Effect of Survivin Down-Regulation by Egr1-Survivin shRNA Combined with Radiotherapy on Radiosensitivity of Esophageal Squamous Carcinoma / Efecto de la Regulación Negativa de Survivina por shRNA de Egr1-Survivina Combinado con Radioterapia sobre la Radiosensibilidad del Carcinoma Escamoso de Esófago

SUMMARY: This study is to investigate the effect of survivin down-regulation by Egr1-survivin shRNA combined with radiotherapy on the apoptosis and radiosensitivity of esophageal squamous cell carcinoma ECA109 and KYSE150 cells. ECA109 and KYSE150 cells were transfected with Egr1-survivin shRNA, and then treated with radiotherapy. After 24 h, the mRNA and protein levels of Egr1-survivin were detected by qPCR and Western-Blot. Cell cycle and apoptosis were detected by flow cytometry. Western blot also detected levels of cleavaged Caspase 3 and Caspase 9. YM155 was used as a positive control to inhibit survivin expression. The levels of survivin mRNA and protein in ECA109 and KYSE150 cells treated with Egr1-survivin shRNA combined with radiotherapy were significantly lower than those of the blank control group, the empty vector control group, and, the YM155 + radiotherapy group (P<0.05). Meanwhile, after survivin down-regulation, the ratio of G2 to S phase of ECA109 and KYSE150 cells increased significantly, leading to significant G2 and S phase arrest. Additionally, apoptosis of ECA109 and KYSE150 cells increased significantly (P <0.01). Further, protein levels of cleavaged Caspase 3 and Caspase 9 significantly increased in Egr1-survivin shRNA combined with radiotherapy group. Egr1-survivin shRNA combined with radiotherapy can down-regulate survivin expression, which further increases the apoptosis, and enhances the radiosensitivity of ECA109 and KYSE150 cells.

Este estudio tuvo como objetivo investigar el efecto de la regulación negativa de survivina por el shRNA de Egr1-survivina combinado con radioterapia sobre la apoptosis y la radiosensibilidad del carcinoma de células escamosas de esófago Células ECA109 y KYSE150. Las células ECA109 y KYSE150 se transfectaron con shRNA de survivina Egr1 y luego se trataron con radioterapia. Después de 24 h, los niveles de ARNm y proteína de Egr1-survivina se detectaron mediante qPCR y Western-Blot. El ciclo celular y la apoptosis se detectaron mediante citometría de flujo. La transferencia Western también detectó niveles de Caspasa 3 y Caspasa 9 escindidas. Se usó YM155 como control positivo para inhibir la expresión de survivina. Los niveles de ARNm y proteína de survivina en células ECA109 y KYSE150 tratadas con shRNA de survivina Egr1 combinado con radioterapia fueron significativamente más bajos que los del grupo control en blanco, el grupo control de vector vacío y el grupo de radioterapia YM155 + (P <0,05). Mientras tanto, después de la regulación negativa de survivina, la proporción entre las fases G2 y S de las células ECA109 y KYSE150 aumentó significativamente, lo que llevó a una detención significativa de las fases G2 y S. Además, la apoptosis de las células ECA109 y KYSE150 aumentó significativamente (P <0,01). Además, los niveles de proteína de Caspasa 3 y Caspasa 9 escindidas aumentaron significativamente en el shRNA de Egr1- survivina combinado con el grupo de radioterapia. El shRNA de survivina de Egr1 combinado con radioterapia puede regular negativamente la expresión de survivina, lo que aumenta aún más la apoptosis y mejora la radiosensibilidad de las células ECA109 y KYSE150.

The IL-6/STAT3 signaling pathway mediated by radiotherapy regulates the expression of PD-L1 in esophageal cancer cells / 中华肿瘤杂志

