Esophagus最新文献

{"title":"Optimizing neoadjuvant radiotherapy for locally advanced esophageal squamous cell carcinoma: a comprehensive review on the role of concomitant or sequential immune checkpoint inhibitors.","authors":"Reza Ghalehtaki, Arya Amini, Romina Abyaneh","doi":"10.1007/s10388-024-01097-1","DOIUrl":"https://doi.org/10.1007/s10388-024-01097-1","url":null,"abstract":"<p><p>Esophageal squamous cell carcinoma (ESCC) is a prevalent form of esophageal cancer with a poor prognosis despite advances in treatment. Combining immune checkpoint inhibitors (ICIs) with radiotherapy (RT) or chemoradiotherapy (CRT) has shown potential in enhancing treatment efficacy. We conducted a comprehensive review of clinical trials published between 2019 and 2024, sourced from PubMed, Scopus, and Embase databases. Studies included were prospective phase II trials that evaluated the combination of ICIs with neoadjuvant chemoradiotherapy (nCRT) in resectable locally advanced ESCC. Ten trials met the inclusion criteria. The review highlights various approaches in combining ICIs with CRT, including concurrent, induction, and consolidation therapy. Among the included trials, a significant proportion focused on concurrently administering ICIs with CRT, showing promising outcomes with high pathological complete response rates (pCR) and manageable toxicities. However, further research is needed to validate the efficacy of induction and consolidation therapies and determine optimal treatment protocols. The combination of ICIs and nCRT can potentially improve treatment responses and outcomes for patients with locally advanced ESCC. Despite recent encouraging findings, most trials were single-arm with small sample sizes, indicating the need for larger studies with longer follow-ups to assess survival outcomes comprehensively.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of multiple esophageal squamous cell carcinomas detected in the surveillance after endoscopic resection.","authors":"Ryo Shimizu, Toshiyuki Yoshio, Kazunori Hijikata, Akiyoshi Ishiyama, Yohei Ikenoyama, Ken Namikawa, Yoshitaka Tokai, Shoichi Yoshimizu, Yusuke Horiuchi, Toshiaki Hirasawa, Hiroshi Kawachi, Takahisa Matsuda, Junko Fujisaki","doi":"10.1007/s10388-024-01096-2","DOIUrl":"https://doi.org/10.1007/s10388-024-01096-2","url":null,"abstract":"<p><strong>Background and study aim: </strong>Endoscopic resection (ER) of esophageal squamous cell carcinoma (ESCC) is an organ-preserving treatment; however, heterochronic carcinomas are often encountered. Most patients are treated using ER; however, for some, this is inadequate and requires additional treatment. We sought to identify the characteristics and frequency of lesions at high risk of metastasis during surveillance based on Lugol-voiding lesion (LVL) grading and esophagogastroduodenoscopy (EGD) intervals.</p><p><strong>Methods: </strong>Of the 1301 patients who underwent ER, 956 underwent surveillance EGD at our hospital for at least 1 year (median, 59 months). We analyzed identified multiple ESCCs to reveal the characteristic of high-metastasis-risk lesions, which was defined ESCC with submucosal or lymphovascular invasion.</p><p><strong>Results: </strong>In the 956 patients, 444 multiple ESCCs were identified in 216 patients and the cumulative incidence of multiple ESCCs was 15.4% and 22.9% at 3 and 5 years, respectively, while for high-risk lesions, it was 1.0% and 1.8%. The risk factors for high-metastasis-risk lesions were being female (odds ratio (OR):5.58, 95% confidence interval (CI):1.96-15.9), lesions located in the cervical/upper thoracic esophagus (OR: 4.81, 95% CI:1.80-12.8), and the presence of submucosal tumor (SMT)-like marginal elevation (OR:65.4, 95% CI:11.0-390). No significant differences in the frequency of high-risk lesions were found based on LVL grade at any EGD intervals.</p><p><strong>Conclusion: </strong>During endoscopic surveillance, attention should be given to the cervical/upper thoracic esophagus and lesions with SMT-like marginal elevation. The frequency of high-metastasis-risk lesions was not different by LVL grade or EGD intervals.