Detection and management of oligometastatic disease in oesophageal cancer and identification of prognostic factors: A systematic review

BACKGROUND Oesophageal cancer is the eighth most common cancer worldwide.The prognosis of oesophageal cancer patients still remains poor.The 5-year survival rate rarely exceeds 5%in case of metastatic disease.Some patients may however present with oligometastasis which can be treated with loco-regional therapy.AIM To assess the current practice regarding the management of patients with oligometastatic oesophageal cancer and identify prognostic factors affecting survival following treatment for oligometastasis.METHODS A systematic search of the literature was performed in Cochrance Library,MEDLINE and EMBASE databases from September 1950 to January 2019.Relevant electronic databases were searched for studies assessing the clinical outcome of oligometastasis.RESULTS A total of 14 publications were included,of which 12 studies assessing metachronous oligometastasis and 2 on synchronous oligometastasis.All included articles evaluated the specific outcomes of metastasis,management modality and survival outcomes.The majority of the patients presented with oesophageal squamous cell carcinoma.The median disease free interval(time to recurrence)in patients was 19.6 mo and the overall survival reached 30.8 months.Unfavourable prognostic factors were assessed in eight studies and included time to recurrence<12 mo,large diameter pulmonary lesions(>20 mm),disease free interval(DFI)<12 mo,extra-pulmonary metastasis,primary tumour pathological stage III/IV.CONCLUSION Oligometastatic oesophageal cancer in selected patients is amenable to locoregional treatment,and the overall survival of this patient cohort may be improved with patient and tumour-specific treatments.

HER2 inhibition in gastro-oesophageal cancer:A review drawing on lessons learned from breast cancer

Human epidermal growth factor receptor 2(HER2)-inhibition is an important therapeutic strategy in HER2-amplified gastro-oesophageal cancer(GOC).A significant proportion of GOC patients display HER2 amplification,yet HER2 inhibition in these patients has not displayed the success seen in HER2 amplified breast cancer.Much of the current evidence surrounding HER2 has been obtained from studies in breast cancer,and we are only recently beginning to improve our understanding of HER2-amplified GOC.Whilst there are numerous licensed HER2 inhibitors in breast cancer,trastuzumab remains the only licensed HER2 inhibitor for HER2-amplified GOC.Clinical trials investigating lapatinib,trastuzumab emtansine,pertuzumab and MM-111 in GOC have demonstrated disappointing results and have not yet changed the treatment paradigm.Trastuzumab deruxtecan may hold promise and is currently being investigated in phase Ⅱ trials.HER2 amplified GOC differs from breast cancer due to inherent differences in the HER2 amino-truncation and mutation rate,loss of HER2 expression,alterations in HER2 signalling pathways and differences in insulin-like growth factor-1 receptor and MET expression.Epigenetic alterations involving different micro RNA profiles in GOC as compared to breast cancer and intrinsic differences in the immune environment are likely to play a role.The key to effective treatment of HER2 amplified GOC lies in understanding these mechanisms and tailoring HER2 inhibition for GOC patients in order to improve clinical outcomes.

Impact of regular enteral feeding via jejunostomy during neo-adjuvant chemotherapy on body composition in patients with oesophageal cancer

BACKGROUND Malnourishment and sarcopenia are well documented phenomena in oesophageal cancer.Patients undergoing neo-adjuvant chemotherapy prior to oesophagectomy have complex nutritional needs.AIM To examine the effect of regular nutritional support via feeding jejunostomy on overall body composition in patients undergoing neo-adjuvant chemotherapy prior to oesophagectomy for oesophageal cancer.METHODS Retrospective data were collected for 15 patients before and after neo-adjuvant chemotherapy.All patients had feeding jejunostomies inserted at staging laparoscopy prior to neo-adjuvant chemotherapy and underwent regular jejunostomy feeding.Changes in body composition were determined by analysis of computed tomography imaging.RESULTS Patient age was 61.3±12.8 years,and 73%of patients were male.The time between start of chemotherapy and surgery was 107±21.6 d.There was no change in weight(74.5±14.1 kg to 74.8±13.1 kg)and body mass index(26.0±3.8 kg/m^2 to 26.1±3.4 kg/m^2).Body composition analysis revealed a statistically significant decrease in lumbar skeletal muscle index despite regular feeding(45.8±8.0 cm^2/m^2 to 43.5±7.3 cm^2/m^2;P=0.045).The proportion of sarcopenic patients increased(33.3% to 60%).Six patients(40%)experienced dose-limiting toxicity during chemotherapy.CONCLUSION Regular jejunostomy feeding during neo-adjuvant chemotherapy can maintain weight and adipose tissue.Feeding alone is not sufficient to maintain muscle mass.Further insight into the underlying processes causing reduced muscle mass in cancer patients may help to provide targeted interventions.

