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LETTER TO THE EDITOR
Year : 2015  |  Volume : 11  |  Issue : 4  |  Page : 1045

Pruning inaccuracies in staging of inoperable carcinoma oesophagus


1 Department of Radiotherapy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
2 Department of Radiodiagnosis, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

Date of Web Publication15-Feb-2016

Correspondence Address:
Mukesh Sharma
Department of Radiotherapy, Indira Gandhi Medical College, Shimla, Himachal Pradesh - 171 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.144561

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How to cite this article:
Sharma M, Sharma A. Pruning inaccuracies in staging of inoperable carcinoma oesophagus. J Can Res Ther 2015;11:1045

How to cite this URL:
Sharma M, Sharma A. Pruning inaccuracies in staging of inoperable carcinoma oesophagus. J Can Res Ther [serial online] 2015 [cited 2020 Jul 3];11:1045. Available from: http://www.cancerjournal.net/text.asp?2015/11/4/1045/144561



Sir,

We have enthusiastically gone through the well-researched article written by Dr. Virendra Bhandari of Sri Aurobindo Institute of Medical Sciences.[1] Esophageal carcinoma still remains an enigma; the cure rates being on the lower side and much remains to be achieved despite newer approaches. Chemoradiotherapy in inoperable cases of esophageal carcinoma presents challenges in another sphere: Staging. The article states that 32.25% of the studied patients were in stage IIb and 67.75% patients in stage III. Computed tomography (CT) scan (thoracic region) and ultrasonography of the abdomen were done for determining the stage of disease. CT is not considered a reliable modality for the staging of esophageal carcinoma.[2] Even PET CT and high-resolution magnetic resonance imaging (MRI) have not been regarded as accurate for this purpose. Endoscopic ultrasonography (EUS) has been regarded the best modality, but even this cannot replace the accuracy of histopathologic staging in excluding higher stage disease. We would like to emphasize the importance of nodal status in this case. The number of involved lymph nodes has been proven to impact the prognosis.[3] The recent AJCC staging has also taken this into account classifying nodal status on the basis of number of involved lymph nodes. CT has been a good investigation for evaluation of nodal metastasis. Periesophageal, mediastinal, and abdominal lymph nodes with short axis greater than 1 cm have widely been considered to be involved.[4] Here it would be pertinent to raise the point that when CT alone has been used for staging in esophageal carcinoma, the nodal status would better correlate with prognosis rather than the overall stage on CT.

In addition, the role of endoscopic ultrasound (EUS) also needs to be emphasized. It visualizes all the layers of esophagus and gives good results in knowing not only the local tumor (T) stage but also the nodal (N) status of disease. The accuracy for T stage by EUS is 85% and N stage being 75%.[5] The use of this investigation needs to be encouraged so that exact stage of malignant esophageal disease is recorded.

Definitive chemoradiation has the inherent drawback of lacking histopathological staging details provided by surgical treatment. Coupled with the selection bias, the inaccuracies in clinical staging tend to favor the surgical series whenever treatment results of chemoradiotherapy and surgery in carcinoma esophagus are compared. Thus, all efforts to minimize these flaws are needed in published studies so that the correct picture can be ascertained.

 
 > References Top

1.
Bhandari V. Role of concurrent chemoradiation in inoperable carcinoma esophagus: A prospective study. J Cancer Res Ther 2014;10:11-4.  Back to cited text no. 1
    
2.
Quint LE, Glazer GM, Orringer MB. Esophageal imaging by MR and CT: Study of normal anatomy and neoplasms. Radiology 1985;156:727-31.  Back to cited text no. 2
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3.
Rizk N, Venkatraman E, Park B, Flores R, Bains MS, Rusch V. American Joint Committee on Cancer staging system. The prognostic importance of the number of involved lymph nodes in esophageal cancer: Implications for revisions of the American Joint Committee on Cancer staging system. J Thorac Cardiovasc Surg 2006;132:1374-81.  Back to cited text no. 3
    
4.
Wolfman NT, Scharling ES, Chen MY. Esophageal squamous carcinoma. Radiol Clin North Am 1994;32:1183-201.  Back to cited text no. 4
    
5.
Rosch T. Endosonographic staging of esophageal cancer: A review of literature results. Gastrointest Endosc Clin N Am 1995;5:537-47.  Back to cited text no. 5
    




 

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