Remarkable response as a new indicator for endoscopic evaluation of local efficacy of non-surgical treatments for esophageal cancer.
Tomonori YanoYoshito HayashiRyu IshiharaKatsunori IijimaKatsuhiko IwakiriMasaya UesatoTsuneo OyamaChikatoshi KatadaKenro KawadaRyoji KushimaYoko TateishiSatoshi FujiiNoriaki ManabeHitomi MinamiHirofumi KawakuboYasuhiro TsubosaSachiko YamamotoTomohiro KadotaKeiko MinashiHiroya TakeuchiYuichiro DokiManabu MutoPublished in: Esophagus : official journal of the Japan Esophageal Society (2024)
In Japan, standard of care of the patients with resectable esophageal cancer is neoadjuvant chemotherapy (NAC) followed by esophagectomy. Patients unfitted for surgery or with unresectable locally advanced esophageal cancer are generally indicated with definitive chemoradiotherapy (CRT). Local disease control is undoubtful important for the management of patients with esophageal cancer, therefore endoscopic evaluation of local efficacy after non-surgical treatments must be essential. The significant shrink of primary site after NAC has been reported as a good indicator of pathological good response as well as favorable survival outcome after esophagectomy. And patients who could achieve remarkable shrink to T1 level after CRT had favorable outcomes with salvage surgery and could be good candidates for salvage endoscopic treatments. Based on these data, "Japanese Classification of Esophageal Cancer, 12th edition" defined the new endoscopic criteria "remarkable response (RR)", that means significant volume reduction after treatment, with the subjective endoscopic evaluation are proposed. In addition, the finding of local recurrence (LR) at primary site after achieving a CR was also proposed in the latest edition of Japanese Classification of Esophageal Cancer. The findings of LR are also important for detecting candidates for salvage endoscopic treatments at an early timing during surveillance after CRT. The endoscopic evaluation would encourage us to make concrete decisions for further treatment indications, therefore physicians treating patients with esophageal cancer should be well-acquainted with each finding.
Keyphrases
- locally advanced
- ultrasound guided
- neoadjuvant chemotherapy
- rectal cancer
- squamous cell carcinoma
- minimally invasive
- radiation therapy
- machine learning
- deep learning
- phase ii study
- transcription factor
- healthcare
- endoscopic submucosal dissection
- newly diagnosed
- primary care
- palliative care
- public health
- coronary artery bypass
- chronic kidney disease
- heart failure
- ejection fraction
- cardiac resynchronization therapy
- physical activity
- clinical trial
- quality improvement
- surgical site infection
- artificial intelligence
- skeletal muscle
- left ventricular
- pain management
- percutaneous coronary intervention
- big data
- robot assisted
- patient reported
- sleep quality
- atrial fibrillation