AIM:To evaluate whether postoperative radiotherapy is an alternative to neck lymph node surgery and if it provides a survival benefit for those receiving twofield,chest and abdomen,lymphadenectomy.METHODS:A total of 5...AIM:To evaluate whether postoperative radiotherapy is an alternative to neck lymph node surgery and if it provides a survival benefit for those receiving twofield,chest and abdomen,lymphadenectomy.METHODS:A total of 530 cases with middle and lower thoracic esophageal carcinoma in our hospital from January 2008 to April 2009 were selected and analyzed,of which 219 cases received right chest,upper abdominal incision Ivor-Lewis surgery and simultaneously underwent mediastinal and abdominal two-field lymphadenectomy.If regional lymph node metastasis occurred within the recurrent laryngeal nerve,the patients would receive bilateral supraclavicular radiotherapy(DT=5000c Gy)to be adopted at postoperative 4-5 wk(Group A)or cervical lymphadenectomy at postoperative 3-4 wk(Group B).If there were no regional lymph node metastases within the recurrent laryngeal nerve,the patients only underwent two-field,chest and abdomen,lymphadenectomy(Group C).RESULTS:In 219 cases who underwent two-field lymphadenectomy,91 cases were diagnosed with regional lymph node metastasis within the recurrent laryngeal nerve.Of them,48 cases received cervical radiotherapy,and 43 cases underwent staging lymphadenectomy;128patients were not given the follow-up treatment of cervical radiotherapy because there was no regional lymph node metastasis within the recurrent laryngeal nerve.Five-year survival rates in group A and B were 47%and50%,respectively,with no statistical difference between them,and the rate in group C was 58%.CONCLUSION:For patients with middle and lower thoracic esophageal carcinoma combined with lymph node metastasis within the recurrent laryngeal nerve,cervical radiotherapy can be a substitute for surgery and provide benefit.展开更多
AIM:To evaluate long-term outcomes and prognostic factors for esophageal squamous cell carcinoma(SCC) treated with three dimensional conformal radiotherapy(3D-CRT).METHODS:Between January 2005 and December 2006,153 pa...AIM:To evaluate long-term outcomes and prognostic factors for esophageal squamous cell carcinoma(SCC) treated with three dimensional conformal radiotherapy(3D-CRT).METHODS:Between January 2005 and December 2006,153 patients(120 males,33 females) with pathologically confirmed esophageal SCC and treated with 3D-CRT in Cancer Hospital of Shantou University were included in this retrospective analysis.Median age was 60 years(range:37-84 years).The proportion of tumor location was as follows:upper thorax(including the cervical region),73(48%);middle thorax,73(48%);lower thorax,7(5%),respectively.The median radiation dose was 64 Gy(range:50-74 Gy).Fifty four cases(35%) received cisplatin-based concurrent chemotherapy.Univariate and multivariate analysis were performed to determine the association between the correlative factors and prognosis.RESULTS:The five-year overall survival rate was 26.3%,with a median follow-up of 49 mo(range:3-66 mo) for patients who were still alive.On univariate analysis,lesion location,lesion length by barium esophagogram,computed tomography imaging characteristics including Y diameter(anterior-posterior,AP,extent of tumor),gross tumor volume of primary lesion(GTV-E),volume of positive lymph nodes(GTV-LN),and the total target volume(GTV-T = GTV-E + GTVLN) were prognostic for overall survival.By multivariate analysis,only the Y diameter [hazard ratio(HR) 2.219,95%CI 1.141-4.316,P = 0.019] and the GTV-T(HR 1.372,95%CI 1.044-1.803,P = 0.023) were independent prognostic factors for survival.CONCLUSION:The overall survival of esophageal carcinoma patients undergoing 3D-CRT was promising.The best predictors for survival were GTV-T and Y diameter.展开更多
INTRODUCTIONDouble primary esophageal carcinoma is defined ashaving two loci of squamous cell cancersimultaneously or consecutively developing indifferent sites of esophagus.This rare diseaseappears mostly in the lite...INTRODUCTIONDouble primary esophageal carcinoma is defined ashaving two loci of squamous cell cancersimultaneously or consecutively developing indifferent sites of esophagus.This rare diseaseappears mostly in the literature as case reports,reports about its treatment are even moreinfrequent.Here we present our experiences展开更多
Objective:To investigate the safety and efficacy of nimotuzumab combined with radiotherapy for elderly patients with non-resectable esophageal carcinoma(EC).Methods:Eligible patients were aged 70 years or older and ha...Objective:To investigate the safety and efficacy of nimotuzumab combined with radiotherapy for elderly patients with non-resectable esophageal carcinoma(EC).Methods:Eligible patients were aged 70 years or older and had treatment-naive,histologically proven inoperable locally advanced EC.Enrolled patients received radiotherapy with a total dose of 50-60 Gy in 25-30 fractions,concurrent with weekly infusion of nimotuzumab.The primary end point was the rate of more than grade 3 toxicities.Results:From June 2011 to July 2016,46 patients with stageⅡ-IV EC with a median age of 76.5 years were enrolled.There were 10,28 and 8 patients with stageⅡ,III and IV