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics of patients with eosinophilic esophagitis and eosinophilic esophageal myositis based on esophageal motility.","authors":"Noriyuki Kawami, Yoshimasa Hoshikawa, Eri Momma, Tomohide Tanabe, Mai Koeda, Shintaro Hoshino, Katsuhiko Iwakiri","doi":"10.1007/s10388-024-01093-5","DOIUrl":"https://doi.org/10.1007/s10388-024-01093-5","url":null,"abstract":"<p><strong>Background: </strong>Eosinophilic esophagitis (EoE) presents with various esophageal motility disorders, and some cases of hypercontractile esophagus (HE) are associated with eosinophilic esophageal myositis (EoEM). This study aimed to compare the clinical characteristics of patients with EoE and EoEM according to their esophageal motility.</p><p><strong>Methods: </strong>The 28 patients with EoE and 2 patients with EoEM were divided into three groups based on esophageal motility: normal motility group, hypomotility group, and spastic contraction group. The clinical characteristics of the three groups were retrospectively compared.</p><p><strong>Results: </strong>Among the 28 patients with EoE, there were 15 with normal esophageal motility, 9 with hypomotility (2 with absent contractility, 7 with ineffective esophageal motility), and 4 with spastic contractions (1 with type III achalasia, 1 with HE, 2 with unclassifiable multipeak contractions). The two patients with EoEM had HE. Most patients in the normal and hypomotility groups had typical endoscopic findings of EoE, whereas these typical findings were less common in the spastic contraction group (P < 0.001). Four of the five patients with esophageal stricture were in the hypomotility group (P = 0.036). The therapy method significantly differed between the three groups: the normal group had more patients that responded to a proton pump inhibitor or potassium-competitive acid blocker, the hypomotility group had more patients that responded to steroids, and the spastic contraction group contained two patients treated with per-oral endoscopic myotomy (P = 0.021).</p><p><strong>Conclusions: </strong>The endoscopic findings and therapy methods differ between patients with EoE and EoEM based on the esophageal motility.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Betulin gel alleviates esophageal stricture following endoscopic submucosal dissection: an animal study.","authors":"Dan Ma, Fan Yang, Qihong Yu, Xin Zhou, Zhaoshen Li, Yunfeng Wang, Jie Chen","doi":"10.1007/s10388-024-01091-7","DOIUrl":"https://doi.org/10.1007/s10388-024-01091-7","url":null,"abstract":"<p><strong>Background: </strong>Esophageal stenosis is a troublesome complication after circumferential ESD. This study examined the efficacy of betulin gel in preventing esophageal stenosis after ESD in a porcine model.</p><p><strong>Methods: </strong>Twelve pigs were randomized to betulin group and control group evenly. At the distal esophagus, circumferential ESD was performed in all animals. In the betulin group, betulin gel was applied at days 1, 3, and 7. Endoscopy examination was performed at day 3, 1 week, 2 weeks, and 4 weeks post-ESD. Then pigs were killed for macroscopic and histologic esophageal evaluation.</p><p><strong>Results: </strong>The rate of esophageal stricture was lower in the betulin group (53.3 ± 12.5% vs 88.3% ± 2.9, p = 0.02). Betulin-treated pigs had lower dysphagia score (2.0 ± 0 vs 3.3 ± 0.5, p < 0.001), less weight loss (11.78% ± 2.16 vs 15.85% ± 3.63, p = 0.04), and better passability of the open and closed biopsies forceps (83.33% vs. 0%, p = 0.015, and 100% vs. 0%, p = 0.002) 4 weeks post-ESD. Histologically, better re-epithelization (63.2 ± 10.7 mm vs 22.8 ± 10.1 mm, p < 0.001), slighter submucosal fibrosis (0.95 ± 0.17 mm vs 2.32 ± 0.48 mm, p = 0.002), lower muscularis propria damage score (1 vs 3, p < 0.001), and less inflammatory cells (307 vs 675 per high-power field, p = 0.002) were noted in the betulin group. The expression levels of TGF-β1, collagen i, collagen III, and α-SMA were significantly lower in the betulin group compared to the control group (p < 0.05).</p><p><strong>Conclusions: </strong>Betulin gel shows promise in reducing fibrosis, enhancing repair, and preventing esophageal stricture after ESD, suggesting a potential new strategy for prevention.