Tracheoesophageal fistula closure after staged dose-escalated radiotherapy for esophageal squamous cell carcinoma: a case report.

An esophageal fistula can be caused by an esophageal tumor as well as the surgery, radiotherapy (RT), or chemoradiotherapy used to treat the tumor. The most dangerous complications are massive hemoptysis and asphyxia. This report describes a 58-year-old man with a >1-month history of dysphagia and hemoptysis. Contrast-enhanced computed tomography revealed a tumor in the upper esophagus and a tracheoesophageal fistula. Esophagography revealed a large lesion measuring approximately 8 cm in length. Esophagogastroduodenoscopy showed an ulcerated tumor with raised margins originating 22 cm from the incisors, and histologic examination of a biopsy specimen indicated squamous cell carcinoma. The tumor was finally classified as stage IVA (T4bN0M0) esophageal squamous cell carcinoma. Massive hemoptysis occurred after the patient was admitted to the hospital. Therefore, we applied staged dose-escalated RT in three stages (6.0 Gy in 5 fractions, 7.5 Gy in 5 fractions, and 46.8 Gy in 26 fractions) to decrease the rate of tumor shrinkage brought on by RT and give the normal tissue enough time to close the fistula. Finally, the hemoptysis resolved and the patient's symptoms were significantly improved. Contrast-enhanced chest computed tomography revealed shrinkage of the tumor. In conclusion, staged dose-escalated RT can be applied for esophageal fistula closure.

Mucosa-associated lymphoid tissue lymphoma of the trachea treated with radiotherapy: A case report.

BACKGROUND: Mucosa-associated lymphoid tissue (MALT) lymphoma originates in the marginal zone of lymphoid tissue. lung is one of the most frequent non-gastrointestinal organs involved, here known as bronchus-associated lymphoid tissue (BALT) lymphoma. BALT lymphoma of unknown etiology, and most patients are asymptomatic. The treatment of BALT lymphoma is controversial. CASE SUMMARY: A 55-year-old man admitted to hospital had a three-month history of progressively coughing up yellow sputum, chest stuffiness, and shortness of breath. Fiberoptic bronchoscopy revealed mucosal visible beaded bumps 4 cm from the tracheal carina at 9 o 'clock and 3 o 'clock, the right main bronchus, and the right upper lobe bronchus. Biopsy specimens showed MALT lymphoma. Computed tomography virtual bronchoscopy (CTVB) showed uneven main bronchial wall thickening and multiple nodular protrusion. BALT lymphoma stage IE was diagnosed after a staging examination. We treated the patient with radiotherapy (RT) alone. A total dose of 30.6 Gy/17 f/25 d was given. The patient had no obvious adverse reactions during RT. The CTVB was repeated after RT and showed that the right side of the trachea was slightly thickened. CTVB was repeated 1.5 mo after RT and again showed that the right side of the trachea was slightly thickened. Annual CTVB showed no signs of recurrence. The patient now has no symptoms. CONCLUSION: BALT lymphoma is an uncommon disease and shows good prognosis. The treatment of BALT lymphoma is controversial. In recent years, less invasive diagnostic and therapeutic approaches have been emerging. RT was effective and safe in our case. The use of CTVB could provide a noninvasive, repeatable, and accurate method in diagnosis and follow-up.

The value of radiotherapy in patients with T1 and T2 breast cancer with one to three positive nodes after modified radical mastectomy.

