Importance of early detection of esophageal cancer before the tumor progresses too much for effective treatment

This editorial comments on an article by Qu et al published in the World Journal of Gastrointestinal Oncology.It focuses on the importance of early detection of esophageal cancer,including recurrence or secondary malignancy after chemoradiotherapy(CRT).Endoscopic resection is the first choice for treatment for esophageal cancer remaining within the mucous membrane,while surgery or radical CRT are treatment options for advanced stages depending on the patient’s general condition and desire.Although these treatments are potentially curative,they are more invasive than endoscopic resection.Early-stage esophageal cancer is often asymptomatic and difficult to detect.Uniform periodic endoscopy is unrealistic.Although less burdensome tests exist,including liquid biopsy and urinary biomarkers,these have not yet been widely used in clinical practice.Early detection is important after radical CRT because the local recurrence rate is higher than that after surgery.However,endoscopic resection or photodynamic therapy is indicated if detected in the early stages,and positive results have been reported.Early detection of esophageal cancer is crucial.Endoscopy is the main diagnostic method;however,new and less burdensome methods should be established to ensure early treatment for patients with esophageal cancer.

Intensify standardized therapy for esophageal and stomach cancer in tumor hospitals

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.

Radiotherapy of 180 cases of operable esophageal carcinoma

AIM To compare the validity of radiotherapy and surgery for operable esophageal carcinoma in 180 patients with pathologically proved esophageal carcinoma who had been accepted for surgery, but for various reasons, were given radical radiation therapy. METHODS The reasons of abandoning surgery in the patients were: poor cardiac function (21), poor pulmonary function (36), poor general condition (9), senility (aged 69～81 years), 32 and refusal by the patient (82). They were treated either by the isocenter technic alone or anteroposterior plus isocenter irradiation to a total dose of 50～70 Gy/5～7wk. RESULTS The 1 , 3 and 5 year survival rates were 64%, 34% and 23%. The 3 and 5 year survival rates showed that lesions in the upper third did better than those in the middle and lower thirds ( P <0 05). The 5 year survival rate by radiation alone (44 5%) of the upper third lesions was slightly better than by surgery. The effect for lesions in the middle third was slightly inferior, and that for the lower third was even poorer than that of surgery. CONCLUSION The result of radiation alone for the operable esophageal carcinoma was similar to that of surgery.

A Randomized Clinical Study on Combination of Concurrent Chemo-Radiotherapy and Thalidomide for Middle-Late Esophageal Cancer

OBJECTIVE To evaluate the response rate and tolerance of patients with middle-late esophageal carcinoma, who were treated with concurrent chemoradiotherapy （CCRT） plus thalidomide.METHODS Sixty-five eligible patients with local middle-late esophageal carcinoma were randomly assigned to the treatment group （TG） and the control group （CG）. The 33 patients from the TG were treated with CCRT plus thalidomide （a 60-70 Gy of radiation dose, and 5-FU plus cisplatin; oral administration of thalidomide at a dose of 100 mg/d on the first week and 200 mg/d on the second. Both were taken with water, at bedtime until completion of the radiotherapy. In the CG, 32 patients received CCRT only. The clinical effects and tolerance to the CCRT between the 2 groups were compared.RESULTS The response rates of the therapeutic combination in the TG and CG were 87.9% and 68.7%, respectively. There were no statistical differences in comparing the response rates between the 2 groups （P 〉 0.05）; the local control rates in the TG and CG were 93% and 91%, respectively, and there were no statistical differences between the 2 groups （P 〉 0.05）; the 1-year survival rates of the patients in the TG and CG were 74.0% and 63.0%, respectively, without statistical differences between the 2 groups （P 〉 0.05）. The improvement rates of KPS scoring in the TG and CG were 57.6% and 31.3%, respectively. There were significant differences in comparing the improvement rates between the 2 groups （P 〈 0.05）. The incidence rates of nausea and vomiting were lower in the TG compared to the CG, with a statistical significance between the 2 groups （P 〈 0.05）. However, the incidence rates of constipation, lethargy and fatigue were higher in the TG than in CG, showing a statistically significant difference between the 2 groups （P 〈 0.05）. CONCLUSION CCRT combined with thalidomide in treating esophageal carcinoma may improve the quality of life of the patients, the treatment may also raise patients＇ compliance to chemoradiotherapy, and possibly increase their long-term survival rate. Further studies related to this topic are needed.