Impact of tumour histological subtype on chemotherapy outcome in advanced oesophageal cancer

To investigate the impact of histology on outcome in advanced oesophageal cancer treated with first-line fluoropyrimidine-based chemotherapy. METHODSIndividual patient data were pooled from three randomised phase III trials of fluoropyrimidine-based chemotherapy ± platinum/anthracycline in patients with advanced, untreated gastroesophageal adenocarcinoma or squamous cell carcinoma (SCC) randomised between 1994 and 2005. The primary endpoint was overall survival of oesophageal cancer patients according to histology. Secondary endpoints were response rates and a toxicity composite endpoint. RESULTSOf the total 1836 randomised patients, 973 patients (53%) were eligible (707 patients with gastric cancer were excluded), 841 (86%) had adenocarcinoma and 132 (14%) had SCC. There was no significant difference in survival between patients with adenocarcinoma and SCC, with median overall survivals of 9.5 mo vs 7.6 mo (HR = 0.85, 95%CI: 0.70-1.03, P = 0.09) and one-year survivals of 38.8% vs 28.2% respectively. The overall response rate to chemotherapy was 44% for adenocarcinoma vs 33% for SCC (P = 0.01). There was no difference in the frequency of the toxicity composite endpoint between the two groups. CONCLUSIONThere was no significant difference in survival between adenocarcinoma and SCC in patients with advanced oesophageal cancer treated with fluoropyrimidine-based chemotherapy despite a trend for worse survival and less chemo-sensitivity in SCC. Tolerance to treatment was similar in both groups. This analysis highlights the unmet need for SCC-specific studies in advanced oesophageal cancer and will aid in the design of future trials of targeted agents.

Paired-related homeobox 1 induces epithelial-mesenchymal transition in oesophageal squamous cancer

BACKGROUND It is unclear that paired-related homeobox 1(PRRX1)induces epithelialmesenchymal transition(EMT)in oesophageal cancer and the specific function of PRRX1 in oesophageal cancer metastasis.AIM To assess the signicance of PRRX1 expression and investigate the mechanism of EMT in oesophageal cancer metastasis.METHODS Detect the expression of PRRX1 by immunohistochemistry in oesophageal tumour tissues and adjacent normal oesophageal tissues;the PRRX1 short hairpin RNA(shRNA)or blank vector lentiviral gene delivery system was transfected into cells;cell proliferation assay,soft agar colony formation assays,cell invasion and migration assays and animal studies were used to observe cells biological characteristics In vitro and in vivo;XAV939 and LiCl were used to alter the activity of Wnt/β-catenin pathway.Immunofluorescence staining and western blot analysis were used to detect protein expression of EMT markers and Wnt/β-catenin pathway.RESULTS PRRX1 is expressed at high levels in oesophageal cancer specimens and is closely related to tumour metastasis in patients with oesophageal cancer.Regulation of PRRX1 expression might exert obvious effects on cell proliferation,especially the migration and invasion of oesophageal cancer cells.Moreover,silencing PRRX1 expression using a shRNA produced the opposite effects.In addition,when PRRX1 was overexpressed,inhibition of the Wnt/β-catenin pathway with XAV939 negated the effect of PRRX1 on EMT,whereas when PRRX1 was downregulated,activation of the Wnt/β-catenin pathway with LiCl impaired the effect on EMT.CONCLUSION PRRX1 is upregulated in oesophageal cancer is closely correlated with cancer metastasis.Additionally,PRRX1 induces EMT in oesophageal cancer metastasis through activation of Wnt/β-catenin signalling.

