BACKGROUND The management of proximal esophageal cancer differs from that of tumors located in the mid and lower part of the esophagus due to the close vicinity of vital structures.Non-surgical treatment options like ...BACKGROUND The management of proximal esophageal cancer differs from that of tumors located in the mid and lower part of the esophagus due to the close vicinity of vital structures.Non-surgical treatment options like radiotherapy and definitive chemoradiation(CRT)have been implemented.The trends in(non-)surgical treatment and its impact on overall survival(OS)in patients with proximal esophageal cancer are unclear,related to its rare disease status.To optimize treatment strategies and counseling of patients with proximal esophageal cancer,it is therefore essential to gain more insight through real-life studies.AIM To establish trends in treatment and OS in patients with proximal esophageal cancer.METHODS In this population-based study,patients with proximal esophageal cancer diagnosed between 1989 and 2014 were identified in the Netherlands Cancer Registry.The proximal esophagus consists of the cervical esophagus and the upper thoracic section,extending to 24 cm from the incisors.Trends in radiotherapy,chemotherapy,and surgery,and OS were assessed.Analyses were stratified by presence of distant metastasis.Multivariable Cox proportional hazards regression analyses was performed to assess the effect of period of diagnosis on OS,adjusted for patient,tumor,and treatment characteristics.RESULTS In total,2783 patients were included.Over the study period,the use of radiotherapy,resection,and CRT in non-metastatic disease changed from 53%,23%,and 1%in 1989-1994 to 21%,9%,and 49%in 2010-2014,respectively.In metastatic disease,the use of chemotherapy and radiotherapy increased over time.Median OS of the total population increased from 7.3 mo[95%confidence interval(CI):6.4-8.1]in 1989-1994 to 9.5 mo(95%CI:8.1-10.8)in 2010-2014(logrank P<0.001).In non-metastatic disease,5-year OS rates improved from 5%(95%CI:3%-7%)in 1989-1994 to 13%(95%CI:9%-17%)in 2010-2014(logrank P<0.001).Multivariable regression analysis demonstrated a significant treatment effect over time on survival.In metastatic disease,median OS was 3.8 mo(95%CI:2.5-5.1)in 1989-1994,and 5.1 mo(95%CI:4.3-5.9)in 2010-2014(logrank P=0.26).CONCLUSION OS significantly improved in non-metastatic proximal esophageal cancer,likely to be associated with an increased use of CRT.Patterns in metastatic disease did not change significantly over time.展开更多
BACKGROUND Aortoesophageal fistula(AEF)is a rare but life-threatening cause of upper gastrointestinal bleeding.Only a handful of cases of successful management of AEF caused by esophageal cancer have been reported.The...BACKGROUND Aortoesophageal fistula(AEF)is a rare but life-threatening cause of upper gastrointestinal bleeding.Only a handful of cases of successful management of AEF caused by esophageal cancer have been reported.The purpose of this study is to report a case of AEF managed by endovascular aortic repair and review the relevant literature.CASE SUMMARY A 66-year-old man with upper gastroenterology bleeding presented at the Emergency Department of our hospital complaining of chest pain,fever and hematemesis for 6 h.He had vomited 400 mL of bright-red blood and experienced severe chest pain 6 h prior.He had a past medical history of advanced esophageal cancer.He received chemoradiotherapy but stopped 8 mo prior because of intolerance.A chest contrast computed tomographic scan revealed communication between the esophagus and the descending aorta as well as a descending aortic pseudoaneurysm.According to the symptoms and imaging findings,AEF was our primary consideration.The patient underwent aortic angiography,which indicated AEF and descending aortic pseudoaneurysm.Emergency percutaneous thoracic endovascular aortic repair(TEVAR)of the descending aorta was performed,and bleeding was controlled after TEVAR.He received antibiotics and was discharged after treatment.However,he died 2 mo after the TEVAR due to cancer progression.CONCLUSION Although AEF is a lethal condition,timely diagnosis and TEVAR may successfully control bleeding.展开更多