Objective: To explore the possible mechanism of radiotherapy regulating the expression of PD-L1 in esophageal carcinoma. Methods: Three esophageal cancer cell lines (Eca109, Kyse150, TE1) were irradiated with different doses of X-rays, and 6 Gy+ AG490 group was set. The mRNA expression of PD-L1 was detected by real-time quantitative polymerase chain reaction (RT-qPCR). The protein expressions of PD-L1, STAT3, p-STAT3 were detected by western blotting and the protein level of IL-6 was detected by ELISA. Results: The mRNA expressions of PD-L1 in Eca109, Kyse150 and TE1 were 2.86±0.30, 960.01±21.27 and 106.78±6.67, higher than 1.07±0.15 in normal esophageal cell line HET-1A (P<0.01). The protein expressions of PD-L1 in Eca109, Kyse150 and TE1 were 0.091±0.036, 1.533±0.079 and 0.914±0.035, higher than 0.063±0.01 in normal esophageal cell line HET-1A (P<0.01). After 48 hours of 6 Gy irradiation, the protein expression levels of PD-L1 in Eca109, Kyse150 and TE1 were 0.135±0.007, 1.66±0.06 and 1.32±0.06, higher than 0.09±0.01, 1.21±0.05 and 0.93±0.03 of the 0 Gy group (P<0.01), while the protein expression levels of p-STAT3 in Eca109, Kyse150 and TE1 were 1.44±0.26, 0.75±0.04 and 1.92±0.17, higher than 0.18±0.05, 0.48±0.02 and 0.36±0.06 of the 0 Gy group (P<0.01). IL-6 protein expression increased significantly after different doses of irradiation (P<0.01). After the IL-6/STAT3 signaling pathway was blocked by the specific inhibitor AG490, the expressions of PD-L1 of Eca109, Kyse150 and TE1 in the 6 Gy+ AG490 groups were 0.11±0.03, 1.07±0.08 and 0.96±0.11, without significant differences of 0.09±0.01, 0.96±0.05 and 0.85±0.09 of the 0 Gy group (P>0.05), while the protein expressions of p-STAT3 were 0.76±0.11, 0.59±0.06 and 0.96±0.12, without significant differences of 0.67±0.08, 0.54±0.06 and 0.84±0.11 of the 0 Gy group (P>0.05). Conclusion: Radiotherapy may regulate the expression of PD-L1 in esophageal cancer cells through IL-6 / STAT3 signaling pathway.

Atuação fonoaudiológica em pacientes com câncer de esôfago submetidos a tratamento radioterápico: Série de casos / Speech therapy performance in patients with esophagus cancer receiving radiotherapy treatment: A case series / Actuación fonoaudiológica en pacientes con cáncer de esófago en radioterapia: Serie de casos

Introdução: A atuação fonoaudiológica na disfagia decorrente do câncer de esôfago ainda é recente. Não foi encontrado até o momento, estudos que descrevam a atuação fonoaudiológica em pacientes com câncer de esôfago submetidos a radioterapia. Sendo assim, este trabalho teve como objetivo descrever a atuação fonoaudiológica em pacientes com câncer de esôfago, submetidos a tratamento radioterápico com queixa de disfagia. Métodos: Trata-se de uma série de cinco casos, que receberam acompanhamento fonoaudiológico ambulatorial. Os pacientes foram avaliados por meio de avaliação clínica da deglutição, classificação do grau de alteração de deglutição com aplicação de escala visual analógica e protocolos de qualidade de vida utilizados na área da oncologia. Foram submetidos ainda a uma abordagem terapêutica para deglutição. Resultados: Os pacientes obtiveram melhora da deglutição, apresentando, ao término do tratamento, diminuição dos sintomas de disfagia, possibilidade de ingesta de alimentos via oral e melhora da qualidade de vida. Conclusão: A fonoterapia, compreendendo a avaliação clínica da deglutição, seguida de treino da deglutição e exercício miofuncional para abertura do esfíncter esofágico superior (Shaker), auxiliou na reabilitação da disfagia esofágica.

Introduction: Speech therapy performance in dysphagia resulting from esophageal cancer is still a recent subject. To date, there are no studies describing the speech therapy performance of patients with esophageal cancer undergoing radiotherapy. For this reason, the aim of this study was to describe speech therapy performance in patients with esophageal cancer receiving radiotherapy treatment and with complaints of dysphagia. Methods: This is a series of five cases, with patients that received outpatient speech therapy. The patients were assessed using clinical swallowing evaluation, classification of the degree of swallowing alteration with application of visual analog scale and quality of life protocols used in oncology. They also underwent a therapeutic approach to swallowing. Results: The patients' swallowing was improved and, at the end of the treatment, there were reduced symptoms of dysphagia, possibility of oral intake of food and improved quality of life. Conclusions: Speech therapy, comprising the clinical assessment of the swallowing function, followed by swallowing training and myofunctional exercise to open the upper esophageal sphincter, supported the rehabilitation of esophageal dysphagia.