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.

Oesophageal surgery

INTRODUCTIONThe origins of oesophageal surgery ,like most surgical treatments ,are based in the treatment of traumatic injury .The Smith Surgical Papyrus describes the examination, diagnosis and treatment of 'a gaping wound of throat, penetrating the gullet' [1].

Metastases of esophageal carcinoma to skeletal muscle:Single center experience

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.

SURGICAL TREATMENT OF PRIMARY ESOPHAGEALADENOCARCINOMA

Objective: To study the biocharacteristics of primary esophageal adenocarcinoma (PEAC) and factors influencing patients’ prognosis and to find rational surgical indications and combined therapy. Methods: To analyze the clinical material of 106 patients with PEAC and compared with that of patients with esophageal squamous-cell carcinoma (ESCC). Results: The overall resectability, morbidity and 30-day mortality rates of PEAC were 92.5%, 23.5% and 2.8% respectively, similar to those of ESCC. The TNM staging, lymph node metastasis, extraesophageal invasion and the nature of operation were major determinants influencing long-term prognosis. The 5-year survival rate of PEAC was 21.0%, which was lower than that of ESCC (P<0.01). Metastasis or recurrence remained to be the cause of death in 82.4% of patients who lived longer than 5 years, which was higher than that of ESCC (P<0.01). Adjuvant radiation did not influence survival of the patients with lymph node metastasis, but appeared helpful to the patients with no lymph node metastasis. Conclusion: compared with ESCC, PEAC is a malignant disease with poor prognosis. Surgical resection is the first and chief choice of treatment. Surgical indications include patients in stage 0, I, II and some in stage III and even in stage IV of PEAC. Early detection, early diagnosis and early treatment as well as radical operation could improve prognosis. Adjuvant radiotherapy appears helpful only to the patients without lymph node metastasis.

浅表食管癌内镜黏膜下剥离术与外科手术疗效对比的研究进展

浅表食管癌(SEC)的传统治疗以内镜治疗和外科手术治疗为主。外科手术是食管肿瘤治疗的标准方法,但其围手术期并发症发生率和病死率均较高。近年来,内镜黏膜下剥离术已取得较大进展,为SEC患者提供了有效的诊断和治疗方法。本文就SEC内镜黏膜下剥离术与外科手术的疗效对比和超出内镜黏膜下剥离术适应证的SEC的治疗策略作一综述,以期提高临床医师对SEC治疗的认知。

食管黏膜下腺导管腺瘤合并医源性食管贲门黏膜撕裂综合征1例

食管黏膜下腺导管腺瘤(esophageal submucosal gland duct adenoma, ESGDA)是一种好发于食管下段的良性上皮源性肿瘤,临床上十分罕见,内镜下通常表现为黏膜下隆起伴或不伴中央凹陷[1]。ESGDA病变起源于食管黏膜下腺导管(esophageal submucosal gland duct, ESGD),主要由双层细胞衬覆的多个囊样腺腔组成。ESGD囊肿形成被认为是ESGDA的前体病变,因为两者在临床病理特征方面有重叠且存在进展关系。虽然ESGDA是一种良性病变,但也有文献报道其有进展为食管腺癌的风险[2-3]。本文回顾1例ESGDA患者的临床资料,并结合既往文献复习,阐述该病的诊治方法以及相关内镜手术并发症的预防,以期帮助临床医师更深入地了解ESGDA的诊治并提供可靠的参考依据。

Upper gastrointestinal submucosal tumor:EUS diagnosis and endoscopic therapy

Twenty-five patients with upper gastrointestinal(GI) tract submucosal tumor were treated endoscopically using high frequency snare.Twenty-two tumors were resected through single high frequency electroectomy.Two tumors were resected at two steps,first maki