disease,respectively.The common acute toxicities included esophagitis(grade 1-2,75.4%;grade 3,8.7%),pneumonitis(grade 1,4.3%;grade 2,6.5%;grade3,2.2%),leukopenia(grade 1-2,60.9%;grade 3-4,4.4%),gastrointestinal reaction(grade 1-2,17.3%;grade 3,2.2%),thrombocytopenia(grade 1-2,21.7%;grade 3,2.2%),and radiothermitis(grade 1-2,39.2%).The incidence of grade 3-4 adverse effects was 17.4%.No grade 5 toxicities were observed.Clinical complete response,partial response,stable disease,and progressive disease were observed in 1(2.2%),31(67.4%),12(26.1%),and 2(4.3%)patients,respectively.The median overall survival(OS)and progression-free survival(PFS)were 17 and 10 months,respectively.The 2-,3-,and 5-year OS and PFS rates were 30.4%,21.7%,19.6%,and 26.1%,19.6%,19.6%,respectively.Conclusions:Nimotuzumab combined with radiotherapy is a safe and effective therapy for elderly patients who are not surgical candidates.Further studies are warranted to confirm its therapeutic effects in elderly EC patients.展开更多
AIM:To investigate the role of neoadjuvant chemoradiotherapy in prognosis and surgery for esophageal carcinoma by a meta-analysis.METHODS:PubMed and manual searches were done to identify all published randomized contr...AIM:To investigate the role of neoadjuvant chemoradiotherapy in prognosis and surgery for esophageal carcinoma by a meta-analysis.METHODS:PubMed and manual searches were done to identify all published randomized controlled trials(RCTs) that compared neoadjuvant chemoradiotherapy plus surgery(CRTS) with surgery alone(S) for esophageal cancer.According to the test of heterogeneity,a fi xed-effect model or a random effect model was used and the odds ratio(OR) was the principal measure of effects.RESULTS:Fourteen RCTs that included 1737 patients were selected with quality assessment ranging from A to C(Cochrane Reviewers' Handbook 4.2.2).OR(95% CI,P value),expressed as CRTS vs S(values>1 favor CRTS arm),was 1.19(0.94-1.48,P=0.28) for 1-year survival,1.33(1.07-1.65,P=0.69) for 2-year survival,1.76(1.42-2.19,P=0.11) for 3-year survival,1.41(1.06-1.87,P=0.11) for 4-year survival,1.64(1.28-2.12,P=0.40) for 5-year survival,0.82(0.39-1.73,P<0.0001) for rate of resection,1.53(1.33-2.84,P=0.007) for rate of complete resection,1.78(1.14-2.78,P=0.79) for operative mortality,1.12(0.89-2.48,P=0.503) for all treatment mortality,1.33(0.94-1.88,P=0.04) for the rate of adverse treatment,1.38(1.23-1.63,P=0.0002) for local-regional cancer recurrence,1.28(0.85-1.58,P=0.60) for distant cancer recurrence,and 1.27(0.86-1.65,P=0.19) for all cancer recurrence.A complete pathological response to chemoradiotherapy occurred in 10%-45.5% of patients.The 5-year survival benefi t was most pronounced when chemotherapy and radiotherapy were given concurrently(OR:1.45,95% CI:1.26-1.79,P=0.015) instead of sequentially(OR:0.85,95% CI:0.64-1.35,P=0.26).CONCLUSION:Compared with surgery alone,neoadjuvant chemoradiotherapy can improve the long-term survival and reduce local-regional cancer recurrence.Concurrent administration of neoadjuvant chemoradiotherapy was superior to sequential chemoradiotherapy.展开更多
Esophageal carcinoma is one of the most common human cancers in China. Radiotherapy plays an important role in combination therapy of esophageal carcinoma. With regret, there is still no unified standard for the treat...Esophageal carcinoma is one of the most common human cancers in China. Radiotherapy plays an important role in combination therapy of esophageal carcinoma. With regret, there is still no unified standard for the treatment of esophageal carcinoma in China, and there are many controversies in the treatment regimens, indications, methods and efficacy. Clinically, the clinical practice guidelines of the National Comprehensive Cancer Network (NCCN) of the United States were often consulted, but the data of them were mainly from the patients from Europe and America, and they might not be applicable for Chinese patients. In order to standardize clinical process of radiotherapy for esophageal carcinoma in China, the Esophageal Carcinoma Cooperative Group of Radiation Oncology Society of Chinese Medical Association wrote a consensus and controversies on the radiotherapy for esophageal carcinoma (draft) after years of research and discussion. We hope it be tried out and discussed with advice and valuable suggestions, in order to accelerate the process of standardization of esophageal carcinoma treatment in China.展开更多
Background and Objective: Many patterns of treatment have been used to treat esophageal carcinoma in the past years, however, an optimal treatment is still the key issue to be explored. Therefore, we analyzed the publ...Background and Objective: Many patterns of treatment have been used to treat esophageal carcinoma in the past years, however, an optimal treatment is still the key issue to be explored. Therefore, we analyzed the published literature about radiotherapy for esophageal cancer in recent 15 years in China, and observed the survival rate, local control rate, adverse events, and so on. Methods: A total of 56 eligible papers about radiotherapy for esophageal squamous cell carcinoma published in Chinese core periodicals between 1994 and 2009 were selected. The survival rates, local control rates, and adverse events were