Recent advances in breast cancer radiotherapy:Evolution or revolution,or how to decrease cardiac toxicity?

Radiation therapy has a major role in the management of breast cancers.However,there is no consensus on how to irradiate and on volume definitions,and there are strong differences in strategies according to different centers and physicians.New treatment protocols and techniques have been used with the principal purpose of decreasing lung and heart toxicity and adapting radiation treatment to patients' anatomy.There is evidence that indicates internal mammary chain radiotherapy should be used carefully and that high quality techniques should be used for decreasing the dose delivered to the heart.This review of the literature presents the state of the art on breast cancer radiotherapy,with special focus on the indications,techniques,and potential toxicity.

Cost-benefit analysis of screening for esophageal and gastric cardiac cancer

In 2005, a program named "Early Detection and Early Treatment of Esophageal and Cardiac Cancer" (EDETEC) was initiated in China. A total of 8279 residents aged 40-69 years old were recruited into the EDETEC program in Linzhou of Henan Province between 2005 and 2008. Howerer, the cost-benefit of the EDETEC program is not very clear yet. We conducted herein a cost-benefit analysis of screening for esophageal and cardiac cancer. The assessed costs of the EDETEC program included screening costs for each subject, as well as direct and indirect treatment costs for esophageal and cardiac severe dysplasia and cancer detected by screening. The assessed benefits of this program included the saved treatment costs, both direct and indirect, on esophageal and cardiac cancer, as well as the value of prolonged life due to screening, as determined by the human capital approach. The results showed the screening cost of finding esophageal and cardiac severe dysplasia or cancer ranged from $2707 to $4512, and the total cost on screening and treatment was $13 115-$14 920. The cost benefit was $58 944-$155 110 (the saved treatment cost, $17 730, plus the value of prolonged life, $41 214-$137 380). The ratio of benefit-to-cost (BCR) was 3.95-11.83. Our results suggest that EDETEC has a high benefit-to-cost ratio in China and could be instituted into high risk areas of China.

Survival outcomes in early-onset oesophageal adenocarcinoma patients:A systematic review and meta-analyses