PEG-rhG-CSF皮下注射与替吉奥联合调强放疗对晚期食管癌的疗效及生存质量的影响

目的探讨皮下注射聚乙二醇化重组人粒细胞集落刺激因子(PEG-rhG-CSF)联合替吉奥在晚期食管癌调强放疗治疗中的价值。方法前瞻性选取2018年1月至2019年9月淮北矿工总医院收治的60例晚期食管癌患者作为研究对象,采用随机数字表法将患者分为观察组和对照组,各30例。对照组患者采用替吉奥+调强放疗措施治疗,观察组患者在对照组基础上同时给予PEG-rhG-CSF注射治疗。比较两组患者放疗近期效果、外周血T淋巴细胞亚群及NK细胞、生存质量评分、毒副反应发生率、生存率及生存时间差异。结果两组的治疗效果分布比较,差异无统计学意义(P>0.05)。治疗后,观察组患者的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、CD16^(+)CD56^(+)NK细胞占比分别为(62.50±4.80)%、(38.51±3.00)%、1.49±0.15、(22.63±2.24)%,均高于对照组[(58.83±5.28)%、(36.67±2.89)%、1.39±0.13、(21.55±1.87)%],差异均有统计学意义(P<0.05)。治疗后,观察组患者的乏力、恶心、食欲不振、失眠评分为(36.29±4.16)、(44.10±5.06)、(33.52±4.27)、(34.20±4.86)分,均低于对照组[(38.85±3.78)、(47.03±4.81)、(37.30±4.52)、(37.56±5.20)分],差异均有统计学意义(P<0.05)。治疗过程中,观察组患者的恶心、呕吐、放射性食管炎、放射性肺炎发生程度均低于对照组,差异有统计学意义(P<0.05)。随访2年,观察组生存率43.33%,对照组生存率33.33%,观察组的中位生存时间21个月,对照组20个月,两组差异无统计学意义(P>0.05)。结论PEG-rhG-CSF联合替吉奥在晚期食管癌调强放疗治疗中应用能缓解放化疗引起的细胞免疫功能受损、改善生存质量、降低毒副反应发生率。

不同目标导向液体治疗对食管癌根治术围术期血流动力学及术后谵妄的影响

目的探讨不同目标导向液体治疗在食管癌根治术患者中的应用效果。方法回顾性分析2020年1月—2022年6月收治的全麻下行食管癌根治术100例的临床资料,根据液体治疗方法分为传统液体治疗组(C组,n=30)、以胸腔内血容积指数(ITBVI)为目标的导向液体治疗组(I组,n=35)、以每搏量变异度(SVV)为目标的导向液体治疗组(S组,n=35)。比较3组手术相关指标、不同时点血流动力学、血管外肺水指数(EVLWI)、肺血管通透性(PVPI)、血清炎性因子、血乳酸水平及术后谵妄发生率。结果I组、S组输液总量、失血量及尿量少于C组(P<0.05)。C组T3~T5时点平均动脉压、心脏指数(CI)均低于T1时点(P<0.05);I组、S组T3~T5时点CI均高于C组(P<0.05)。C组T6时点EVLWI水平高于T1时点(P<0.05);I组、S组T6时点EVLWI水平低于C组,且I组低于S组(P<0.05)。3组T2~T6时点血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)均高于T1时点(P<0.05);I组、S组T3~T6时点血清IL-6、TNF-α水平低于C组(P<0.05)。T6时点I组血乳酸水平低于T1时点,C组血乳酸水平高于T1时点(P<0.05)。I组T6时点血乳酸水平低于S组和C组,且S组低于C组(P<0.05)。I组、S组术后谵妄发生率低于C组(P<0.05)。结论以SVV与ITBVI为目标的导向液体治疗均能维持食管癌根治术中血流动力学稳定,抑制炎症反应,降低术后谵妄发生风险,且以ITBVI为目标的导向液体治疗具有更高的敏感度,可能在改善患者预后方面更具优势。