analyzed. Results: The 1-, 2-, 3-, and 5-year overall survival rates of the patients reported in the 56 papers were (67.99 ± 12.55)%, (49.59 ± 11.79)%, (34.50 ± 11.49)%, and (23.31 ± 10.21)%, respectively. The 1-, 2-, 3-, and 5-year local control rates were (73.04 ± 13.37)%, (61.60 ± 15.50)%, (51.77 ± 15.00)%, and (50.15 ± 21.36)%, respectively. The acute esophageal toxicity rate was (44.84 ± 25.71)% in 32 papers reported in recent 15 years, and the acute esophageal toxicity over grade II accounted for (35.93 ± 22.90)%. The rates of acute esophageal toxicity were (26.84 ± 13.12)% for conventional radiation, (53.72 ± 21.82)% for late course accelerated hyperfractionation radiation, (61.33 ± 28.69)% for concurrent chemoradiotherapy, and (40.31 ± 27.22)% for other ways of radiation. The late toxicity rate described in 23 papers was (5.13 ± 4.07)% in recent 15 years. The late toxicity rates were (5.66 ± 3.42)% for conventional radiation, (4.53 ± 4.07)% for late course accelerated hyperfractionation radiation, (2.24 ±1.31)% for concurrent chemoradiotherapy, and (7.34 ± 5.06)% for other ways of radiation. The Meta analysis indicated that concurrent chemoradiotherapy was better than late course accelerated hyperfractionation radiation and conventional radiation. Conclusions: The long-term survival of patients with esophageal cancer is still disappointed in recent years. Concurrent chemoradiotherapy shows advantages in treating esophageal cancer and, currently, is the best non-surgical treatment of esophageal cancer.展开更多
Background and Objective:Although there are many randomized clinical trials of late course accelerated hyperfractionated radiotherapy (LCAHFR) combined with FP chemotherapy for esophageal cancer, the efficacy and toxi...Background and Objective:Although there are many randomized clinical trials of late course accelerated hyperfractionated radiotherapy (LCAHFR) combined with FP chemotherapy for esophageal cancer, the efficacy and toxicity are controversial. This study was to evaluate the efficacy and toxicity of LCAHFR combined with FP chemotherapy in treating esophageal cancer. Methods: Reports of randomized clinical trials on LCAHFR combined with FP chemotherapy for esophageal cancer published between January 1999 and January 2009 were researched through Wanfang, CNKI, and PubMed databases. RevMan4.2 software was used for Meta-analysis. Results: Twenty-one reports, including 2030 patients, were included in the meta-analysis. Of the 2030 patients, 1006 underwent LCAHFR (LCAHFR group), and 1024 underwent LCAHFR combined with FP chemotherapy (combination group). Compared with those of the LCAHFR group, the 1-, 2-, 3-, 5-years survival rates and 1-, 2-, 3-year local control rates of the combination group were significant increased, and the acute toxicity was also increased, but chronic toxicity showed no significant difference. C onclusions: LCAHFR combined with FP chemotherapy can improve the survival rate and the local control rate of the patients with esophageal cancer. The increased acute toxicity need to be concerned, whereas the chronic toxicity needs a long-term observation.展开更多
BACKGROUND There has been no study comparing the difference in the failure patterns between patients with or without postoperative radiotherapy(PORT)after esophagectomy for pT3-4N0-3M0 esophageal squamous cell carcino...BACKGROUND There has been no study comparing the difference in the failure patterns between patients with or without postoperative radiotherapy(PORT)after esophagectomy for pT3-4N0-3M0 esophageal squamous cell carcinoma(ESCC).AIM To investigate the difference in the failure patterns of stage pT3-4N0-3M0 ESCC patients with or without PORT.METHODS Patients with stage pT3-4N0-3M0 ESCC,who underwent surgery with or without PORT,were enrolled in this study.The primary endpoint was to investigate the difference in the failure patterns between patients with or without PORT after esophagectomy.The secondary endpoint was to estimate whether patients with stage pT3-4 ESCC could achieve a disease-free survival(DFS)advantage after receiving adjuvant PORT.Statistical analyses were performed by the Kaplan-Meier method,Cox regression model,and Chi-squared test or Fisher’s exact test.RESULTS In total,230 patients with stage pT3-4N0-3M0 ESCC were included in this study.Fifty-six patients who received PORT were screened from a prospective cohort(S+R arm).And 174 patients involving surgery alone were retrospectively selected from July 2006 to October 2014(S arm).There were no significant differences in the clinical or pathological characteristics of patients between the two arms,except for tumor location(P=0.031).The failure patterns between the two arms were significantly different(P<0.001).Patients in the S arm had a significantly higher proportion of locoregional recurrence and a lower proportion of distant metastasis than those in the S+R arm(92.0%vs 35.7%,P<0.001 and 19.0%vs 75.0%,P<0.001,respectively).The difference in the median DFS between the two arms was statistically significant(12.7 vs 8 mo,P=0.048).Univariate analysis and multivariate analysis both demonstrated that the number of lymph node metastases≥3(HR=0.572,95% CI:0.430-0.762,P<0.001)was an independent poor prognostic factor for DFS in patients with stage pT3-4N0-3M0 ESCC.CONCLUSION PORT could improve DFS and local control of patients with stage pT3-4N0-3M0 ESCC.However,further studies need to be conducted to control hematogenous metastasis after PORT.展开更多
