Covered nitinol stents for the treatment of esophageal strictures and leaks

AIM:To compare 2 different types of covered esophageal nitinol stents(Ultraflex and Choostent) in terms of efficacy,complications,and long-term outcome.METHODS:A retrospective review of a consecutive series of 65 patients who underwent endoscopic placement of an Ultraflex stent(n = 33) or a Choostent(n = 32) from June 2001 to October 2009 was conducted.RESULTS:Stent placement was successful in all patients without hospital mortality.No significant differences in patient discomfort and complications were observed between the Ultraflex stent and Choostent groups.The median follow-up time was 6 mo(interquartile range 3-16 mo).Endoscopic reintervention was required in 9 patients(14%) because of stent migration or food obstruction.No significant difference in the rate of reintervention between the 2 groups was observed(P = 0.8).The mean dysphagia score 1 mo after stent placement was 1.9 ± 0.3 for the Ultraflex stent and 2.1 ± 0.4 for the Choostent(P = 0.6).At 1-mo follow-up endoscopy,the cover membrane of the stent appeared to be damaged more frequently in the Choostent group(P = 0.34).Removal of the Choostent was possible up to 8 wk without difficulty.CONCLUSION:Ultraflex and Choostent proved to be equally reliable for palliation of dysphagia and leaks.Removal of the Choostent was easy and safe under mild sedation.

Does Photofrin II Combined with a Radio-Adaptive Dose Lead to a Synergistic or Additive Effect after Ionising Irradiation <i>In Vitro</i>?

Background: The radiosensitizing effect of Photofrin II has been demonstrated in vitro and in animal models, even in tumor models known to be highly radioresistant, such as glioblastoma and bladder carcinoma. Radio-adaptive doses are also known to lead to an augmented cell or tissue reaction. The aim of this study was to investigate potential synergistic or additive effects when combining the two methods in vitro for an improved therapeutic concept in bladder cancer. Material and Methods: RT4 human bladder carcinoma cell line and HCV29 human bladder epithelium cells were seeded and incubated with various concentrations of Photofrin II. The cells were additionally irradiated with ionizing radiation (0.05 Gy/2 Gy/0.05 Gy + 2 Gy). Cells without Photofrin II incubation and irradiation served as controls. The cell survival was evaluated. Results: The survival rate of both cell lines, RT4 and HCV29, did not differ significantly when incubated with a non-toxic concentration of Photofrin II and exposed to a pre-irradiation dose of 0.05 Gy prior to the 2 Gy radiation fraction, compared to cells exposed to Photofrin II plus a 2 Gy ionizing radiation. Conclusion: The combination of both methods did neither demonstrate a synergistic or additive effect nor did it lead to a negative influence of both modulating factors in an in vitro setting.

Is Neutrophil-to-Lymphocyte Ratio a Prediction Marker for Success of Immunotherapy? Preliminary Results

Background: Cancer immunotherapy treatments enhance the cancer treatment approach. The neutrophil-to-lymphocyteratio (NLR) has been associated with cancer prognosis, affecting progression, chemosensitivity, radiosensitivity and toxicity. Patients and Methods: Ten patients (nine males, one female), aged 68 ± 10 years, were included in this study. Six patients had squamous cell carcinoma of the lungs and two had adenocarcinoma of the lungs. One patient suffered from limb soft tissue sarcoma and one had renal cell carcinoma. All patients had metastatic disease and were pretreated with chemotherapy or biologic agents. The rationale of testing NLR was to compare it to the clinical response of the patients assessed by RECIST criteria using computerized tomography (CT) scans. Results: In regression analysis, older patients were found to respond better to immunotherapy treatment than younger patients. NLR was 4.26 ± 2.25 (p 0.01) in the older patients group and 2.84 ± 0.90 (p 0.01) in the younger patients group. No difference in response according to tumor type (p = 0.479) was observed. Conclusion: We provide preliminary evidence demonstrating that low NLR helps in understanding the value of the underlying immune system in expecting a good outcome to immune treatment. The NLR is a simple and available biomarker, easy to apply in clinical practice.