Introducción: La actuación fonoaudiológica en disfagia decurrente de cáncer del esófago es todavía reciente. Hasta ahora, no se han encontrado estudios que describan la actuación fonoaudiológica en pacientes con cáncer de esófago sometidos a radioterapia. De esta forma, este trabajo tuvo como objetivo describir la actuación del fonoaudiologo en pacientes con cáncer de esófago sometidos a tratamiento de radioterapia con queja de disfagia.Métodos: Esta es una serie de cinco casos, que recibieron terapia fonoaudiologica en ambulatorio. Los pacientes fueron evaluados mediante evaluación clínica de deglución, clasificación del nivel de alteración de la deglución con aplicación de escala visual analógica y protocolos de calidad de vida utilizados en el área de oncología. También fueron sometidos a un enfoque terapéutico para la deglución. Resultados: Los pacientes mejoraron su deglución, presentando, al final del tratamiento, una reducción en los síntomas de disfagia, la posibilidad de ingesta de alimentos por vía oral y una mejora en la calidad de vida. Conclusión: La terapia fonoaudiologica, que comprende la evaluación clínica de deglución, seguida del entrenamiento de deglución y ejercicio miofuncional para abrir el esfínter esofágico superior, ayudó en la rehabilitación de la disfagia esofágica.

Nimotuzumab combinado con quimioradioterapia en pacientes con carcinoma epidermoide esofágico avanzado en el mundo real / Nimotuzumab combined with chemoradiotherapy in patients with advanced esophageal squamous cell carcinoma in the real world

Introducción: La supervivencia global de pacientes con cáncer de esófago continúa siendo baja a pesar de los avances terapéuticos realizados en las últimas décadas. Objetivo: Evaluar respuesta al tratamiento y supervivencia global. Métodos: Se realizó un estudio retrospectivo y observacional en pacientes con carcinoma epidermoide esofágico avanzado, tratados con nimotuzumab combinado con quimioradioterapia, atendidos en el Servicio de Oncología Clínica del Hospital Ameijeiras, entre enero 2013 y junio de 2019 (n = 94). Se utilizó chi-cuadrado para la asociación de variables, con un valor p< 0,05. Se evaluó supervivencia global por el método de Kaplan Meier, y la prueba de Log-Rank para la comparación de las curvas. Resultados: La tasa de respuesta objetiva y de control de enfermedad fue 64,9 por ciento y 83 por ciento, respectivamente. El esquema de quimioterapia con cisplatino/fluouracilo fue el empleado con más frecuencia. Las variables con mayor respuesta y significación estadística fueron: ECOG cero, color de piel no blanca, tratamiento radiante ≥ 50 Gy, y más de catorce dosis de nimotuzumab. La mediana de supervivencia fue 13,03 meses (IC95 por ciento -10,9; 15,2), y las variables asociadas a una mayor probabilidad de supervivencia fueron: ECOG cero, dosis de quimioterapia > 75 por ciento de lo planificado, tratamiento radiante ≥ 50 Gy, más de catorce dosis de nimotuzumab, y alcanzar una respuesta objetiva (p< 0,05). Solo 5,8 por ciento de los pacientes presentaron toxicidades clasificadas como grado 3-5. Conclusiones: En condiciones de práctica clínica, este esquema de combinación obtuvo óptimas tasas de respuesta objetiva y supervivencia con buen perfil de toxicidad(AU)

