[en] The effectiveness of palliative radiotherapy was evaluated in 59 patients with inoperable esophageal cancer. The cancers were most often inoperable because of invasion to the trachea and bronchus: hematogenous metastasis had occurred in several cases. The scheduled dose of more than 50 Gy was successfully administered to 84.7% of patients ; reasons for lesser doses included hematemesis, fever, and bypass surgery. The immediate cause of death in 24 cases was pneumonia or pyothorax due to recurrent nerve paralysis or esophagobronchial fistula. Distant metastasis occurred in only eight cases. The survival rate of 50 patients that received the scheduled dose was 66% at 6 months, 20% at 1 year, and 6% at 2 years. There were no significant differences in survival rates between patients with locally deep invasion and patients with distant metastasis. Since there were few significant adverse reactions, we thought to be able to treat patients with advanced esophageal cancer by the nearly radical radiotherapy. (author)

[en] Computed tomographic (CT) scans were performed in 179 patients with esophageal carcinoma to evaluate mediastinal lymph node metastasis. Histopathologic findings were compared with CT findings in a total of 7,218 resected lymph nodes. First, the criterion for lymph node metastasis on CT scans was 10 mm or more in long transverse diameter. The overall sensitivity and positive predictive value (PPV) were 19% (60 of 317 nodes) and 33% (60 of 180 nodes), respectively. Analysis of each of the eight subgroups of mediastinal nodes revealed that the PPV was more than 70% in node Nos. 105, 108, 110, and 112. In other subgroups, however, the PPV was less than 60%. Sensitivity was less than 50% in all eight subgroups. Second, the criterion for metastasis was 10 mm or more in short transeverse diameter. The overall sensitivity and PPV were 8% (26 of 317 nodes) and 63% (26 of 41 nodes), respectively. Analysis of subgroups showed that the PPV in NO.106 nodes increased to 92%. In NO.106 nodes, use of a 5 mm criterion in long transverse diameter increased sensitivity to only 55%. Of the 317 histopathologically proven metastatic lymph nodes, 90 nodes (28%) were 10 mm or more in size, 112 (35%) were 5-1O mm, and 115 (36%) were less than 5 mm. Of the 6,901 non-metastatic lymph nodes, 473 nodes (7%) were 10 mm or more in size. Small (less than 5 mm in size) metastatic nodes were present in all eight subgroups. Among No. 107 and 109 nodes, large (10 mm or more in size) non metastatic nodes were prominent, resulting in low sensitivity and PPV. We conclude that CT does not provide an accurate assessment of metastatic versus non-metastatic mediastinal lymph nodes in patients with esophageal carcinoma. (author)

[en] The usefulness of radiotherapy for esophageal cancer has been evaluated in twenty aged patients over 80. Forty-five percent of these aged patients were indicational of a curative irradiation. The rate of the curative irradiation in aged patients was higher than that in the younger. The curative irradiated patients received a dose of 60 Gy or more without any significant adverse reactions. The 1-year survival rate of this curative irradiation group was 67%, which was substantially high, and the group included many early-stage cases that could not be treated by surgery because of some complication in addition to their advanced age. These results suggest that even for aged patients over 80, if curative irradiation is permitted, full dose irradiation over an adequate field may yield a better prognosis than a lower irradiation dose. (author)

[en] A study of 256 patients whose dates and patterns of first mode of recurrence after curative esophagectomy from 1984 to 2004 revealed the recent improvement in survival after the detection of tumor recurrence. This tendency was evident in lymphatic recurrence, particularly in the cervical area. Lung metastasis was another mode of recurrence that has shown recent improvement. In this series, 20 patients with lymph node metastases underwent reoperation for local or regional tumor control. The addition of systemic chemotherapy or chemoradiotherapy was our general rule. The 5-year survival rate after the detection of tumor recurrence in these 20 patients was 47.4%. Six with lung metastases in the group of patients whose esophagectomies were performed in the last 7 years underwent video-assisted pulmonary tumor resection. Five patients in this group are alive without signs of further recurrence for 92 to 1,437 days. The early detection of recurrent tumor, vigorous attempts to achieve locoregional control, and the addition of systemic chemotherapy are all important in achieving better results. We routinely perform conventional cervical and abdominal ultrasonography and computed tomography every 6 months until 6 years after surgery is performed. (author)