JTCS St. Jude Medical
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Jeffrey A. Hagen
Tom R. DeMeester
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hagen, J. A.
Right arrow Articles by DeMeester, T. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hagen, J. A.
Right arrow Articles by DeMeester, T. R.
Related Collections
Right arrow Esophagus - cancer
Right arrowRelated Article

J Thorac Cardiovasc Surg 2003;125:988-991
© 2003 The American Association for Thoracic Surgery

Editorials

Staging of esophageal carcinoma

Jeffrey A. Hagen, MD, Tom R. DeMeester, MD

From the University of Southern California, Department of Surgery, Keck School of Medicine.

Received for publication Aug 6, 2002. Accepted for publication Aug 15, 2002. Address for reprints: Tom R. DeMeester, MD, USC HealthCare Consultation Center, 1510 San Pablo St, Suite 514, Los Angeles, CA 90033-4612 (E-mail: cbernolak@surgery.usc.edu).

The first 300 words of the full text of this article appear below.

See related article on page 1091.


Figure Removed (Available Only in the Full Text)
View larger version (83K):
[in this window]
[in a new window]
  		USC Thoracic and Foregut Research

 
In this month's issue of the Journal, Rice and colleaguesGo 1 report a thorough retrospective analysis of prospectively collected data titled "Role of Clinically Determined Depth of Tumor Invasion in the Treatment of Esophageal Carcinoma" The report has 3 major conclusions. First, the authors conclude that clinical staging with endoscopic ultrasonography (EUS) reliably reflects pathologic staging with an accuracy of 87%. This observation adds to the growing body of data indicating that EUS is the most reliable method available for the clinical staging of esophageal cancer. Second, they conclude that the tumor and nodal responses to induction therapy (chemoradiotherapy) are linked. This implies that a benefit seen in downstaging T (tumor) indicates a similar downstaging of N (nodal disease). They then ask the following pertinent question: Does downstaging T portend an improved survival? The answer is partially provided in their third conclusion that when nodal disease persists, the downstaging of the tumor does not improve survival. This implies that even though T and N stage are linked in both their occurrence and response to induction therapy, N is predominant and independent of T in predicting survival. With these points made, they attempt to identify, with clinical staging methodology, subgroups of patients who are likely to benefit from induction therapy. Overall, the report is a movement away from the current trend toward the belief that neoadjuvant therapy is the standard of care for all patients with esophageal cancer. Their movement is justified by the failure of prospective randomized clinical trials to show a convincing and consistent benefit of neoadjuvant therapy in carcinoma of the esophagus (Table 1).Go Go 2-8


View this table:
[in this window]
[in a new window]
  		Table 1. Randomized trials of neoadjuvant chemoradiotherapy followed by surgical intervention versus surgical intervention alone for esophageal cancer
 
In an effort to identify . . . [Full Text of this Article]


Related Article

Role of clinically determined depth of tumor invasion in the treatment of esophageal carcinoma
Thomas W. Rice, Eugene H. Blackstone, David J. Adelstein, Gregory Zuccaro, Jr, John J. Vargo, John R. Goldblum, Sudish C. Murthy, Malcolm M. DeCamp, and Lisa A. Rybicki
J. Thorac. Cardiovasc. Surg. 2003 125: 1091-1102. [Abstract] [Full Text] [PDF]





HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2003 by The American Association for Thoracic Surgery.