西黄胶囊辅助晚期肺癌、贲门/食管癌患者化疗的疗效分析

目的 探讨西黄胶囊辅助晚期肺癌、贲门/食管癌化疗的治疗效果。方法 选取2017年5月1日至2022年5月1日在安徽医科大学第三附属医院治疗的101例晚期肺癌、贲门/食管癌患者按是否使用西黄胶囊分为2组。对照组47例,采用常规方案化疗;观察组54例,采用西黄胶囊联合常规方案化疗;比较2组患者的临床疗效、免疫功能和不良反应。结果 观察组治疗有效率为92.5%;对照组治疗有效率为74.4%,2组差异有统计学意义(P<0.05)。观察组在治疗效果上明显优于对照组。观察组发生不良反应9例(16.6%),对照组发生不良反应18例(38.3%),2组差异有统计学意义(P<0.05)。治疗后,观察组的CD3^(+)、CD4^(+)、CD8^(+)的水平明显高于对照组,差异均有统计学意义(P<0.05)。结论 西黄胶囊对晚期的肺癌、食管/贲门癌化疗具有良好的辅助治疗效果,可有效减少化疗药物的不良反应,增强患者的免疫功能。

食管癌同步放化疗与单纯超分割放疗的疗效对比观察

目的 比较化疗同时超分割放疗与单纯超分割放疗对中上段食管癌的近期疗效和长期生存率。方法 15 8例中上段食管癌患者随机分为两组 ,75例列入放化疗同步组 ,83例列入单放组 ,化疗方案 :DDP 2 0mg/m2 ivgttd1～d5 ,5 FU 5 0 0mg/m2 静滴d1～d5 ,连续静滴 6～ 8h ,化疗并同时放疗 ,两组超分割放疗方法相同 :1.3Gy/次 ,2次 /日。结果 同步放化疗组近期有效率为 84 .0 % ,1、3、5年生存率分别为 70 .7%、4 0 .0 %和 2 4 .0 % ;单放组的近期有效率为 6 7.5 % ,1、3、5年生存率分别为5 1.8%、2 1.7%和 10 .8%。经 χ2 检验 ,差异有显著意义 ,两组毒副作用均可以耐受。结论 以DDP及 5 FU化疗同步超分割放疗可以提高中上段食管癌的近期有效率及长期生存率 ,毒副反应所有患者均能耐受。

丙戊酸钠对肝癌细胞系HepG2的生长抑制作用

目的探讨丙戊酸钠（valproate acid sodium,VPA）对肝癌细胞系HepG2的生长抑制作用。方法不同浓度的VPA分别作用于HepG2细胞24、48、72和96h,观察细胞数量和形态的变化,用MTT法分析细胞增殖活力的改变,AnnexinⅤ/PI双染法检测细胞凋亡率的改变,PI法观察细胞周期的变化。结果经0.75～4.0mmol/L不同浓度VPA作用后细胞数量明显减少、形态不规则,部分细胞变圆、细胞核固缩和胞质减少。各浓度药物干预组随药物作用时间、药物浓度的不同均出现了不同程度的生长抑制、细胞凋亡以及增殖周期G1期阻滞。结论VPA可明显抑制HepG2的生长,具有显著的促凋亡和细胞增殖周期G1期阻滞作用。

紫杉醇治疗食管癌疗效分析

目的：观察国产紫杉醇（紫素，ＴＡＸ）单药、与顺铂和５氟尿嘧啶联合治疗食管癌的疗效。方法：用从我国红豆杉中提取的ＴＡＸ治疗Ⅲ、Ⅳ期食管癌。单药治疗食管癌：ＴＡＸ１５０～１７５ｍｇ／ｍ２，静滴３小时，每３周一次，共２周期。ＴＡＸ／ＤＤＰ／５ＦＵ联合化疗：ＴＡＸ１３５ｍｇ／ｍ２，ｉｖ；ＤＤＰ每天２５ｍｇ／ｍ２，第１～３天静滴；５ＦＵ每天５００～７５０ｍｇ／ｍ２，第１～５天静滴。同期内用ＤＤＰ／５ＦＵ方案：ＤＤＰ每天２５ｍｇ／ｍ２，第１～３天静滴，５ＦＵ每天５００～７５０ｍｇ／ｍ２，第１～５天静滴。联合化疗每２８天重复为一周期，２～３周期为一疗程。结果：紫杉醇单药化疗有效率３３３％（３／９）；ＴＡＸ／ＤＤＰ／５ＦＵ治疗３０例食管癌的有效率为７７％（２３／３０）；ＤＤＰ／５ＦＵ治疗食管癌４５例，有效率为５３％（２４／４５）。前一联合方案的总有效率高于后者（Ｐ＜００５），不良反应也较后者重，但大多数患者能耐受。结论：紫杉醇是治疗食管癌的有效单药，与ＤＤＰ／５ＦＵ方案联用能明显提高疗效。