Introduction: Overall survival of esophageal cancer patients remains low despite the therapeutic advances achieved in the last decades. Objective: Evaluate response to treatment and overall survival. Methods: An observational retrospective study was conducted of patients with advanced esophageal squamous cell carcinoma treated with nimotuzumab combined with chemoradiotherapy at the Clinical Oncology Service of Ameijeiras Hospital from January 2013 to June 2019 (n = 94). Association of variables was analyzed with the chi-square test, using a value of p < 0.05. Overall survival was evaluated with the Kaplan-Meier method, whereas the Log-Rank test was used to compare the curves. Results: Objective response and disease control rates were 64.9 percent and 83 percent, respectively. The chemotherapy scheme with cisplatin / fluorouracil was the most commonly applied. The variables with the greatest response and statistical significance were ECOG zero, skin color not white, radiation therapy ≥ 50 Gy and more than 14 doses of nimotuzumab. Median survival was 13.03 months (CI 95 percent -10,9; 15,2), whereas the variables associated to a greater probability of survival were ECOG zero, chemotherapy dose > 75% of plan, radiation therapy ≥ 50 Gy, more than 14 doses of nimotuzumab, and achieving an objective response (p< 0.05). Only 5.8 percent of the patients presented toxicities classified as grades 3-5. Conclusions: In clinical practice conditions, this combination scheme achieved optimum objective response and survival rates with a good toxicity profile(AU)

High serum superoxide dismutase activity improves radiation-related quality of life in patients with esophageal squamous cell carcinoma

OBJECTIVES: Esophageal squamous cell carcinoma (ESCC) is one of the most common malignant tumors in China. Intensity-modulated radiation therapy and volume-modulated arc therapy have become the main treatments for esophageal carcinoma; however, side effects caused by radiotherapy greatly impact the quality of life in these patients. This study aimed to explore the impact of serum superoxide dismutase (SOD) levels on the prognosis of patients with ESCC undergoing radiotherapy. METHODS: Patients aged between 18 and 80 years with lower-middle ESCC who underwent radiotherapy were eligible for this assessment. Adverse events, responses, treatment outcomes, and overall survival (OS) were assessed. Between 2012 and 2014, 195 patients were enrolled, of which 65 were assigned to the low- and high-SOD groups based on their serum SOD values. RESULTS: The baseline characteristics were similar between the two groups, except for the T staging. Adverse events in the low-SOD group were significantly higher than those in the high-SOD group (radiation esophagitis, p=0.007; radiation pneumonitis, p=0.032; leukopenia, p=0.023; thrombocytopenia, p=0.037; anemia, p=0.041). There were no significant differences in response, treatment outcomes, or OS. CONCLUSION: In conclusion, high serum SOD activity improved post-radiotherapy quality of life but did not impact the prognosis of patients with ESCC. To the best of our knowledge, this study is the first to report that serum SOD activity is associated with radiation-induced toxicity and moderately increased radiotherapeutic response in patients with ESCC undergoing radiotherapy.

Aconselhamento Nutricional em Pacientes com Câncer de Cabeça, Pescoço e Esôfago em Tratamento (Quimio)Radioterápico / Nutritional Cousenling in Patients with Head, Neck and Esophagus Cancer in (Chemo)Radiotherapy / Asesoramiento Nutricional en Pacientes com Cáncer de Cabeza, Cuello y Esófago em Tratamiento (Quimio)Radioterápico

Introdução: A presença de um nutricionista no setor de radioterapia objetiva a recuperação e a manutenção do estado nutricional dos pacientes. Objetivo: Comparar os resultados do aconselhamento nutricional diário com o aconselhamento nutricional semanal em pacientes com câncer de cabeça, pescoço e esôfago em tratamento radioterápico. Método: Foram selecionados 29 pacientes para o estudo e separados aleatoriamente em dois grupos. O grupo intervenção recebeu aconselhamento nutricional diariamente. O grupo padrão recebeu aconselhamento nutricional semanalmente. De ambos os grupos, foram aferidos peso corporal, circunferência braquial ou de panturrilha, avaliação subjetiva global produzida pelo próprio paciente (ASG-PPP) e cálculo do recordatório alimentar diário. Resultados: A maioria dos participantes era do sexo masculino (80%), com média de idade de 62,7 ± 26 anos. A terapia nutricional oral foi necessária para 48% dos indivíduos e, ao final do tratamento, 60% estavam em uso de nutrição enteral. A perda de peso média no grupo intervenção foi de 1,89 ± 2,58 Kg comparada à perda média de peso no grupo padrão de 9,92 ± 6,68 Kg (p=0,017). Metade dos pacientes do grupo intervenção, que iniciaram o tratamento categorizados pela ASG-PPP em A, finalizou o tratamento nessa mesma categoria (41,7%). Mais de 40% dos pacientes do grupo intervenção alcançaram as necessidades calóricas durante cinco semanas do tratamento. Conclusão: Encontraram-se resultados significativos para menor perda de peso em pacientes com aconselhamento nutricional diário que podem futuramente ser precursores de diretrizes que orientem e direcionem profissionais a condutas específicas aos pacientes com esse perfil.