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of sprayable, highly adhesive hydrophobized gelatin microparticles on esophageal stenosis after endoscopic submucosal dissection: an experimental study in a swine model.","authors":"Hiroki Yano, Fumisato Sasaki, Hidehito Maeda, Shohei Uehara, Masayuki Kabayama, Yusuke Fujino, Akihito Tanaka, Makoto Hinokuchi, Shiho Arima, Shinichi Hashimoto, Shuji Kanmura, Shima Ito, Akihiro Nishiguchi, Tetsushi Taguchi, Akio Ido","doi":"10.1007/s10388-024-01090-8","DOIUrl":"https://doi.org/10.1007/s10388-024-01090-8","url":null,"abstract":"<p><strong>Background: </strong>Esophageal mucosal resection for superficial esophageal cancer can lead to postoperative esophageal stricture, with current preventive measures being insufficient. Sprayable wound dressings containing hydrophobized microparticles exhibit strong adhesion. This study aimed to investigate the preventive effects of hydrophobized microparticles on esophageal stenosis following endoscopic submucosal dissection.</p><p><strong>Methods: </strong>Circumferential esophageal endoscopic submucosal dissection was performed on miniature swine (n = 6). Swine were categorized into two groups: those sprayed with hydrophobized microparticles (sprayed group) and those not sprayed (non-sprayed group). Hydrophobized microparticles were sprayed onto the sprayed group on Days 0, 3, and 7 of endoscopic submucosal dissection. The non-sprayed group underwent endoscopy on the same days. Esophageal stricture rate, submucosal inflammatory cell infiltration, submucosal fibrosis, and thickening of the muscular layer were compared between the groups on Day 14 of endoscopic submucosal dissection.</p><p><strong>Results: </strong>Spraying of hydrophobized microparticles was easily performed using an existing endoscopic spraying device. The esophageal stricture rate was significantly lower in the sprayed group than in the non-sprayed group (76.1% versus 90.6%, p < 0.05). The sprayed group showed suppression of inflammatory cell infiltration in the submucosal layer (p < 0.01) and thickening of the muscular layer (p < 0.01).</p><p><strong>Conclusions: </strong>Sprayable tissue-adhesive hydrophobized microparticles reduce the stricture rate after esophageal ESD by inhibiting inflammatory cell infiltration, submucosal fibrosis, and thickening of the muscular layer. The use of hydrophobized microparticles for preventing post-endoscopic submucosal dissection esophageal stenosis offers a promising avenue for clinical applications in endoscopic procedures, potentially improving patient outcomes.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a prediction score for Barrett's esophagus in Japanese health checkup settings.","authors":"So Kodama, Kenta Watanabe, Yosuke Shimodaira, Sho Fukuda, Tatsuki Yoshida, Yohei Saruta, Ryo Okubo, Tamotsu Matsuhashi, Taiga Komatsu, Katsunori Iijima","doi":"10.1007/s10388-024-01079-3","DOIUrl":"10.1007/s10388-024-01079-3","url":null,"abstract":"<p><strong>Background: </strong>The incidence of esophageal adenocarcinoma has recently increased in Asia, including Japan. A system to identify individuals at high risk for Barrett's esophagus (BE), a pre-cancerous condition of esophageal adenocarcinoma, among the general population is needed to perform endoscopic surveillance appropriately. We therefore developed risk prediction scores for BE at health checkups in Japan.</p><p><strong>Methods: </strong>4128 consecutive health checkup examinees were retrospectively enrolled from October 2021 to March 2022. A prediction score for BE was developed based on the linear transformation of β-regression coefficients in a multivariable regression model incorporating BE predictors. Internal validation was performed by evaluating discrimination and calibration of the prediction model.</p><p><strong>Results: </strong>Three prediction scores corresponding to BE based on its length were developed: all lengths, ≥ 1 cm, ≥ 2 cm. All scores were internally validated, and the model calibration was excellent. The performance of the prediction models was better for longer BE, with a c-statistic of 0.70 for BE ≥ 2 cm, than for shorter values. The prediction score for BE ≥ 2 cm yielded sensitivity and specificity of 52.9% and 78.6% in high-risk subjects and 91.2% and 29.3% in intermediate- or high-risk subjects, respectively.</p><p><strong>Conclusions: </strong>This prediction score can potentially increase the endoscopic detection of BE by identifying potentially high-risk individuals from the general population. This is the first report on developing a prediction score for BE that may suit the Japanese population.