BACKGROUND The incidence of oesophageal adenocarcinoma(OAC)has been reported to be increasing in many countries.Alongside this trend,an increase in incidence of early-onset OAC,defined as OAC in adults aged under 50 years,has been observed.It is unclear whether survival outcomes for early-onset OAC patients differ from older age groups.AIM To investigate survival outcomes in early-onset OAC patients.METHODS Ovid Medline and Embase were searched from inception to January 2022 for relevant studies relating to early-onset OAC and survival outcomes.Results regarding the overall five-year survival and risk of death of younger and older patients with OAC were extracted and pooled using meta-analyses to produce pooled estimates and 95%CIs where possible.RESULTS Eleven studies which compared survival of early-onset OAC,defined as age at diagnosis of<50 years,with older patients were included.A narrative review of median and mean survival demonstrated conflicting results,with studies showing early-onset OAC patients having both better and worse outcomes compared to older age groups.A meta-analysis of five-year survival demonstrated similar outcomes across age groups,with 22%-25%of patients in the young,middle and older age groups alive after five years.A meta-analysis of four studies demon-strated that early-onset OAC patients did not have a significantly increased risk of death compared to middle-aged patients(hazard ratio 1.12,95%CI:0.85-1.47).INTRODUCTION There is concern that the incidence of oesophageal adenocarcinoma(OAC)in patients under 50,described as early-onset OAC,is increasing.However,data regarding survival of younger patients with OAC is sparse.Globally,while increasing age remains a major non-modifiable risk factor for cancer,the incidence of early-onset cancers,largely accepted to be in adults aged under 50 years,is increasing[1].This includes an observed increase in the incidence of gastrointestinal malignancies such as colorectal,oesophageal,gastric and hepatobiliary cancers[2-4].Despite oesophageal squamous cell carcinoma(OSCC)being more common globally(88%of cases)[5],a striking increase in oesophageal OAC incidence has been reported in developed countries,such as the United States and Europe[6,7].Worryingly,the United Kingdom has the highest incidence of OAC cases in the world[8].In addition to the increase in OAC,an increase in incidence of early-onset OAC,defined as OAC in adults aged under 50 years,has been observed[9,10].A population-based cohort in the Netherlands,consisting of 59584 patients,demonstrated the incidence of early-onset OAC to have tripled from 1989 to 2018,while OSCC cases declined in this age group[7].OAC usually develops in the lower third of the oesophagus and the gastro-oesophageal junction,with risk factors including obesity and gastro-oesophageal reflux disease[11].A poor prognosis is observed,with the overall five-year survival rate for oesophageal cancer between 15%-20%,even with treatment[12,13].These low survival rates are likely due to a combination of late diagnosis,intrinsic resistance to systemic therapy and the limited efficacy of surgical resection.Younger patients tend to present at a more advanced stage at diagnosis compared to those diagnosed later in life.A single centre,retrospective study found that 33.3%of patients in the younger age category(<50 years old)presented with stage IV OAC,compared to the 20.6%of the oldest age category(>70 years old)[14].Another population-based study in the Netherlands observed that OAC patients under 50 years old also presented with distant metastasis more often in comparison to older patients(50.5%vs 44.7%),and that tumour differentiation also varied between age groups[15].Reports of survival estimates in patients with early-onset OAC compared with older patients have resulted in contrasting findings to date.Some studies report that due to the advanced stage and aggressiveness of the tumours seen that the prognosis of these patients is almost always worse than their older counterparts[16].In contrast,another study found that the overall survival,as well as stage-specific survival was higher in those who were younger[17].A Dutch study which included only resectable cases found no difference in 5-year disease specific survival[18].Given the conflicting evidence to date,the aim of this systematic review was to investigate survival in OAC patients according to age at diagnosis.A protocol was composed,and the reporting of this systematic review designed,using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines[19].The protocol included:The review question,search strategy,inclusion criteria,type of quality assessment,the strategy for data analysis,and the‘population,intervention,comparator,and outcome’criteria.These are expanded below.

Gastroesophageal signet ring cell carcinoma morbidity and mortality: A retrospective review

BACKGROUND Upper gastrointestinal(GI)signet ring cell carcinomas(SRCC)confer a poor prognosis.The benefit of operative intervention for this patient group is contro-versial in terms of overall survival.AIM To investigate factors relating to survival in patients with upper GI SRCC.METHODS A retrospective,tertiary,single-centre review of patients who were diagnosed with oesophageal,gastroesophageal junction and gastric SRCC was performed.The primary outcome was to compare mortality of patients who underwent operative management with those who had nonoperative management.Secon-dary outcomes included assessing the relationship between demographic and histopathological factors,and survival.RESULTS One hundred and thirty-one patients were included.The one-year survival for the operative group was 81%and for the nonoperative group was 19.1%.The five-year survival in the operative group was 28.6%vs 1.5%in the nonoperative group.The difference in overall survival between groups was statistically significant(HR 0.19,95%CI(0.13-0.30),P<0.001).There was no difference in survival when ad-justing for age,smoking status or gender.On multivariate analysis,patients who underwent surgical management,those with a lower stage of disease,and those with a lower Charlson Comorbidity Index(CCI)had significantly improved sur-vival.CONCLUSION Well-selected patients with upper GI SRCC appear to have reasonable medium-term survival following surgery.Offering surgery to a carefully selected patient group may improve the outcome for this disease.