Objective: To investigate the diagnosis and treatment for recurrent dysphagia of esophageal carcinoma after radical radiotherapy. Methods: The experince of 41 cases with recurrent dysphagia of esophageal carcinoma af...Objective: To investigate the diagnosis and treatment for recurrent dysphagia of esophageal carcinoma after radical radiotherapy. Methods: The experince of 41 cases with recurrent dysphagia of esophageal carcinoma after radical radiotherapy were retrospectively summerized. Results: All of the cases were surgically treated form July, 1989 to May, 1997 with resectability rate in 97%, operative mortality in 4.8%, postoperative morbidity in 29%. Pathological examination showed squemous cell carcinoma in 82.8%, and serious radiation reaction in 13.2% after operation. The 1, 3, 5year survival rates after operation were 72.7%, 36.3%, 18.1% respectively, and those after radiation in 100%, 60%, and 35.5% respectively. Conclusion: Most of recurrent dysphagia for these cases were due to uncontrolled/recurrent cancer, and minority of them were due to constriction after radiotherapy. It is difficult to distinguish cancer with benigh constriction before operation. Some cases have lymphatic metastasis without local cancer recurrence. For those patients with recurrent disphagia should be treated with operation as early as possible.展开更多
INTRODUCTIONCancer treatment situation in tumor hospitals inChina has its own unique characteristics which arenot found in other parts of the world. Because ofthe huge population and high incidence rates ofesophageal ...INTRODUCTIONCancer treatment situation in tumor hospitals inChina has its own unique characteristics which arenot found in other parts of the world. Because ofthe huge population and high incidence rates ofesophageal and stomach cancer[1-5], the number ofcancer patients waiting for admission isinconceivably large.展开更多
Metastases of esophageal carcinoma to the skeletal muscle are rare,but the incidence may be increasing because of better diagnosis resulting from widespread use of positron emission tomography/computed tomography(PET/...Metastases of esophageal carcinoma to the skeletal muscle are rare,but the incidence may be increasing because of better diagnosis resulting from widespread use of positron emission tomography/computed tomography(PET/CT).A cohort of 205 patients with esophageal carcinoma treated at our center who had PET/CT between 2006 and 2010 was retrospectively evaluated for the presence of skeletal muscle metastases.Four patients had skeletal muscle metastases of esophageal carcinoma,including two patients with squamous cell carcinoma.In another patient with squamous cell carcinoma of the esophagus and synchronous skeletal muscle metastases,muscle metastases were subsequently shown to be related to second primary pancreatic adenocarcinoma.In all cases,skeletal muscle metastases were the first manifestation of systemic disease.In three patients palliation was obtained with the combination of external beam radiation therapy,systemic chemotherapy or surgical resection.Skeletal muscle metastases are a rare complication of esophageal carcinoma.展开更多
Earthworm capsule is an extract from earthworm made in our laboratory.From1986 to 1989,486 patients with carcinoma of esophagus or lung were randomly divided into 2groups,one group received radiotherapy alone(control ...Earthworm capsule is an extract from earthworm made in our laboratory.From1986 to 1989,486 patients with carcinoma of esophagus or lung were randomly divided into 2groups,one group received radiotherapy alone(control group)and the other radiotherapycombined with earthworm capsules(treatment group).All cases were diagnosedpathologically or cytologically.In a two-month treatment course,earthworm capsuleswere given orally twice a day,2~3 capsules each time,each capsule containing 60 mg ofthe extract.Compared with the control group,the CR(complete remission)rate andCR+PR(partial remission)rate in patients with carcinoma of esophagus treated byradiotherapy in combination with earthworm capsule increased 9.7%(P【0.01) and 9.6%(P【0.05),while in patients with carcinoma of lung,they increased 10.6%(P【0.05)and13.5%(P【0.05),respectively.The earthworm capsule caused irritation in the alimentarytract,the patients displaying slight nausea and vomiting(16.7% in thecombination treatment group and 10.0% in the control group).However,these side ef-fects could be alleviated when capsules were taken after meal or with honey concomitantly.No deleterious effects on the heart,liver,kidney,skin,hematopoietic or nervous systemwere seen.展开更多
