الفهرس 
PathologyOnly 14 pages are availabe for public view
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Abstract
Esophageal cancer is a rare but highly virulent malignancy and is considered one of the most lethal of all neoplasms. Patients usually present late in the course of the disease and almost half of them present with either locally advanced or metastatic disease. The overall success rate nationally in treating esophageal carcinomas remains poor with over 90% of patients succumbing to the disease, thus management of this virulent malignancy has been a great challenge to both surgeons and clinical oncologists. Our study was conducted on 55 patients who attended Mansoura Gastroenterology Surgical Center and Clinical Oncology and Nuclear Medicine Department in the period between May 2001 and May 2004. Patients with early stage potentially respectable tumors underwent either Surgery alone (15 cases) or preoperative CRT followed by surgery (12 cases). Patients with locally advanced tumors were subjected to receive either RT alone (13 cases) or CRT (15 cases). Only 45 patients on enrollment completed treatment and were evaluable. The median age of patients was 55 years with age range between 2472 years, 35 were males and 10 were females. Dysphagia was present in almost all cases, with the most common presenting symptoms being a combination of dysphagia, weight loss, chest pain and heart burn. Most of the cases had history of smoking. In our study the lower third esophagus was the commonest site of involvement (71%), and squamous cell carcinoma was the commonest histopathological subtype (64.4%). In our study chemoradiation therapy was well tolerated with haematologic and gastrointestinal toxicities being the most prevalent. Leucopenia and esophagitis occurred in 33.3%and 13.4% of cases respectively. The median survival in patients with early staged resectable tumors was 13 months in surgery alone group versus 12 months in preoperative CRT group, with no statistically significant difference in survival. whereas median survival in patients with advanced esophageal cancer was 11 months in CRT group versus 6.9 months in RT group with a high statistically significant difference (P=0.0006). In conclusion, we believe in agreement with others that when coping with any malignancy, the goals of treatment have to be not only palliation but also prolongation of survival if possible. A variety of different approaches is available as treatment modalities for esophageal carcinoma. Radical surgery alone remains the standard of care for patients with locoregional esophageal cancer (T1, T2 tumors) who are sufficiently fit to tolerate the procedure. For patients with locally advanced disease who are not surgical candidates, definitive chemoradiation with concurrent and adjuvant cisplatin /5FU has been established as the present standard of care being more effective and well tolerated. Current interest is focusing on the development of more effective combination regimens using newer chemotherapeutic agents, including paclitaxel, irinotecan, and oxaliplatin, administering continuous low doses of cytotoxic agents throughout radiotherapy, and delivery radiotherapy in hyperfractionated twice daily schedules.