Clinicopathological study of cardiac tamponade due to pericardial metastasis originating from gastric cancer

AIM： To review the cases reported in the literature, examined their clinicopathological features, and evaluated the efficacy of different therapeutic modalities for this rare condition. METHODS： A search of the MEDLINE database revealed 16 cases of pericarditis carcinomatosa （PC） originating from GC reported in the literature between 1982 and 2005. Additional detailed data were obtained from the authors of these studies for subsequent clinicopathological investigation. We have also described about a case study from our own clinic. RESULTS： The mean age of cases with pericarditis carcinomatosa originating from GC was 54 years. Females were diagnosed at a younger age （46.3 years） compared to males （58 years）. The mean survival period afer diagnosis was 4.5 mo. No statistical differences in the length of survival time were found between different therapeutic modalities, such as drainage, and local and/or systemic chemotherapy after drainage. However, three cases who underwent systemic chemotherapy survived for more than 10 mo. Cases that developed metachronous cardiac tamponade for more than 2 years afer the diagnosis of GC generally survived for a longer period of time, although this was not statistically significant. Multivariate analysis revealed that low levels of carcinoembryonic antigen （CEA）, and CEA and/or cancer antigen 19-9 （CA 19-9） were associated with longer survival. CONCLUSION： Cases with low levels of CEA, and CEA and/or CA 19-9 should undergo systemic chemotherapy with or without local chemotherapy afer drainage.

Elevated cardiovascular risk and acute events in hospitalized colon cancer survivors:A decade-apart study of two nationwide cohorts

BACKGROUND Over the years,strides in colon cancer detection and treatment have boosted survival rates;yet,post-colon cancer survival entails cardiovascular disease(CVD)risks.Research on CVD risks and acute cardiovascular events in colorectal cancer survivors has been limited.AIM To compare the CVD risk and adverse cardiovascular outcomes in current colon cancer survivors compared to a decade ago.METHODS We analyzed 2007 and 2017 hospitalization data from the National Inpatient Sample,studying two colon cancer survivor groups for CVD risk factors,mortality rates,and major adverse events like pulmonary embolism,arrhythmia,cardiac arrest,and stroke,adjusting for confounders via multivariable regression analysis.RESULTS Of total colon cancer survivors hospitalized in 2007(n=177542)and 2017(n=178325),the 2017 cohort often consisted of younger(76 vs 77 years),male,African-American,and Hispanic patients admitted non-electively vs the 2007 cohort.Furthermore,the 2017 cohort had higher rates of smoking,alcohol abuse,drug abuse,coagulopathy,liver disease,weight loss,and renal failure.Patients in the 2017 cohort also had higher rates of cardiovascular comorbidities,including hypertension,hyperlipidemia,diabetes,obesity,peripheral vascular disease,congestive heart failure,and at least one traditional CVD(P<0.001)vs the 2007 cohort.On adjusted multivariable analysis,the 2017 cohort had a significantly higher risk of pulmonary embolism(PE)(OR:1.47,95%CI:1.37-1.48),arrhythmia(OR:1.41,95%CI:1.38-1.43),atrial fibrillation/flutter(OR:1.61,95%CI:1.58-1.64),cardiac arrest including ventricular tachyarrhythmia(OR:1.63,95%CI:1.46-1.82),and stroke(OR:1.28,95%CI:1.22-1.34)with comparable all-cause mortality and fewer routine discharges(48.4%vs 55.0%)(P<0.001)vs the 2007 cohort.CONCLUSION Colon cancer survivors hospitalized 10 years apart in the United States showed an increased CVD risk with an increased risk of acute cardiovascular events(stroke 28%,PE 47%,arrhythmia 41%,and cardiac arrest 63%).It is vital to regularly screen colon cancer survivors with concomitant CVD risk factors to curtail long-term cardiovascular complications.