目的:分析和比较在食管癌放射治疗中胸腹平架和头颈肩架固定装置对患者的体位固定效果。方法:回顾性筛选2020年11月至2021年4月在某院放疗科行放射治疗的41例病变位于胸中段或胸上段的食管癌患者,其中20例采用胸腹平架固定(作为胸腹平架...目的:分析和比较在食管癌放射治疗中胸腹平架和头颈肩架固定装置对患者的体位固定效果。方法:回顾性筛选2020年11月至2021年4月在某院放疗科行放射治疗的41例病变位于胸中段或胸上段的食管癌患者,其中20例采用胸腹平架固定(作为胸腹平架组),21例采用头颈肩架固定(作为头颈肩架组)。比较X(左右)、Y(头脚)、Z(腹背)、RX(矢状面)、RY(横断面)、RZ(冠状面)方向上的整体摆位误差、胸锁关节摆位误差和肩锁关节摆位误差及靶区外放范围。采用SPSS 25.0软件进行统计学分析。结果:在整体摆位误差方面,胸腹平架组在X、RX和RZ方向上显著小于头颈肩架组(0.15 cm vs 0.21 cm,P=0.000;0.66°vs 0.80°,P=0.034;0.52°vs 0.80°,P=0.000),但在Y方向上显著大于头颈肩架组(0.26 cm vs 0.22 cm,P=0.002)。在胸锁关节摆位误差方面,胸腹平架组在X、RY、RZ方向上显著小于头颈肩架组(0.15 cm vs 0.24 cm,P=0.000;0.92°vs 1.19°,P=0.000;0.63°vs 1.00°,P=0.000)。在肩锁关节摆位误差方面,胸腹平架组在RX方向上显著小于头颈肩架组(0.90°vs 1.08°,P=0.019),在Y和RY方向上显著大于头颈肩架组(0.26 cm vs 0.22 cm,P=0.024;0.81°vs 0.62°,P=0.016)。在整体靶区外放方面,胸腹平架组和头颈肩架组在X、Y和Z方向上需要的外放范围分别为0.43、0.66、0.46 cm和0.60、0.58、0.43 cm。结论:对于需要放射治疗的胸中上段食管癌患者,胸腹平架和头颈肩架在不同方向上的固定效果各有优劣,临床上应该根据具体情况选择合适的固定装置。展开更多
文摘BACKGROUND The management of proximal esophageal cancer differs from that of tumors located in the mid and lower part of the esophagus due to the close vicinity of vital structures.Non-surgical treatment options like radiotherapy and definitive chemoradiation(CRT)have been implemented.The trends in(non-)surgical treatment and its impact on overall survival(OS)in patients with proximal esophageal cancer are unclear,related to its rare disease status.To optimize treatment strategies and counseling of patients with proximal esophageal cancer,it is therefore essential to gain more insight through real-life studies.AIM To establish trends in treatment and OS in patients with proximal esophageal cancer.METHODS In this population-based study,patients with proximal esophageal cancer diagnosed between 1989 and 2014 were identified in the Netherlands Cancer Registry.The proximal esophagus consists of the cervical esophagus and the upper thoracic section,extending to 24 cm from the incisors.Trends in radiotherapy,chemotherapy,and surgery,and OS were assessed.Analyses were stratified by presence of distant metastasis.Multivariable Cox proportional hazards regression analyses was performed to assess the effect of period of diagnosis on OS,adjusted for patient,tumor,and treatment characteristics.RESULTS In total,2783 patients were included.Over the study period,the use of radiotherapy,resection,and CRT in non-metastatic disease changed from 53%,23%,and 1%in 1989-1994 to 21%,9%,and 49%in 2010-2014,respectively.In metastatic disease,the use of chemotherapy and radiotherapy increased over time.Median OS of the total population increased from 7.3 mo[95%confidence interval(CI):6.4-8.1]in 1989-1994 to 9.5 mo(95%CI:8.1-10.8)in 2010-2014(logrank P<0.001).In non-metastatic disease,5-year OS rates improved from 5%(95%CI:3%-7%)in 1989-1994 to 13%(95%CI:9%-17%)in 2010-2014(logrank P<0.001).Multivariable regression analysis demonstrated a significant treatment effect over time on survival.In metastatic disease,median OS was 3.8 mo(95%CI:2.5-5.1)in 1989-1994,and 5.1 mo(95%CI:4.3-5.9)in 2010-2014(logrank P=0.26).CONCLUSION OS significantly improved in non-metastatic proximal esophageal cancer,likely to be associated with an increased use of CRT.Patterns in metastatic disease did not change significantly over time.
