JSCO2016: International Session 21 Esophageal Cancer

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The 54th Annual Meeting of Japan Society of Clinical Oncology (JSCO2016)

"Renovation of Cancer Medicine in the Mature Society"



International Session 1: Lung Cancer
International Session 2: Colorectal Cancer
International Session 3: Gastric Cancer
International Session 4: Urological Cancer (Prostate and Renal Cancer)
International Session 5: Supportive Care for Adverse Events
International Session 6: Gynecological Cancer (Uterine Body Cancer and Ovarian Cancer)
International Session 7: Central Nervous System Tumor
International Session 8: New Development of Particle Beam Therapy for Cancer
International Session 9: International Cooperation in Radiation Medicine
International Session 10: Recent Advances In Cancer Immunotherapy
International Session 11: Breast Cancer
International Session 12: Pharmacology of Antitumor Agents: New Drug Application (NDA)
International Session 13: Malignant Lymphoma
International Session 14: Palliative Care
International Session 15: Radiation Therapy
International Session 16: Head and Neck Cancer
International Session 17: Skin Cancer (Malignant Melanoma)
International Session 18: Hepato-Biliary and Pancreas Cancers
International Session 19: Leukemia
International Session 20: Ethics for Clinical Research
International Session 21: Esophageal Cancer
International Session 22: Bone and Soft Tissue Tumor
FACO/JSCO Joint Symposium

Abstract Archives (in Japanese)


International Session 21: Esophageal Cancer


Treatment guidelines for carcinoma of the esophagus in Japan
Tatsuya Miyazaki (General Surgical Science, Gunma University Graduate School)
[Background] The Guidelines for Diagnosis and Treatment of Carcinoma of the Esophagus is being revised as 4th edition in responding to public comments by consensus meeting in the 70th annual meeting of Japan esophageal society.
・ In this edition, flow charts in each stage were newly constructed and clinical questions of each topics were discussed.
・ A systematic review and meta-analysis and the certainty of evidence has been conducted in clinical question.
・ The grade of recommendation have been decided by voting after consideration and discussion about the balance of desirable and undesirable consequences, the certainty of evidence, patients' values and preferences, and resource use.
[Endoscopic treatment] Indications for endoscopic resection: Among lesions that do not exceed the mucosal layer, those remaining within the mucosal epithelium or the lamina propria mucosae are extremely rarely associated with lymph node metastasis.
[Surgery] At present, efforts are focused on the establishment of surgical treatments by the standardization of surgical techniques represented by three-field lymph node dissection for cases of thoracic esophageal carcinoma, as well as the promotion of endoscopic surgery based on established surgical treatments, and minimization of surgical invasion through the use of limited surgery.
[Adjuvant therapy] Based on results of the randomized controlled trial (JCOG9907 study), neoadjuvant chemotherapy + radical surgery for resectable Stage II or III thoracic esophageal carcinoma was positioned as a standard treatment in Japan. Neoadjuvant chemoradiotherapy combined with surgery is administered to patients with locally advanced carcinoma in some institutions, although currently, there is no firm basis for its recommendation.
[Chemoradiotherapy] Chemoradiotherapy is regarded as the standard therapy for patients with esophageal carcinoma when non-surgical treatment is the choice by the result of randomized controlled studies.


Individualized and precision therapy of esophageal cancer
Mitchell C. Posner (Surgical Oncology, Surgery, University of Chicago, USA)
The optimal surgical approach for patients with esophageal cancer(EC) remains undecided. No firm evidence exists favoring one surgical approach over another however, postoperative mortality is inversely related to both surgeon and hospital esophagectomy(E) volume. Minimally invasive approaches to esophagectomy have become favored by many surgeons but its equivalency compared to open esophagectomy for long term outcomes remains unproven. Preoperative chemoradiotherapy (CRT) or chemotherapy(C) is now considered standard of care in patients with EC. It has been demonstrated that the most important predictor of improved survival is achieving an R0 resection. The CROSS trial results emphasized the importance of a multipronged approach. Operative mortality was less than 4% in both groups, and the R0 resection rate and median survival was significantly improved in those patients receiving CRT plus E versus the E-alone arm. Preoperative CRT is now accepted as a standard of care in the U.S.; outside the U.S, preoperative C is more routinely applied. Exploring new agents, identifying high value targets and applying novel therapeutic approaches is justified in a highly lethal malignancy such as EC and early results are promising for locally advanced EC. Next-generation clinical trials will adopt innovative strategies to address the challenge of tumor molecular heterogeneity and continue to examine immunotherapy checkpoints and targeted therapies to realize the goals of individualized therapy and precision medicine.


Recent advance of esophageal cancer treatment in Japan
Yuichiro Doki (Gastroenterological Surgery, Osaka University Graduate School)
In Japan, we have relatively high incidence and mortality for esophageal cancers, showing approximately 23900 new patients and 11500 cancer death (9.2 per 100,000) every year, accounting for 7th cause of cancer death.
More than 90% is squamous cell carcinoma and adenocarcinomca is gradually increasing but still 7% of total esophageal cancers. For junctional adenocarcinoma, we have less Siewert type I and the majority is type II. Type II tumors are sometimes treated as gastric cancer by gastrectomy, whereas the others as esophageal cancer by esophagectomy. National wide retrospective survey has conducted for junctional adenocarcinoma under the collaboration between JGCA and JES.
Japanese guideline has employed preoperative chemotherapy as the standard treatment for locally advanced cancers, according to JCOG 9907 study. Subsequent problems are that preoperative chemotherapy including CDDP+5FU seems to be not enough for advanced stage III, and that we don't have enough experience of preoperative chemoradiotherapy which is standard care in western countries. The answers will be obtained by ongoing JCOG 1109 study.
Approximately 6000 esophagectomies are performed every year. Operative mortality is probably the lowest in the world, as 3.4 % in Japan. Thoracoscopic esophagectomy is rapidly spreading about one third in 2011-2012 but now one half in 2015. The clinical benefit of minimum invasive esophagectomy was not evident in the retrospective survey of NCD. Prospective randomized trial JCOG1409 is ongoing.
Narrow band imaging has increased the detection of superficial cancers, which should be removed by endoscopic submucosal dissection. Number of ESD is strikingly increasing and every year, more than 2000 is performed in Japan. However there is no trend to decrease the number of esophagectomy and cancer death. Screening system for high risk patients should be considered to reduce esophageal cancer death in Japan.


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