CARDIAC ARRHYTHMIA AFTER LUNG CANCER SURGERY －－ANALYSIS OF 140 PNEUMONECTTOMY CASES

Among 808 surgically resected lung cancer cases at Shanghai Chest Hospital during 1991 to 1992, 140 of them (17.3%) underwent Pneumonectomy. Of the 140 cases:124 male, 16 female; aged 27-74 yrs, 35.7% elder (60 and over), preoperative abnormal EKG was found in 38 cases, operative mortality was 4.3%. The histopathological diagnosis were: squamous 43.6%, adeno. 36.4%, small cell 8.6%, mixed type 11.4%. The pTNM stages: stage I 2.9%, II 17.1%, IIIa 55.0%, IIIb 21.4%, IV 3.6%.Postoperatively, arrhythmia occuried in 76 cases, with an incidence of 54.3%. Of the 76 arrhythmias, atrial fibrillation was seen in 7 patients, atrial premature beats in 2, supraventricular tachycardia in 1, and sinus tachycardia in 66. The incidences of cadiac arrhythmia during the postoperative day (DO), first day (D1), D2, D3,and D4 were 48.7%, 35.5%, 7.9%, 4.0%and 2.6%respectively. Conclusion: the cardiac arrhythmia is the most common complication after pneumonectomy for lung cancer surgery. The major causes were incisional pain, hypovolemia due to blood loss and respirative insufficiency due to anomia. The perioperative prevention and treatment for arrhythmia were also discussed.

Digestive and breast cancer patients managed during the first wave of COVID-19 pandemic:Short and middle term outcomes

BACKGROUND The first wave of coronavirus disease 2019(COVID-19)pandemic in Spain lasted from middle March to the end of June 2020.Spanish population was subjected to lockdown periods and scheduled surgeries were discontinued or reduced during variable periods.In our centre,we managed patients previously and newly diagnosed with cancer.We established a strategy based on limiting perioperative social contacts,preoperative screening(symptoms and reverse transcriptionpolymerase chain reaction)and creating separated in-hospital COVID-19-free pathways for non-infected patients.We also adopted some practice modifications(surgery in different facilities,changes in staff and guidelines,using continuously changing personal protective equipment…),that supposed new inconveniences.AIM To analyse cancer patients with a decision for surgery managed during the first wave,focalizing on outcomes and pandemic-related modifications.METHODS We prospectively included adults with a confirmed diagnosis of colorectal,oesophago-gastric,liver-pancreatic or breast cancer with a decision for surgery,regardless of whether they ultimately underwent surgery.We analysed short-term outcomes[30-d postoperative morbimortality and severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection]and outcomes after 3 years(adjuvant therapies,oncological events,death,SARS-CoV-2 infection and vaccination).We also investigated modifications to usual practice.RESULTS From 96 included patients,seven didn’t receive treatment that period and four never(3 due to COVID-19).Operated patients:28 colon and 21 rectal cancers;laparoscopy 53.6%/90.0%,mortality 3.57%/0%,major complications 7.04%/25.00%,anastomotic leaks 0%/5.00%,3-years disease-free survival(DFS)82.14%/52.4%and overall survival(OS)78.57%/76.2%.Six liver metastases and six pancreatic cancers:no mortality,one major complication,three grade A/B liver failures,one bile leak;3-year DFS 0%/33.3%and OS 50.0%/33.3%(liver metastases/pancreatic carcinoma).5 gastric and 2 oesophageal tumours:mortality 0%/50%,major complications 0%/100%,anastomotic leaks 0%/100%,3-year DFS and OS 66.67%(gastric carcinoma)and 0%(oesophagus).Twenty breast cancer without deaths/major complications;3-year OS 100%and DFS 85%.Nobody contracted SARS-CoV-2 postoperatively.COVID-19 pandemic–related changes:78.2%treated in alternative buildings,43.8%waited more than 4 weeks,two additional colostomies and fewer laparoscopies.CONCLUSION Some patients lost curative-intent surgery due to COVID-19 pandemic.Despite practice modifications and 43.8%delays higher than 4 weeks,surgery was resumed with minimal changes without impacting outcomes.Clean pathways are essential to continue surgery safely.

Amiodarone Therapy for Cardiac Arrhythmias: Is It Associated with the Development of Cancers?

Amiodarone is used worldwide to treat cardiac arrhythmias, as well as highly symptomatic cases of atrial fibrillation. With this expanded use, especially following its 1985 United States Food and Drug Administration approval, and its use as a long-term therapy in common practice, reports of cancers temporarily related to amiodarone have begun to increase. Animal studies, several clinical trials, numerous case reports, and a population-based cohort study have suggested that cancers may be associated with amiodarone use. This review focuses on the ever increasing evidence in the literature that suggests amiodarone therapy, especially with long-term use, may increase the potential risk of cancer development. It also expresses the need for more definitive studies to be conducted to provide clinicians with a clear answer to this important question.

