Metastatic Oesophagus Carcinoma Presented with Neck and Arm Pain:A Case Report

Oesophageal carcinoma is among malignancies with poor prognosis due to the late onset symptoms related with large submucosal involvement, early lymphatic metastasis and its multicentric characteristics, majority of the patients decrease within the first year of diagnosis. However, bone metastasis is uncommon and reported to be 1% to 14% in autopsy series. Herein we report a case that was admitted to our outpatient clinics with severe neck and arm pain as presenting symptoms and diagnosed as metastatic oesophageal carcinoma afterwards.

Effectiveness and tolerability of programmed cell death protein-1 inhibitor+chemotherapy compared to chemotherapy for upper gastrointestinal tract cancers

BACKGROUND The combination of programmed cell death protein-1(PD-1)inhibitor and che-motherapy is approved as a standard first-or second-line treatment in patients with advanced oesophageal or gastric cancer.However,it is unclear whether this combination is superior to chemotherapy alone.AIM To assess the comparative effectiveness and tolerability of combining PD-1 inhibitors with chemotherapy vs chemotherapy alone in patients with advanced gastric cancer,gastroesophageal junction(GEJ)cancer,or oesophageal carcinoma.METHODS We searched the PubMed and Embase databases for studies that compared the efficacy and tolerance of PD-1 inhibitors in combination with chemotherapy vs chemotherapy alone in patients with advanced oesophageal or gastric cancer.We employed either random or fixed models to analyze the outcomes of each clinical trial,en-compassing data on overall survival(OS),progression-free survival(PFS),objective response rate,and adverse events(AEs).RESULTS Nine phase 3 clinical trials(7016 advanced oesophageal and gastric cancer patients)met the inclusion criteria.Our meta-analysis demonstrated that the pooled PD-1 inhibitor+chemotherapy group had a significantly longer OS than the chemotherapy-alone group[hazard ratio(HR)=0.76,95%confidence interval(CI):0.71-0.81];the pooled PFS result was consistent with that of OS(HR=0.67,95%CI:0.61-0.74).The count of patients achieving an objective response in the PD-1 inhibitor+chemotherapy group surpassed that of the chemotherapy-alone group[odds ratio(OR)=1.86,95%CI:1.59-2.18].AE incidence was also higher in the combination-therapy group than in the chemotherapy-alone group,regardless of whether≥grade 3 only(OR=1.30,95%CI:1.07-1.57)or all AE grades(OR=1.88,95%CI:1.39-2.54)were examined.We performed a subgroup analysis based on the programmed death-ligand 1(PD-L1)combined positive score(CPS)and noted extended OS and PFS durations within the CPS≥1,CPS≥5,and CPS≥10 subgroups of the PD-1 inhibitor+chemotherapy group.CONCLUSION In contrast to chemotherapy alone,the combination of PD-1 inhibitor and chemotherapy appears to present a more favorable option for initial or subsequent treatment in patients with gastric cancer,GEJ tumor,or oesophageal cancer.This holds true particularly for individuals with PD-L1 CPS scores of≥5 and≥10.

Corrosive injury to upper gastrointestinal tract: Still a major surgical dilemma

In the developed and developing countries, corrosive injury to the gastrointestinal system as a consequence of either accidental ingestion or as a result of self-harm has become a less common phenomenon compared to decades ago. This could partly be attributed to the tighter legislation imposed by the government in these countries on detergents and other corrosive products and general public awareness. Most busy upper gastrointestinal surgical units in these countries, especially in the developed countries will only encounter a small number of cases per year. Up to date knowledge on the best management approach is lacking. In this article, we present our experience of two contrasting cases of corrosive injury to the upper gastrointestinal tract in our thoracic unit in the last 2 years and an up-to-date Medline literature search has been carried out to highlight the areas of controversies in the management of corrosive injuries of the upper gastrointestinal tract. We concluded that the main principle in managing such patients requires a good understanding of the pathophysiology of corrosive injury in order to plan both acute and future management. Each patient must be evaluated individually as the clinical picture varies widely. Signs and symptoms alone are an unreliable guide to injury.

Chemoradiotherapy followed by surgery could improve the efficacy of treatments in patients with resectable esophageal carcinoma

Background The effectiveness of chemoradiotherapy followed by surgery （CRTS） in patients with resectable esophageal carcinoma remains controversial.We performed a systematic review of the literature with meta-analysis.Methods Electronic databases were used to identify published studies between January 1992 and April 2012.Pooled relative risk （RR） with 95％ confidence interval （95％ CI） was utilized to estimate the strength of the association between CRTS and surgery alone （SA） survival of the resectable esophageal carcinoma patients.Heterogeneity and publication bias were also assessed in the present study.Results The final analysis of 2755 resectable esophageal carcinoma cases from 21 randomized controlled trials （RCTs） are presented.Compared to the SA group,the 1,3-and 5-year survival rates were significantly higher in the CRTS group （all P ＜0.05）; the 3-and 5-year survival rates for the Eastern patients,Western patients,patients undergoing concurrent chemoradiotherapy,patients with squamous cell carcinoma,patients undergoing High-dose radiotherapy （≥40 Gy）,and patients given either ＂cisplatin ＋ Fluorouracil＂ or ＂cisplatin ＋ paclitaxel＂ chemotherapy were significantly higher in the CRTS group （all P ＜0.05）.There were no statistical significances in the 3-and 5-year survival rates for patients undergoing sequential chemoradiotherapy or patients with adenocarcinoma between the two groups （all P ＞0.05）.Compared to the RCTS group,the surgery rate in the SA group was higher （P ＜0.05）,while the CRTS group had significantly higher radical resection rate,R0 resection rate and lower postoperative local recurrence rate （all P ＜0.05）.The differences in postoperative complication incidence,post-operative distant metastasis and postoperative mortality rate were not statistically significant between the two groups （all P ＞0.05）.Conclusion CRTS can significantly improve the survival and surgical conditions of patients with resectable esophageal carcinoma.