A randomized trial of intracavitary microwave hyperthermia combined with external irradiation (R+H) versus radiation (R) alone in the treatment of esophageal cancer was performed form February 1986 to February 1988. I...A randomized trial of intracavitary microwave hyperthermia combined with external irradiation (R+H) versus radiation (R) alone in the treatment of esophageal cancer was performed form February 1986 to February 1988. In the R group, radiation was given by 8 MV X-ray with 2 Gy/fraction, 5 fractions per week with a total dose of 60 Gy/6 weeks. In the R+H group, the radiation was given as R group but with a total dose of 40 Gy/4 weeks. Intracavitary 915 Mhz microwave hyperthermia was given with a nominal temperature of 43.5℃ at the margin of the tumor surface, 45 minutes/session, 1-2 sessions/week for 4-8 session. The 1-, 3-, and 5-year survival rates in R+H group were 81.2% (48/59 cases), 42.4% (25/59) and 23.7% (14/59), while in the R group 59.0% (39/66 cases), 24.2% (16/66) and 16.7% (11/66) respectively. The differences in 1- and 3-year survival rates were statistically significant (P<0.05) between the 2 groups. Using the thermal dose T90 analysis, after the cases with T90<43℃ (insufficient thermal dose) were eliminated, 52 cases with T90 equal to or higher than 43 ℃ had 1, 3, and 5 year survival rates of 84.6%, 44.2% and 26.9%, respectively. Statistically significant differences in the 2 groups were also limited only to 1- and 3-year survivals. Higher 5-year survivals is anticipated if more cases are studied.展开更多
目的检索并总结食管癌术后患者早期经口进食管理的最佳证据。方法按照循证“6S”检索证据模型,检索UpToDate、BMJ Best Practice、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、英国国家卫生与临床优化研究所、中国知网、万方...目的检索并总结食管癌术后患者早期经口进食管理的最佳证据。方法按照循证“6S”检索证据模型,检索UpToDate、BMJ Best Practice、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、英国国家卫生与临床优化研究所、中国知网、万方数据库、中国生物医学文献数据库等数据库及相关网站中有关食管癌术后患者早期经口进食的所有证据,包括临床决策、指南、系统评价、Meta分析、专家共识、证据总结及随机对照试验。检索时限为建库至2022年5月。由2名接受过循证护理系统培训的研究者独立完成文献质量评价,并结合专业人员判断,对符合质量标准的证据进行提取和汇总。结果最终纳入14篇文献,包括临床决策2篇、指南4篇、专家共识3篇、系统评价1篇、随机对照试验4篇。从早期经口进食时机选择、吞咽功能评估、进食方案制订、风险识别及预防4个方面汇总24条最佳证据。结论食管癌术后患者早期经口进食安全可行。护理人员应结合临床情景、应用证据的促进因素和阻碍因素、患者意愿选择最佳证据,为临床提供科学、有循证依据的食管癌术后患者早期经口进食管理方案,从而加速患者术后康复,减少并发症,缩短住院时间。展开更多
基金Supported by grant from Doctoral Startup Project of Liaoning Provincial Science and Technology Department,No.20121133
文摘AIM:To evaluate whether postoperative radiotherapy is an alternative to neck lymph node surgery and if it provides a survival benefit for those receiving twofield,chest and abdomen,lymphadenectomy.METHODS:A total of 530 cases with middle and lower thoracic esophageal carcinoma in our hospital from January 2008 to April 2009 were selected and analyzed,of which 219 cases received right chest,upper abdominal incision Ivor-Lewis surgery and simultaneously underwent mediastinal and abdominal two-field lymphadenectomy.If regional lymph node metastasis occurred within the recurrent laryngeal nerve,the patients would receive bilateral supraclavicular radiotherapy(DT=5000c Gy)to be adopted at postoperative 4-5 wk(Group A)or cervical lymphadenectomy at postoperative 3-4 wk(Group B).If there were no regional lymph node metastases within the recurrent laryngeal nerve,the patients only underwent two-field,chest and abdomen,lymphadenectomy(Group C).RESULTS:In 219 cases who underwent two-field lymphadenectomy,91 cases were diagnosed with regional lymph node metastasis within the recurrent laryngeal nerve.Of them,48 cases received cervical radiotherapy,and 43 cases underwent staging lymphadenectomy;128patients were not given the follow-up treatment of cervical radiotherapy because there was no regional lymph node metastasis within the recurrent laryngeal nerve.Five-year survival rates in group A and B were 47%and50%,respectively,with no statistical difference between them,and the rate in group C was 58%.CONCLUSION:For patients with middle and lower thoracic esophageal carcinoma combined with lymph node metastasis within the recurrent laryngeal nerve,cervical radiotherapy can be a substitute for surgery and provide benefit.
文摘AIM:To evaluate long-term outcomes and prognostic factors for esophageal squamous cell carcinoma(SCC) treated with three dimensional conformal radiotherapy(3D-CRT).METHODS:Between January 2005 and December 2006,153 patients(120 males,33 females) with pathologically confirmed esophageal SCC and treated with 3D-CRT in Cancer Hospital of Shantou University were included in this retrospective analysis.Median age was 60 years(range:37-84 years).The proportion of tumor location was as follows:upper thorax(including the cervical region),73(48%);middle thorax,73(48%);lower thorax,7(5%),respectively.The median radiation dose was 64 Gy(range:50-74 Gy).Fifty four cases(35%) received cisplatin-based concurrent chemotherapy.Univariate and multivariate analysis were performed to determine the association between the correlative factors and prognosis.RESULTS:The five-year overall survival rate was 26.3%,with a median follow-up of 49 mo(range:3-66 mo) for patients who were still alive.On univariate analysis,lesion location,lesion length by barium esophagogram,computed tomography imaging characteristics including Y diameter(anterior-posterior,AP,extent of tumor),gross tumor volume of primary lesion(GTV-E),volume of positive lymph nodes(GTV-LN),and the total target volume(GTV-T = GTV-E + GTVLN) were prognostic for overall survival.By multivariate analysis,only the Y diameter [hazard ratio(HR) 2.219,95%CI 1.141-4.316,P = 0.019] and the GTV-T(HR 1.372,95%CI 1.044-1.803,P = 0.023) were independent prognostic factors for survival.CONCLUSION:The overall survival of esophageal carcinoma patients undergoing 3D-CRT was promising.The best predictors for survival were GTV-T and Y diameter.