EVALUATION OF STAPLING TECHNIQUE IN SURGICAL TREATMENT OF ESOPHAGEAL AND CARDIAC CANCER

Objective: To investigate an effective method to prevent anastomotic leakage and stenosis, evaluating the role of stapling technique in surgical treatment of esophageal and cardiac cancer. Methods: The stapling technique was used in end-to-side esophagogastromosis in surgical treatment of esophageal and cardiac cancer. Results: 128 patients were so treated. One patient died of superior mesenteric artery embolism, and the operative mortality was 0.78%. No anastomotic leakage or stenosis was found in this series. The other complications included postoperative thoracic cavity bleeding in 1 (0.78%), myocardial infarction in 2 (1.56%), stress ulcer of stomach in 1 (0.78%), and gastroparsis in 4 (3.12%). The overall morbidity rate was 4.7%. Conclusion: Using stapler to perform end-to-side esophagogastromosis has the advantages of being simple and safe, cutting short the operation time, and preventing leakage and stenosis. It is an ideal technique in the treatment of esophageal and cardiac cancer.

Cardiac mass in a patient with colorectal cancer:“Not all that glitters is gold!”

When performing echocardiography in a 74-year-old woman admitted with non ST elevation myocardial infarction and concomitant colorectal cancer(CC),a dense calcification of the mitral annulus was detected. Differential diagnosis between secondary metastasis and other etiologies of cardiac masses was essential for staging and therapeutic decision-making.Multimodality imaging with echocardiography alongside a computed tomography scan and cardiac magnetic resonance was crucial for the final diagnosis of caseous calcification of the mitral annulus(CCMA).CCMA is briefly reviewed and some possible explanations for the previously undescribed association of CC with CCMA are suggested.

Intrinsic Wave Velocity Propagation:A Novel Parameter for Assessing the Effect of Anthracycline Chemotherapy Agents on Cardiac Diastolic Function in Breast Cancer Patients

Objective Anthracycline chemotherapeutic agents have significant cardiotoxicity.The present study emphasized the effect of anthracycline chemotherapy drugs on left ventricular(LV)myocardial stiffness in breast cancer patients by measuring the intrinsic wave velocity propagation(IVP),and evaluating the potential clinical value of IVP in detecting early LV diastolic function impairment.Methods A total of 68 newly diagnosed breast cancer patients,who were treated with anthracycline-based chemotherapy,were analyzed.Transthoracic echocardiography was performed at baseline(T0),and after 1,2,3,4 and 8 chemotherapeutic cycles(T1,T2,T3,T4 and T5,respectively).Then,the IVP,LV strain parameters[global longitudinal strain(GLS),longitudinal peak strain rate at systole(LSRs),longitudinal peak strain rate at early diastole(LSRe),longitudinal peak strain rate at late diastole(LSRa),and the E/LSRe ratio],and conventional echocardiographic parameters were obtained and further analyzed.A relative reduction of>15%in GLS was considered a marker of early LV subclinical dysfunction.Results Compared to the T0 stage,IVP significantly increased at the T1 stage.However,there were no significant changes in GLS,LSRs,or LSRe between the T0 and T1 stages.These parameters significantly decreased from the T2 stage.LSRa started to significantly decrease at the T5 stage,and the E/LSRe ratio started to significantly increase at the T3 stage(all P<0.05).At the T0 stage,IVP(AUC=0.752,P<0.001)had a good predictive value for LV subclinical dysfunction after chemotherapy.Conclusions IVP is a potentially sensitive parameter for the early clinical assessment of anthracycline-related cardiac diastolic impairment.