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":"552-562"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicenter retrospective analysis of complications and risk factors in endoscopic resection for esophageal cancer across Japan.","authors":"Ryu Ishihara, Tsuneo Oyama, Manabu Takeuchi, Dai Hirasawa, Kengo Kanetaka, Masaya Uesato, Yosuke Tsuji, Noriko Matsuura, Seiichiro Abe, Tomohiro Kadota, Toshiyuki Yoshio, Tsutomu Tanaka, Yuji Urabe, Yugo Suzuki, Manabu Muto","doi":"10.1007/s10388-024-01073-9","DOIUrl":"10.1007/s10388-024-01073-9","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic resection (ER) is a minimally invasive treatment for esophageal cancer that sometimes causes complications. To understand the real-world incidence and risk factors for these complications, a nationwide survey was conducted across Japan.</p><p><strong>Methods: </strong>This retrospective multicenter study included patients who underwent ER for esophageal cancer from April 2017 to March 2018 (2017 complication analysis) and April 2021 to March 2022 (2021 complication analysis). The study assessed the complication rates and conducted risk factor analyses for endoscopic submucosal dissection (ESD) using data for these patients, with exclusions based on specific criteria to ensure data accuracy.</p><p><strong>Results: </strong>In the 2021 complication analysis, there were two mortalities highly likely attributable (0.03%) to ER and one mortality possibly attributable (0.01%) to ER. Intraoperative perforation, delayed bleeding, and pneumonia occurred in 137 cases (1.8%), 44 cases (0.6%), and 130 cases (1.7%), respectively. In the multivariate analysis for complications after ESD, low ER volume of the facility was an independent risk factor for perforation, while lesion location in the cervical or upper thoracic esophagus was an independent factor for reduced risk of perforation. Age ≥ 80 years was a risk factor for pneumonia, while use of traction techniques was a factor for reduced risk of pneumonia. Lesions located in the middle thoracic esophagus had a lower risk of stricture, and the risk of stricture increased as the circumferential extent of the lesion increased.</p><p><strong>Conclusions: </strong>This large-scale study provided detailed insights into the complications associated with esophageal ER and identified significant risk factors.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":"430-437"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141563048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous cuff pressure control on middle-aged and elderly patients undergoing endoscopic submucosal dissection of the esophagus effect of airway injury.","authors":"Xianwei Jin, Yuewen Ding, Qiaoling Weng, Chumiao Sun, Dongbo Liu, Jia Min","doi":"10.1007/s10388-024-01061-z","DOIUrl":"10.1007/s10388-024-01061-z","url":null,"abstract":"<p><strong>Objective: </strong>Assessment of the effect of continuous cuff pressure control on airway injury in middle-aged and elderly patients undergoing endoscopic submucosal dissection (ESD).</p><p><strong>Method: </strong>A total of 104 eligible middle-aged and elderly patients requiring esophageal ESD from July 2022-September 2023 at the First Affiliated Hospital of Nanchang University were selected and randomly divided into two groups: the group undergoing general anesthesia tracheal intubation with continuous control of cuff pressure after intubation (Group A, n = 51) and the group undergoing general anesthesia tracheal intubation with continuous monitoring without control of cuff pressure (Group B, n = 53). After endotracheal intubation in Group A, under the guidance of an automatic cuff pressure controller, the air was used to inflate the tracheal cuff until the cuff pressure was 25-30cmH₂O. The cuff pressure after intubation was recorded, and then the cuff pressure parameters were directly adjusted in the range of 25-30cmH₂O until tracheal extubation after the operation. After endotracheal intubation, patients in Group B inflated the tracheal cuff with clinical experience, then monitored and recorded the cuff pressure with a handheld cuff manometer and instructed the cuff not to be loosened after being connected to the handheld cuff manometer-continuous monitoring until the tracheal extubation, but without any cuff pressure regulation. The patients of the two groups performed esophageal ESD. The left recumbent position was taken before the operation, and the cuff's pressure was recorded. Then, insert the gastrointestinal