Introduction: The presence of a nutritionist in the radiotherapy sector intends to recover and maintain the nutritional status of the patients. Objective: To compare the results of daily nutritional counseling with weekly nutritional advising for patients with head, neck and esophagus cancer in radiotherapy treatment. Method: 29 patients were assigned to the study and randomly divided into two groups. The intervention group received nutritional advice daily. The standard group received weekly nutritional counseling. For both groups, body weight, calf or calf circumference, global subjective evaluation produced by the patient (ASG-PPP) and calculation of the daily dietary recall were measured. Results: The majority of the participants were male (80%), mean age 62.7 ± 26 years. Oral nutrition therapy was required treatment 60% were in use of enteral nutrition. The mean weight loss in the intervention group was 1.89 ± 2.58 kg compared to the mean weight loss in the standard group of 9.92 ± 6.68 kg (p <0.001). Half of the patients in the intervention group who began treatment categorized by ASG-PPP in A, finished treatment in the same category (41.7%). More than 40% of patients in the intervention group achieved caloric needs during five weeks of treatment. Conclusion: This study found significant results for lower weight loss in patients with daily nutritional counseling. These results may in the future be precursors of guidelines that steer and direct professionals to specific conducts to patients with this profile.

Introducción: La presencia de un nutricionista en el sector de radioterapia intenciona la recuperación y mantenimiento del estado nutricional de los pacientes. Objetivo: Comparar los resultados del asesoramiento nutricional diario con el asesoramiento nutricional semanal en pacientes con cáncer de cabeza, cuello y esófago en tratamiento radioterápico. Método: Fueron seleccionados 29 pacientes para el estudio y separados aleatoriamente en dos grupos. El grupo de intervención recibió asesoramiento nutricional diariamente. El grupo estándar recibió asesoramiento nutricional semanalmente. De ambos grupos se evaluaron peso corporal, circunferencia braquial o de pantorrilla, evaluación subjetiva global producida por el propio paciente (ASG-PPP) y cálculo del recordatorio alimentario diario. Resultados: La mayoría de los participantes eran del sexo masculino (80%), con una media de edad de 62,7 ± 26 años. La terapia nutricional oral fue necesaria para el 48% de los individuos y al final del tratamiento el 60% estaban en uso de nutrición enteral. La pérdida de peso media en el grupo de intervención fue de 1,89 ± 2,58 Kg comparada con la pérdida media de peso en el grupo estándar de 9,92 ± 6,68 Kg (p<0,001). La mitad de los pacientes del grupo intervención que iniciaron el tratamiento categorizados por la ASG-PPP en A, finalizaron el tratamiento en esa misma categoría (41,7%). Más del 60% de los pacientes del grupo de intervención alcanzaron las necesidades calóricas durante cinco semanas del tratamiento. Conclusión: Este estudio encontró resultados significativos para una menor pérdida de peso en pacientes con asesoramiento nutricional diario. Estos resultados pueden en el futuro ser precursores de pautas que orientan y dirigen profesionales a conductas específicas a los pacientes con este perfil.

A comparison of results by sequential and concurrent chemo radiotherapy in locally advanced carcinoma esophagus.

Aim: Many Trials using sequential and concurrent chemo radiotherapy have been done so far and has established the role of concurrent chemo radiotherapy in treatment of inoperable carcinoma esophagus. In this study, we have compared the results of concurrent chemo radiotherapy with sequential chemo radiotherapy. We have treated inoperable carcinoma esophagus in both the settings and present here the comparison of results in the two settings. Materials and Methods: There were 26 patients of carcinoma esophagus in sequential and 31 in concurrent chemo radiotherapy arm. In sequential arm methotrexate and Cisplatin followed by radiotherapy was given whereas in concurrent arm, Cisplatin was given once weekly along with radiotherapy. Results: The 2 year survival was 38% in sequential and35.5% in the concurrent setting and the median survival was 19.5 and 18 months respectively in the two arms.The toxicities in both the arms were comparable. P value of 0.4774 with confidence interval of 95% was obtained, which is not significant. Dysphagia was improved earlier in sequential than in the concurrent arm. Conclusion: As the results and toxicities in both the arms are almost similar with better symptom control, so larger randomized trials are required to assess the response and the use of methotrexate in sequential chemo radiotherapy can be further explored.