Relationship of telomerase activity and p53 gene mutation in cardiac cancer

Objective： To study the relationship of the telomerase activity and the p53 gene mutation in cardiac cancer. Methods： Telomerase activity and the p53 gene mutation were detected in 46 case of cardiac cancer, peri-cancerous and 30 case of normal mucosa by TRAP-ELISA and PCR-SSCP. Results： The rate of expression of telomerase activity in cardiac cancer, peri-cancerous and normal mucosa were 82.61% （38/46）, 43.48% （20/46） and 13.33% （4/30） respectively. The rate of Exon5→,8 of p53 gene mutation were 39,13% （18/46）, 4.35% （2/46） and 0.00% respectively. There was significant difference between group cancer and without cancer （P 〈 0.01）. Mean of A^- value of telomerase is 1.89：1：0.41 in cancer group and were 1.49：1： 0.43, 0.54：1：0.45 respectively in peri-canvcerous and normal mucosa, there were significant differences in cancer group and group of without cancer （P 〈 0.05）. The rate of p53 gene mutations in group of expression of telomerase activity was 44.74% （17/38）, and 12.50% （1/8） in without expression of telomerase activity. There were significant differences between the two groups. Conclusion： The rate of expression of telomerase activity and mean of A^- value of telomerase in cardiac cancer were obviously higher than without cancer, which indicating telomerase activity was closely related with the occurrence of cardiac cancer. P53 gene mutation in cardiac cancer were higher than the tissue of without cancer, and the rate of p53 gene mutation in telomerase activity were obviously higher than the group of without cancer. This shows the p53 gene mutation can loss of function of suppressing cancer and prompt telomerase activity and cause the cardiac cancer.

Cardiac Safety with High Cumulative Dose of Pegylated Liposomal Doxorubicin in Patients with Metastatic Breast Cancer Previously Treated with Conventional Anthracyclines

Introduction: The treatment of metastatic breast cancer (MBC) is still challenging. Many studies documented the efficacy of pegylated liposomal doxorubicin (PLD) in patients with MBC, but there is a limited data about the cardiac safety with high cumulative dose (HCD) of PLD. Aim of the work: We conducted this trial to outline the cardiac safety of HCD of PLD in patients with MBC who previously received conventional anthracyclines. Methods: During the period of nine years (January 2011 to December 2019). We extracted the data of the patients with MBC receiving PLD at Medical Oncology Department, South Egypt Cancer Institute, Assiut University. These included patients’ demographics and therapeutic data including the full data of PLD, prior conventional anthracyclines, prior trastuzumab, and prior radiotherapy. Also, data about comorbidities as well as cardiac and other toxicities of PLD were obtained. The data was analysed using SPSS v. 21. Results: For all 81 eligible patients, the mean age was 43.9 years (±standard deviation (SD) 13.2). The mean cumulative dose of PLD was 378.4 mg/m2 (± SD of 250.2) and a range of 100 - 1200 mg/m2. About thirty-one (38.3%) patients received high cumulative dose (400 mg/m2 or more), while the remaining 50 patients did not. The decline in left ventricular ejection fraction (LVEF) was relatively rare;and of low grade. Grade 2 decline in LVEF occurred in only two patients who received high cumulative dose of PLD, and only one patient who did not reach HCD (p = 0.555). Grade 3 or 4 decline in LVEF did not occur in patients either with or without HCD. Regarding other toxicities, there was a significant increase in incidence of all grades palmar plantar erythrodysesthesia (PPE) in patients who received HCD of PLD when compared to those who did not reach the HCD (38.7% versus 16% respectively;p = 0.021). Conclusion: Our study concluded that the use of PLD seems to be a justified agent in the treatment of MBC who previously treated by conventional anthracyclines in the adjuvant, metastatic or both settings, even in patients reaching the cumulative dose of conventional anthracycline.

Malignant cardiac metastasis from breast cancer: Imaging contribution to surgical attitude

Metastasic cardiac disease from the breast is rarely diagnosed in the lifetime. It has a poor prognosis and limited management. Both echocardiography and computerized tomography (CT) should be the first imaging studies in suspicion of this entity. Other diagnostic methods should be based on the possibilities of treatment although a histopathological analysis of the metastasic mass is needed to confirm the diagnosis. Magnetic resonance imaging (MRI) could be useful to complete a morphological and functional evaluation in case of surgical removal.