Study of the patterns of failure in carcinoma esophagus.

Ratnagiri, Ranganath (2007) Study of the patterns of failure in carcinoma esophagus. Masters thesis, Cancer Institute (WIA), Chennai.


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INTRODUCTION : Carcinoma esophagus is the fifth most common malignancy world wide and occurs at a crude incidence rate of 5.5 per 100000 population. It is unique among cancers of the gastrointestinal tract in that it traverses three anatomical compartments: the neck, thorax and the abdomen, and encompasses two different primary histologies: adenocarcinoma and squamous cell carcinoma. Natural history data and patterns of failure after specific treatment modalities provide an insight into the biologic tendencies of esophageal malignancy and suggest potential therapeutic avenues to explore. At presentation, the majority of patients have locally or regionally advanced or disseminated cancer, irrespective of histology. The lack of a serosal envelope and the rich submucosal lymphatic network of the esophagus provide a favorable milieu for extensive local infiltration by the tumor as well as lymph node involvement. Even if distant disease is not apparent clinically or radiologically at presentation, studies suggest that micrometastases are invariably present. This is borne out by the high incidence of distant sites as a significant and universally fatal component of failure. Bone marrow samples from ribs obtained during thoracotomy for esophagectomy were shown to be positive for tumor cells by immunohistochemistry and polymerase chain reaction (PCR) studies in up to 90% of the patients sampled. The clinical significance of these findings is not known, but probably indicates the need to focus on systemic therapy in addition to loco regional treatment. OBJECTIVES : 1. To study the patterns of failure in patients of carcinoma esophagus treated with various modalities. 2. To identify the treatment related morbidity and the means to reduce the same. 3. To study the feasibility and validity of the sentinel node concept in carcinoma esophagus. CONCLUSION : This retrospective study of 346 patients of esophageal cancer demonstrates the dismal survival rates achieved with radiation therapy alone, which seem to be improved dramatically with the addition of concurrent chemotherapy. No definitive claims can be made on this front however, in view of the small number of patients administered chemoradiation therapy. There was a high rate of complications with the surgical arm, though the 5 year survival achieved approximated the best in available literature. Pathologic tumor stage, nodal positivity and peri nodal spread were found to be prognostic on univariate analysis, however only peri nodal extension of tumor was the only factor found to be statistically significant on multivariate analysis. Hence a balance needs to be struck between the survival benefit of extended lymph node dissections and the consequent complications. Sentinel node biopsy offers a simple and efficient means of achieving this and further research should be in this direction.

Item Type: Thesis (Masters)
Uncontrolled Keywords: patterns of failure ; carcinoma ; esophagus.
Subjects: MEDICAL > Surgical Oncology
Depositing User: Kambaraman B
Date Deposited: 26 Jul 2017 02:34
Last Modified: 26 Jul 2017 02:34

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