基金Supported by the Natural Science Foundation of Zhejiang Province (No. LQ19H030002)
文摘BACKGROUND Aortoesophageal fistula(AEF)is a rare but life-threatening cause of upper gastrointestinal bleeding.Only a handful of cases of successful management of AEF caused by esophageal cancer have been reported.The purpose of this study is to report a case of AEF managed by endovascular aortic repair and review the relevant literature.CASE SUMMARY A 66-year-old man with upper gastroenterology bleeding presented at the Emergency Department of our hospital complaining of chest pain,fever and hematemesis for 6 h.He had vomited 400 mL of bright-red blood and experienced severe chest pain 6 h prior.He had a past medical history of advanced esophageal cancer.He received chemoradiotherapy but stopped 8 mo prior because of intolerance.A chest contrast computed tomographic scan revealed communication between the esophagus and the descending aorta as well as a descending aortic pseudoaneurysm.According to the symptoms and imaging findings,AEF was our primary consideration.The patient underwent aortic angiography,which indicated AEF and descending aortic pseudoaneurysm.Emergency percutaneous thoracic endovascular aortic repair(TEVAR)of the descending aorta was performed,and bleeding was controlled after TEVAR.He received antibiotics and was discharged after treatment.However,he died 2 mo after the TEVAR due to cancer progression.CONCLUSION Although AEF is a lethal condition,timely diagnosis and TEVAR may successfully control bleeding.
文摘目的:分析和比较在食管癌放射治疗中胸腹平架和头颈肩架固定装置对患者的体位固定效果。方法:回顾性筛选2020年11月至2021年4月在某院放疗科行放射治疗的41例病变位于胸中段或胸上段的食管癌患者,其中20例采用胸腹平架固定(作为胸腹平架组),21例采用头颈肩架固定(作为头颈肩架组)。比较X(左右)、Y(头脚)、Z(腹背)、RX(矢状面)、RY(横断面)、RZ(冠状面)方向上的整体摆位误差、胸锁关节摆位误差和肩锁关节摆位误差及靶区外放范围。采用SPSS 25.0软件进行统计学分析。结果:在整体摆位误差方面,胸腹平架组在X、RX和RZ方向上显著小于头颈肩架组(0.15 cm vs 0.21 cm,P=0.000;0.66°vs 0.80°,P=0.034;0.52°vs 0.80°,P=0.000),但在Y方向上显著大于头颈肩架组(0.26 cm vs 0.22 cm,P=0.002)。在胸锁关节摆位误差方面,胸腹平架组在X、RY、RZ方向上显著小于头颈肩架组(0.15 cm vs 0.24 cm,P=0.000;0.92°vs 1.19°,P=0.000;0.63°vs 1.00°,P=0.000)。在肩锁关节摆位误差方面,胸腹平架组在RX方向上显著小于头颈肩架组(0.90°vs 1.08°,P=0.019),在Y和RY方向上显著大于头颈肩架组(0.26 cm vs 0.22 cm,P=0.024;0.81°vs 0.62°,P=0.016)。在整体靶区外放方面,胸腹平架组和头颈肩架组在X、Y和Z方向上需要的外放范围分别为0.43、0.66、0.46 cm和0.60、0.58、0.43 cm。结论:对于需要放射治疗的胸中上段食管癌患者,胸腹平架和头颈肩架在不同方向上的固定效果各有优劣,临床上应该根据具体情况选择合适的固定装置。
