Adenocarcinoma of the proximal esophagus: report of 9 patients and review of the literature.
BACKGROUND
Adenocarcinoma of the proximal esophagus is a rare clinical entity, with only 28 cases described in the literature. We report our experience with 9 patients and a review of the literature on this topic.


METHODS
Between 1980 and 2004, 1010 patients with esophageal or gastroesophageal junction adenocarcinoma (from a total of 4655 cancers, 3510 squamous and 1145 adeno) presenting at our department were retrospectively evaluated.


RESULTS
Nine patients (0.9%) had adenocarcinoma located in the proximal esophagus. Four patients (Group A) were considered unfit for surgery due to severe comorbidities and/or advanced stage disease. Three of them received endoscopic yttrium-aluminum-garnet (YAG)-laser therapy; 1 patient had feeding gastrostomy. Their median survival was 6 months (range, 3-9 months). The other 5 patients (Group B) were given a first-line cytoreductive treatment: 4 had complete response, and 1 patient did not complete chemotherapy due to toxicity and underwent surgery for residual disease. The median survival for these 5 patients receiving cytoreductive therapy was 36 months (range, 24-132 months). For the 4 patients with complete clinical response to cytoreductive treatment, the median survival was 54 months (range, 24-132 months).


CONCLUSIONS
First-line chemoradiotherapy is an effective treatment for adenocarcinoma of the proximal esophagus. Salvage surgery may be reserved for patients with incomplete response or recurrent disease.
Marano
Salvatore
S
Department of Gastroenterological and Surgical Sciences, Clinica Chirurgica III, University of Padova School of Medicine, Padova, Italy.
Ruol
Alberto
A
Castoro
Carlo
C
Portale
Giuseppe
G
Cagol
Matteo
M
Alfieri
Rita
R
Michieletto
Silvia
S
Ancona
Ermanno
E
D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D004943:Esophagogastric Junction / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate