indications and contraindications, development of the method and technique of endoscopic implantation of a domestic meshed self-expanding stent. The complications resulting from the process of mounting and the stent itself are analyzed. The methods of eliminating the complications are shown. The immediate and nearest results of endoprosthesing are assessed. Recommendations are given concerned with the cases of ingrowth of tumor into the stent.

A procedure of argon-plasma coagulation is suggested to be used alone or in conjunction with chemical necrolysis and high-frequency electrosurgery for endoscopic palliation of dysphagia. Its outstanding impact on tumor-induced dysphagia, involving no life-threatening complications, was demonstrated in a group of 97 patients. A number of basic factors immediately influencing the results of therapy are outlined and relevant recommendations on clinical use are provided.