后程加速超分割适形放疗加同步化疗治疗食管癌的临床观察

目的:比较后程加速超分割适形放疗(简称适形放疗)和适形放疗加同步化疗治疗食管癌的疗效与毒副反应。方法:将无远处转移的62例初治食管鳞癌患者随机分成适形放疗组和适形放疗协同化疗组(简称综合组)。适形放疗组:先行放疗41.4Gy/(23次.5周),后行放疗27Gy/(18次.2周);综合组:放射治疗方法同适形放疗组,只是在放射治疗的开始时同期均加用2个周期化疗(5-FU 0.75g,静脉滴入,1次/d,d1~d5;DDP 40mg,静脉滴入,1次/d,d1~d3),从放疗第1天开始,28d为1个周期。观察指标主要包括食管和肺的近期急性反应、后期放射损伤、血液学不良反应、1~5年局控率、无瘤生存率和总体生存率等。结果:综合组总生存率和无瘤生存率均高于适形放疗组,但差异无统计学意义,P>0.05。综合组的急性毒副反应较严重,Ⅲ级急性食管炎、骨髓抑制发生率与适形放疗组比较差异有统计学意义,P值分别为0.001和0.02。晚期并发症主要表现为食管狭窄和肺纤维化,两组比较差异无统计学意义。结论:后程加速超分割适形放疗加同步化疗治疗食管癌,患者能耐受,但其加重了急性反应,未加重远期毒副反应;能提高1~5年无瘤生存率和总体生存...

多西他赛联合顺铂同期放化疗治疗食管癌术后复发转移的临床观察

目的：观察多西他赛加顺铂化疗配合放疗治疗食管癌术后复发转移的近期疗效及毒副反应。方法：化疗方案：多西他赛75mg／m^2，静脉滴入，d1；顺铂80mg／m^2，静脉滴入，d1～d3，3周重复；总化疗105个周期，平均每例2．5个周期。放疗方法：采用针对转移灶小野照射，中位总剂量60C-y／（30次·6周）。放疗于第1个周期化疗结束后第2天进行。结果：42例术后复发转移食管鳞癌患者，应用化疗加放疗治疗后，CR11例（26．2％），PR22例（52．4％），NC6例（14．3％），PD3例（7．1％），总有效率（CR＋PR）为78．6％。中位缓解期7．3个月，中位生存期14．8个月，半年、1年的生存率分别为89．6％和67．1％。主要剂量限制性毒副反应为Ⅱ、Ⅲ级白细胞下降（42．9％）和放射性气管炎（36．1％）。结论：多西他赛加顺铂化疗配合放疗治疗食管癌术后复发转移的毒副反应轻，患者能够耐受，近期疗效可靠，值得临床进一步研究。

同步放化疗结合中医扶正治疗食管癌的临床研究

127例食管癌患者随机分为单放组(RT组51例)、放化组(CRT组30例)和适形放疗加化疗结合中医扶正组(三联组46例)。单放组采用常规三野等中心放射治疗;放化组自常规放疗开始后第1、5周加用化疗;三联组采用适形放疗,自放疗开始后第1、5周加用化疗,同时放疗期间每日服用扶正升血煎剂。随访至2005年6月,单放组、放化组及三联组的骨髓抑制发生率分别为25.5%、90%和54.3%;急性放射性食管炎发生率分别为94.1%、96.7%和21.7%;放射性肺炎发生率分别为11.8%、26.7%和4%;完全缓解率分别为39.2%、66.7%和84.8%,部分缓解率分别为60.8%、33.3%和15.2%;1年生存率分别为43.1%、50%和71.7%;2年生存率分别为33.3%、40%和56.5%;3年生存率分别为13.7%、27%和39.1%。初步研究结果提示,适形放疗加化疗结合中医扶正治疗食管癌在提高患者生存质量、近期疗效及短期生存率方面明显优于单纯放疗及放化结合治疗,而且毒副反应较小。