文摘INTRODUCTIONDouble primary esophageal carcinoma is defined ashaving two loci of squamous cell cancersimultaneously or consecutively developing indifferent sites of esophagus.This rare diseaseappears mostly in the literature as case reports,reports about its treatment are even moreinfrequent.Here we present our experiences
基金supported by Wu Jieping Medical Foundation,the National Key Projects of Research and Development of China(No.2016YFC0904600)。
文摘Objective:To investigate the safety and efficacy of nimotuzumab combined with radiotherapy for elderly patients with non-resectable esophageal carcinoma(EC).Methods:Eligible patients were aged 70 years or older and had treatment-naive,histologically proven inoperable locally advanced EC.Enrolled patients received radiotherapy with a total dose of 50-60 Gy in 25-30 fractions,concurrent with weekly infusion of nimotuzumab.The primary end point was the rate of more than grade 3 toxicities.Results:From June 2011 to July 2016,46 patients with stageⅡ-IV EC with a median age of 76.5 years were enrolled.There were 10,28 and 8 patients with stageⅡ,III and IV disease,respectively.The common acute toxicities included esophagitis(grade 1-2,75.4%;grade 3,8.7%),pneumonitis(grade 1,4.3%;grade 2,6.5%;grade3,2.2%),leukopenia(grade 1-2,60.9%;grade 3-4,4.4%),gastrointestinal reaction(grade 1-2,17.3%;grade 3,2.2%),thrombocytopenia(grade 1-2,21.7%;grade 3,2.2%),and radiothermitis(grade 1-2,39.2%).The incidence of grade 3-4 adverse effects was 17.4%.No grade 5 toxicities were observed.Clinical complete response,partial response,stable disease,and progressive disease were observed in 1(2.2%),31(67.4%),12(26.1%),and 2(4.3%)patients,respectively.The median overall survival(OS)and progression-free survival(PFS)were 17 and 10 months,respectively.The 2-,3-,and 5-year OS and PFS rates were 30.4%,21.7%,19.6%,and 26.1%,19.6%,19.6%,respectively.Conclusions:Nimotuzumab combined with radiotherapy is a safe and effective therapy for elderly patients who are not surgical candidates.Further studies are warranted to confirm its therapeutic effects in elderly EC patients.
文摘AIM:To investigate the role of neoadjuvant chemoradiotherapy in prognosis and surgery for esophageal carcinoma by a meta-analysis.METHODS:PubMed and manual searches were done to identify all published randomized controlled trials(RCTs) that compared neoadjuvant chemoradiotherapy plus surgery(CRTS) with surgery alone(S) for esophageal cancer.According to the test of heterogeneity,a fi xed-effect model or a random effect model was used and the odds ratio(OR) was the principal measure of effects.RESULTS:Fourteen RCTs that included 1737 patients were selected with quality assessment ranging from A to C(Cochrane Reviewers' Handbook 4.2.2).OR(95% CI,P value),expressed as CRTS vs S(values>1 favor CRTS arm),was 1.19(0.94-1.48,P=0.28) for 1-year survival,1.33(1.07-1.65,P=0.69) for 2-year survival,1.76(1.42-2.19,P=0.11) for 3-year survival,1.41(1.06-1.87,P=0.11) for 4-year survival,1.64(1.28-2.12,P=0.40) for 5-year survival,0.82(0.39-1.73,P<0.0001) for rate of resection,1.53(1.33-2.84,P=0.007) for rate of complete resection,1.78(1.14-2.78,P=0.79) for operative mortality,1.12(0.89-2.48,P=0.503) for all treatment mortality,1.33(0.94-1.88,P=0.04) for the rate of adverse treatment,1.38(1.23-1.63,P=0.0002) for local-regional cancer recurrence,1.28(0.85-1.58,P=0.60) for distant cancer recurrence,and 1.27(0.86-1.65,P=0.19) for all cancer recurrence.A complete pathological response to chemoradiotherapy occurred in 10%-45.5% of patients.The 5-year survival benefi t was most pronounced when chemotherapy and radiotherapy were given concurrently(OR:1.45,95% CI:1.26-1.79,P=0.015) instead of sequentially(OR:0.85,95% CI:0.64-1.35,P=0.26).CONCLUSION:Compared with surgery alone,neoadjuvant chemoradiotherapy can improve the long-term survival and reduce local-regional cancer recurrence.Concurrent administration of neoadjuvant chemoradiotherapy was superior to sequential chemoradiotherapy.
文摘Esophageal carcinoma is one of the most common human cancers in China. Radiotherapy plays an important role in combination therapy of esophageal carcinoma. With regret, there is still no unified standard for the treatment of esophageal carcinoma in China, and there are many controversies in the treatment regimens, indications, methods and efficacy. Clinically, the clinical practice guidelines of the National Comprehensive Cancer Network (NCCN) of the United States were often consulted, but the data of them were mainly from the patients from Europe and America, and they might not be applicable for Chinese patients. In order to standardize clinical process of radiotherapy for esophageal carcinoma in China, the Esophageal Carcinoma Cooperative Group of Radiation Oncology Society of Chinese Medical Association wrote a consensus and controversies on the radiotherapy for esophageal carcinoma (draft) after years of research and discussion. We hope it be tried out and discussed with advice and valuable suggestions, in order to accelerate the process of standardization of esophageal carcinoma treatment in China.