Revisión bibliográfica de cáncer de esófago / Literature review of esophageal cancer

El cáncer de esófago es una patología asociada a gran mortalidad ya que generalmente su diagnóstico es tardío. Existen múltiples factores de riesgo que pueden influir es su aparición que varían según el tipo histológico presente. El 95 por ciento de estas neoplasias pertenecen a 2 tipos histológicos: Adenocarcinoma y Carcinoma Epidermoide. Gracias a las características anatómicas del esófago, los síntomas pueden aparecer de manera tardía lo que dificulta su sospecha. Existen múltiples estudios por imágenes que permiten hacer un diagnóstico y clasificación de la lesión de manera certera. La cirugía es el procedimiento que presenta mejores resultados curativos, sin embargo no todos los pacientes son candidatos para la misma. Por lo tanto la quimioterapia así como la radioterapia brindan un buen soporte como tratamiento neoadyudante o adyudante.

Terapêutica neo-adjuvante aumenta as complicações pós-operatórias da esofagectomia / Does neoadjuvant therapy increase postoperative complications of esophagectomy

RACIONAL: O câncer de esôfago é o oitavo tipo de câncer mais incidente na população no mundo, sendo que no Brasil são estimados 10.630 novos casos para o ano de 2010. Na terapêutica curativa, a esofagectomia destaca-se nas suas mais diversas modalidades de tratamento. OBJETIVO: Avaliar por meio de um estudo retrospectivo não-randomizado as complicações peri-operatórias dos pacientes submetidos à esofagectomia por carcinoma epidermóide do esôfago, com ou sem terapêutica neo-adjuvante. MÉTODOS: Foram analisados 123 pacientes operados, submetidos na sua maioria (80 por cento) à esofagectomia transmediastinal com anastomose esofagogástrica cervical, assim distribuídos: 81 (65,8 por cento) submetidos à radioterapia neo-adjuvante, 16 (13 por cento) à radioterapia e quimioterapia neo-adjuvantes e 26 (21,2 por cento) à cirurgia exclusiva. RESULTADOS: As principais complicações consideradas foram: hemorragia intra-operatória (4 por cento), pneumotórax / hemotórax (73,1 por cento), broncopneumonia (20,3 por cento) e fístulas e estenose de anastomose (44,7 por cento). Não houve diferenças significativas nas complicações entre os grupos, exceto em relação pneumotórax / hemotórax em que houve menor ocorrência no grupo de cirurgia exclusiva. A mortalidade geral foi de 14 casos (8,8 por cento), não relacionada ao tratamento empregado. CONCLUSÃO: O emprego da terapêutica neo-adjuvante com quimioterapia e radioterapia com a finalidade de obter-se melhor sobrevida e taxas de ressecção completa não resultou em aumento nas complicações peri-operatórias.

BACKGROUND: Esophageal cancer is the eighth most frequent type of cancer in the population in the world, and in Brazil 10.630 new cases are estimated for the year 2010. In curative treatment, esophagectomy stands out in its various treatment modalities. AIM: To assess by means of a retrospective nonrandomized the perioperative complications of patients submitted to esophagectomy for squamous cell carcinoma of the esophagus, with or without neoadjuvant therapy. METHODS: Were analyzed 123 patients operated, undergoing mostly (80 percent) transmediastinal esophagectomy with cervical esophagogastric anastomosis, distributed as follows: 81 (65.8 percent) underwent radiotherapy neo-adjuvant, 16 (13 percent) chemoradiotherapy neoadjuvant and 26 (21,2 percent) to surgery alone. RESULTS: Major complications considered were: intraoperative hemorrhage (4 percent), pneumothorax / hemothorax (73.1 percent), pneumonia (20.3 percent) and fistula and anastomotic stenosis (44.7 percent). No significant differences in complications between the groups, except for pneumothorax / hemothorax in which there was a lower incidence in the group of surgery alone. Overall mortality was 14 cases (8.8 percent), unrelated to the treatment used. CONCLUSION: The neoadjuvant chemoradiotherapy in order to obtain better survival rates and complete resection resulted in no increase in perioperative complications.