endoscope to find the lesion site and perform appropriate CO₂ inflation to display the diseased esophageal wall for surgical operation fully. After determining the location, the cuff pressure of the two groups was recorded when the cuff pressure was stable. After the operation, the upper gastrointestinal endoscope was removed and the cuff pressure of the two groups was recorded. Postoperative airway injury assessment was performed in both groups, and the incidence of sore throat, hoarseness, cough, and blood in sputum was recorded. The incidence of postoperative airway mucosal injury was also observed and recorded in both groups: typical, episodic congestion spots and patchy local congestion.</p><p><strong>Result: </strong>The incidence of normal airway mucosa in Group A was higher than that in Group B (P < 0.05). In comparison, the incidence of occasional hyperemia and local plaque congestion in Group A was lower than in Group B (P < 0.05).</p><p><strong>Conclusion: </strong>Continuous cuff pressure control during operation can reduce airway injury in patients with esophageal ESD and accelerate their early recovery after the operation.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":"456-463"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The implementation status of prehabilitation during neoadjuvant chemotherapy for patients with locally advanced esophageal cancer: a questionnaire survey to the board-certified facilities in Japan.","authors":"Tsuyoshi Harada, Tetsuya Tsuji, Takuya Fukushima, Tomohiro Ikeda, Shusuke Toyama, Nobuko Konishi, Hiroki Nakajima, Katsuyoshi Suzuki, Keiji Matsumori, Takumi Yanagisawa, Kakeru Hashimoto, Hitoshi Kagaya, Sadamoto Zenda, Takashi Kojima, Takeo Fujita, Junya Ueno, Nanako Hijikata, Aiko Ishikawa, Ryuichi Hayashi","doi":"10.1007/s10388-024-01075-7","DOIUrl":"10.1007/s10388-024-01075-7","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":"496-504"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of proton-based definitive chemoradiotherapy and surgery-based therapy for esophageal squamous cell carcinoma: a multi-center retrospective Japanese cohort study.","authors":"Koichi Ogawa, Hitoshi Ishikawa, Takeshi Toyozumi, Kazuhiro Noma, Koji Kono, Hidehiro Hojo, Hiroyasu Tamamura, Yusuke Azami, Toshiki Ishida, Yoshihiro Nabeya, Hiromitsu Iwata, Masayuki Araya, Sunao Tokumaru, Kazushi Maruo, Tatsuya Oda, Hisahiro Matsubara","doi":"10.1007/s10388-024-01068-6","DOIUrl":"10.1007/s10388-024-01068-6","url":null,"abstract":"<p><strong>Background: </strong>Proton-based, definitive chemoradiotherapy (P-CRT) for esophageal squamous cell carcinoma (ESCC) previously showed comparable survival outcomes with the surgery-based therapy, i.e., neoadjuvant chemotherapy followed by esophagectomy (NAC-S), in a single-institutional study. This study aimed to validate this message in a Japanese multicenter study.</p><p><strong>Methods: </strong>Eleven Japanese esophageal cancer specialty hospitals have participated. A total of 518 cases with clinical Stage I-IVA ESCC between 2010 and 2019, including 168 P-CRT and 350 NAC-S patients, were enrolled and long-term outcomes were evaluated. Propensity-score weighting analyses with overlap weighting for confounding adjustment were used.</p><p><strong>Results: </strong>The 3-year overall survival (OS) of the P-CRT group was equivalent to the NAC-S group (74.8% vs. 72.7%, hazard ratio [HR]: 0.87, 95% confidence interval [CI]: 0.61-1.25). Although, the 3-year P-CRT group progression-free survival (PFS) was inferior to the NAC-S group (51.4% vs. 59.6%, HR 1.39, 95% CI 1.04-1.85), the progression P-CRT group cases showed better survival than the NAC-S group (HR 0.58, 95% CI 0.38-0.88), largely because of salvage surgery or endoscopic submucosal dissection for local progression. The survival advantage of P-CRT over NAC-S was more pronounced in the cT1-2 (HR 0.61, 95% CI 0.29-1.26) and cStage I-II (HR 0.50, 95% CI 0.24-1.07) subgroups, although this trend was not evident in other populations, such as cT3-4 and cStage III-IVA.</p><p><strong>Conclusions: </strong>Proton-based CRT for ESCC showed equivalent OS to surgery-based therapy. Especially for patients with cT1-2 and cStage I-II disease, proton-based CRT has the potential to serve as a first-line treatment.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":"484-494"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}