BACKGROUND AND OBJECTIVE: The role of adjuvant radiotherapy to the regional nodes in women with T1 to T2 breast cancer and one to three positive nodes is controversial. This study compared and analyzed the prognosis of patients with T1-T2 breast cancer with one to three positive nodes after modified radical mastectomy with or without postoperative radiotherapy. METHODS: The cases of 434 women patients with T1 to T2 breast cancer with one to three positive lymph nodes after modified radical mastectomy were reviewed, of which 196 patients received postoperative radiotherapy and 238 patients did not. The ipsilateral chest wall and supraclavicular fossa were irradiated with doses of 46-50 Gy in 23-25 fractions. RESULTS: For all patients, the 3- and 5-year rates of overall survival (OS) were 94.7% and 85.7% respectively, local control (LC) 96.5% and 95.6%;, and disease-free survival (DFS) 89.3% and 82.3% respectively. The 3- and 5-year OS rates for patients without radiotherapy were 92.7% and 97.1% and for those with radiotherapy were 82.4% and 89.2%, both with significant differences (P = 0.039). The 3- and 5-year LC rates for patients without radiotherapy were 94.8% and 98.4% and for those with radiotherapy were 93.6% and 97.7%, again with significant differences (P = 0.041). The 3- and 5-year DFS rates for patients without radiotherapy were 87.8% and 91.3% and for patients with radiotherapy were 78.5% vs 86.1% (P = 0.047). CONCLUSIONS: Postoperative radiotherapy confers better rates of OS, LC, and DFS in patients with T1 to T2 breast cancer with one to three positive nodes after modified radical mastectomy.

TGF-beta1 in serum and induced sputum for predicting radiation pneumonitis in patients with non-small cell lung cancer after radiotherapy.

BACKGROUND AND OBJECTIVE: Research has confirmed that transforming growth factor-beta1 (TGF-beta1) is one of the cytokines related to radiation pneumonitis. But the level of TGF-beta1 in serum needed to predict radiation pneumonitis is still not clear. This study assessed the value of TGF-beta1 in both serum and induced sputum in predicting radiation pneumonitis, providing a reference for the radiotherapy of patients with non-small cell lung cancer (NSCLC). METHODS: A total of 23 patients with NSCLC treated with three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiation therapy (IMRT) in our department between November 2007 and January 2009 were analyzed and evaluated. TGF-beta1 levels in both serum and sputum were detected before and near the end of radiotherapy for all the patients. The TGF-beta1 level in serum was measured with enzyme-linked immunosorbent assay (ELISA). Immunocytochemistry assays were used to detect TGF-beta1 expression in sputum sediment. Radiation pneumonitis was graded according to Radiation Therapy Oncology Group (RTOG) radiation scoring criteria every 3 weeks from the start to 3 months after the end of treatment. RESULTS: Radiation pneumonitis was noted in 9 patients in this cohort. The total incidence of radiation pneumonitis was 39.1% (9/23) and those with Grade II or worse was 30.4% (7/23). The absolute TGF-beta1 level in serum after radiotherapy was higher than before radiotherapy, but there was no statistical difference (P = 0.139). Patients with increased levels of TGF-beta1 had a higher incidence of radiation pneumonitis (45.5%) than those with decreased TGF-beta1 levels post-radiotherapy (40.0%). Though there was a tendency of higher incidence of radiation pneumonitis with increases in TGF-beta1 level, no statistical difference was found (P = 1.000). Patients with tumor response had higher incidence of radiation pneumonitis (50.0%) than patients without when TGF-beta1 levels in serum increased, but there was no statistical difference (P = 0.792). TGF-beta1 was positively expressed (brown yellow) in sputum on immunocytochemistry assays and located in the cytoplasm of either macrophages or epithelial cells. Macrophages were the main cells expressing TGF-beta1. A significantly higher positive expression rate (71.4%) was found in sputum post-radiotherapy than pre-radiotherapy (28.6%) (P = 0.015). The higher incidence of radiation pneumonitis (46.7%) was found in patients with positive TGF-beta1 expression in sputum post-radiotherapy than those with negative expression post-radiotherapy (14.3%) (P = 0.193). CONCLUSION: It may be more reasonable to predict radiation pneumonitis by combining the change of TGF-beta1 levels in serum with tumor response than just the change of TGF-beta1 levels in serum alone. TGF-beta1 can positively express in the sputum of patients with NSCLC, located in macrophages and epithelial cells, with macrophages as the main areas of expression. Patients with positively expressed TGF-beta1 in sputum after radiotherapy have a higher incidence of radiation pneumonitis than those with negative expressions. The positive expression of TGF-beta1 in sputum is expected to become a factor for predicting radiation pneumonitis.