文摘Background and Objective: Many patterns of treatment have been used to treat esophageal carcinoma in the past years, however, an optimal treatment is still the key issue to be explored. Therefore, we analyzed the published literature about radiotherapy for esophageal cancer in recent 15 years in China, and observed the survival rate, local control rate, adverse events, and so on. Methods: A total of 56 eligible papers about radiotherapy for esophageal squamous cell carcinoma published in Chinese core periodicals between 1994 and 2009 were selected. The survival rates, local control rates, and adverse events were analyzed. Results: The 1-, 2-, 3-, and 5-year overall survival rates of the patients reported in the 56 papers were (67.99 ± 12.55)%, (49.59 ± 11.79)%, (34.50 ± 11.49)%, and (23.31 ± 10.21)%, respectively. The 1-, 2-, 3-, and 5-year local control rates were (73.04 ± 13.37)%, (61.60 ± 15.50)%, (51.77 ± 15.00)%, and (50.15 ± 21.36)%, respectively. The acute esophageal toxicity rate was (44.84 ± 25.71)% in 32 papers reported in recent 15 years, and the acute esophageal toxicity over grade II accounted for (35.93 ± 22.90)%. The rates of acute esophageal toxicity were (26.84 ± 13.12)% for conventional radiation, (53.72 ± 21.82)% for late course accelerated hyperfractionation radiation, (61.33 ± 28.69)% for concurrent chemoradiotherapy, and (40.31 ± 27.22)% for other ways of radiation. The late toxicity rate described in 23 papers was (5.13 ± 4.07)% in recent 15 years. The late toxicity rates were (5.66 ± 3.42)% for conventional radiation, (4.53 ± 4.07)% for late course accelerated hyperfractionation radiation, (2.24 ±1.31)% for concurrent chemoradiotherapy, and (7.34 ± 5.06)% for other ways of radiation. The Meta analysis indicated that concurrent chemoradiotherapy was better than late course accelerated hyperfractionation radiation and conventional radiation. Conclusions: The long-term survival of patients with esophageal cancer is still disappointed in recent years. Concurrent chemoradiotherapy shows advantages in treating esophageal cancer and, currently, is the best non-surgical treatment of esophageal cancer.
文摘Background and Objective:Although there are many randomized clinical trials of late course accelerated hyperfractionated radiotherapy (LCAHFR) combined with FP chemotherapy for esophageal cancer, the efficacy and toxicity are controversial. This study was to evaluate the efficacy and toxicity of LCAHFR combined with FP chemotherapy in treating esophageal cancer. Methods: Reports of randomized clinical trials on LCAHFR combined with FP chemotherapy for esophageal cancer published between January 1999 and January 2009 were researched through Wanfang, CNKI, and PubMed databases. RevMan4.2 software was used for Meta-analysis. Results: Twenty-one reports, including 2030 patients, were included in the meta-analysis. Of the 2030 patients, 1006 underwent LCAHFR (LCAHFR group), and 1024 underwent LCAHFR combined with FP chemotherapy (combination group). Compared with those of the LCAHFR group, the 1-, 2-, 3-, 5-years survival rates and 1-, 2-, 3-year local control rates of the combination group were significant increased, and the acute toxicity was also increased, but chronic toxicity showed no significant difference. C onclusions: LCAHFR combined with FP chemotherapy can improve the survival rate and the local control rate of the patients with esophageal cancer. The increased acute toxicity need to be concerned, whereas the chronic toxicity needs a long-term observation.
基金Supported by Emerging Advanced Technology Joint Research Project of Shanghai Shenkang Hospital Development Center,No.SHDC12017103Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support,No.20161433
文摘BACKGROUND There has been no study comparing the difference in the failure patterns between patients with or without postoperative radiotherapy(PORT)after esophagectomy for pT3-4N0-3M0 esophageal squamous cell carcinoma(ESCC).AIM To investigate the difference in the failure patterns of stage pT3-4N0-3M0 ESCC patients with or without PORT.METHODS Patients with stage pT3-4N0-3M0 ESCC,who underwent surgery with or without PORT,were enrolled in this study.The primary endpoint was to investigate the difference in the failure patterns between patients with or without PORT after esophagectomy.The secondary endpoint was to estimate whether patients with stage pT3-4 ESCC could achieve a disease-free survival(DFS)advantage after receiving adjuvant PORT.Statistical analyses were performed by the Kaplan-Meier method,Cox regression model,and Chi-squared test or Fisher’s exact test.RESULTS In total,230 patients with stage pT3-4N0-3M0 ESCC were included in this study.Fifty-six patients who received PORT were screened from a prospective cohort(S+R arm).And 174 patients involving surgery alone were retrospectively selected from July 2006 to October 2014(S arm).There were no significant differences in the clinical or pathological characteristics of patients between the two arms,except for tumor location(P=0.031).The failure patterns between the two arms were significantly different(P<0.001).Patients in the S arm had a significantly higher proportion of locoregional recurrence and a lower proportion of distant metastasis than those in the S+R arm(92.0%vs 35.7%,P<0.001 and 19.0%vs 75.0%,P<0.001,respectively).The difference in the median DFS between the two arms was statistically significant(12.7 vs 8 mo,P=0.048).Univariate analysis and multivariate analysis both demonstrated that the number of lymph node metastases≥3(HR=0.572,95% CI:0.430-0.762,P<0.001)was an independent poor prognostic factor for DFS in patients with stage pT3-4N0-3M0 ESCC.CONCLUSION PORT could improve DFS and local control of patients with stage pT3-4N0-3M0 ESCC.However,further studies need to be conducted to control hematogenous metastasis after PORT.
文摘Objective: To investigate the diagnosis and treatment for recurrent dysphagia of esophageal carcinoma after radical radiotherapy. Methods: The experince of 41 cases with recurrent dysphagia of esophageal carcinoma after radical radiotherapy were retrospectively summerized. Results: All of the cases were surgically treated form July, 1989 to May, 1997 with resectability rate in 97%, operative mortality in 4.8%, postoperative morbidity in 29%. Pathological examination showed squemous cell carcinoma in 82.8%, and serious radiation reaction in 13.2% after operation. The 1, 3, 5year survival rates after operation were 72.7%, 36.3%, 18.1% respectively, and those after radiation in 100%, 60%, and 35.5% respectively. Conclusion: Most of recurrent dysphagia for these cases were due to uncontrolled/recurrent cancer, and minority of them were due to constriction after radiotherapy. It is difficult to distinguish cancer with benigh constriction before operation. Some cases have lymphatic metastasis without local cancer recurrence. For those patients with recurrent disphagia should be treated with operation as early as possible.
基金Supported by the Hebei Provincial Scientific Commission, No. 97276162D
文摘INTRODUCTIONCancer treatment situation in tumor hospitals inChina has its own unique characteristics which arenot found in other parts of the world. Because ofthe huge population and high incidence rates ofesophageal and stomach cancer[1-5], the number ofcancer patients waiting for admission isinconceivably large.
文摘Metastases of esophageal carcinoma to the skeletal muscle are rare,but the incidence may be increasing because of better diagnosis resulting from widespread use of positron emission tomography/computed tomography(PET/CT).A cohort of 205 patients with esophageal carcinoma treated at our center who had PET/CT between 2006 and 2010 was retrospectively evaluated for the presence of skeletal muscle metastases.Four patients had skeletal muscle metastases of esophageal carcinoma,including two patients with squamous cell carcinoma.In another patient with squamous cell carcinoma of the esophagus and synchronous skeletal muscle metastases,muscle metastases were subsequently shown to be related to second primary pancreatic adenocarcinoma.In all cases,skeletal muscle metastases were the first manifestation of systemic disease.In three patients palliation was obtained with the combination of external beam radiation therapy,systemic chemotherapy or surgical resection.Skeletal muscle metastases are a rare complication of esophageal carcinoma.
文摘Earthworm capsule is an extract from earthworm made in our laboratory.From1986 to 1989,486 patients with carcinoma of esophagus or lung were randomly divided into 2groups,one group received radiotherapy alone(control group)and the other radiotherapycombined with earthworm capsules(treatment group).All cases were diagnosedpathologically or cytologically.In a two-month treatment course,earthworm capsuleswere given orally twice a day,2~3 capsules each time,each capsule containing 60 mg ofthe extract.Compared with the control group,the CR(complete remission)rate andCR+PR(partial remission)rate in patients with carcinoma of esophagus treated byradiotherapy in combination with earthworm capsule increased 9.7%(P【0.01) and 9.6%(P【0.05),while in patients with carcinoma of lung,they increased 10.6%(P【0.05)and13.5%(P【0.05),respectively.The earthworm capsule caused irritation in the alimentarytract,the patients displaying slight nausea and vomiting(16.7% in thecombination treatment group and 10.0% in the control group).However,these side ef-fects could be alleviated when capsules were taken after meal or with honey concomitantly.No deleterious effects on the heart,liver,kidney,skin,hematopoietic or nervous systemwere seen.
文摘A randomized trial of intracavitary microwave hyperthermia combined with external irradiation (R+H) versus radiation (R) alone in the treatment of esophageal cancer was performed form February 1986 to February 1988. In the R group, radiation was given by 8 MV X-ray with 2 Gy/fraction, 5 fractions per week with a total dose of 60 Gy/6 weeks. In the R+H group, the radiation was given as R group but with a total dose of 40 Gy/4 weeks. Intracavitary 915 Mhz microwave hyperthermia was given with a nominal temperature of 43.5℃ at the margin of the tumor surface, 45 minutes/session, 1-2 sessions/week for 4-8 session. The 1-, 3-, and 5-year survival rates in R+H group were 81.2% (48/59 cases), 42.4% (25/59) and 23.7% (14/59), while in the R group 59.0% (39/66 cases), 24.2% (16/66) and 16.7% (11/66) respectively. The differences in 1- and 3-year survival rates were statistically significant (P<0.05) between the 2 groups. Using the thermal dose T90 analysis, after the cases with T90<43℃ (insufficient thermal dose) were eliminated, 52 cases with T90 equal to or higher than 43 ℃ had 1, 3, and 5 year survival rates of 84.6%, 44.2% and 26.9%, respectively. Statistically significant differences in the 2 groups were also limited only to 1- and 3-year survivals. Higher 5-year survivals is anticipated if more cases are studied.
文摘目的检索并总结食管癌术后患者早期经口进食管理的最佳证据。方法按照循证“6S”检索证据模型,检索UpToDate、BMJ Best Practice、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、英国国家卫生与临床优化研究所、中国知网、万方数据库、中国生物医学文献数据库等数据库及相关网站中有关食管癌术后患者早期经口进食的所有证据,包括临床决策、指南、系统评价、Meta分析、专家共识、证据总结及随机对照试验。检索时限为建库至2022年5月。由2名接受过循证护理系统培训的研究者独立完成文献质量评价,并结合专业人员判断,对符合质量标准的证据进行提取和汇总。结果最终纳入14篇文献,包括临床决策2篇、指南4篇、专家共识3篇、系统评价1篇、随机对照试验4篇。从早期经口进食时机选择、吞咽功能评估、进食方案制订、风险识别及预防4个方面汇总24条最佳证据。结论食管癌术后患者早期经口进食安全可行。护理人员应结合临床情景、应用证据的促进因素和阻碍因素、患者意愿选择最佳证据,为临床提供科学、有循证依据的食管癌术后患者早期经口进食管理方案,从而加速患者术后康复,减少并发症,缩短住院时间。