[Evaluation of dose distribution accuracy in HDR brachytherapy of esophagus cancer based on MRI normoxic polymer gel dosimetry]

The purpose of this work was to study the ability of MRI normoxic polymer gel dosimetry for evaluating the dose distribution in HDR brachytherapy of esophageal cancer at Imam Reza brachytherapy center [Mashahd, Iran]. Initially, 2 liters of normoxic gel [MAGIc] was fabricated and then poured into 12 calibration test tubes and placed in a perspex walled phantom. The gel phantom was irradiated with a brachytherapy remote-afterloader unit using a cobalt-60 brachytherapy source and the test tubes wee irradiated with a range of known doses with a cobalt-60 teletherapy unit. Imaging was performed with a multi-spin-eco protocol and a T2 quantitative technique using a Siemens 1.5 T MRI machine. The MRI images were transferred to a computer and then image processing was performed in the MATLAB environment to extract R2 maps of the irradiated area. In this study and at the reference point, the dose deviation between the gel dosimetry and the calculated data was 4.5%. The distance to agreement [DTA] for dose profiles was 2.7 mm. Also, dose sensitivity of the MAGIC gel dosimeter was 0.693 S-1Gy-1 [R2=0.9376]. In this work, the data obtained from TPS calculations were found in very good agreement with the measured results provided by gel dosimetry. It was evaluated using a comparison of isodoses and dose at the reference point, and dose profile verification. It is also concluded that the gel dosimetry systems have proven to be a useful tool for dosimetry in clinical radiotherapy applications

Aspectos atuais da terapêutica neo-adjuvante no carcinoma epidermóide do esôfago. Revisão da literatura / New aspects of the neo-adjuvant therapy in esophageal squamous cell carcinoma. A review of medical literature

INTRODUÇÃO: O câncer de esôfago é o oitavo tipo de câncer mais incidente na população, com alta letalidade a despeito da melhora do tratamento cirúrgico nas últimas décadas. O carcinoma epidermóide tem maior prevalência em vários países em também no Brasil. Sendo assim, estratégias de tratamento neo-adjuvante tornaram-se objeto de estudo em vários centros mundiais de referência.OBJETIVO: Identificar aspectos atuais da terapêutica neo-adjuvante no tratamento do carcinoma epidermóide do esôfago.MÉTODOS: Revisão bibliográfica de artigos científicos disponíveis no Medline e na base de dados Cochrane cruzando-se os descritores neoplasia esofágicas, cirurgia, quimioterapia, radioterapia.CONCLUSÃO: A estratégia da terapêutica neo-adjuvante é cada vez mais utilizada como forma de oferecer melhores resultados tardios na sobrevida e na qualidade de vida dos pacientes portadores de carcinoma do esôfago.

INTRODUCTION: Esophageal neoplasm is the eighth more prevalent cancer in the general population, with high letality in spite of improvements in surgery in the last decades. The squamous cell carcinoma have higher prevalence in many countries and also in Brazil. Therefore, treatment strategies become target of study in many reference centres around the world.AIM: To identify the new aspects of the neo-adjuvant therapy in the esophageal squamous cell carcinoma.METHODS: Bibliography review of scientific papers available at Medline and Cohchrane Database crossing the following headings: esophageal neoplasms, surgery, drug therapy, radiotherapy.CONCLUSION: Neo-adjuvant therapy is increasingly employed in patients with carcinoma of the esophagus in efforts to improve survival and quality of life of these patients.

Concurrent Chemoradiotherapy Compared with Concurrent Chemoradiotherapy with Surgery in Locally Advanced Resectable Esophageal Cancer / 대한소화기학회지

BACKGROUND/AIMS: This study was designed to compare the survival rates between patients with localized esophgeal cancer who were treated with concurrent chemoradiation therapy without surgery and patients who were treated with concurrent chemoradiation therapy including surgery. METHODS: Eighty-eight patients from January 1997 to December 2005 with locally advaned resectable esophageal cancer were selected and retrospectively analyzed. Survival period was defined as the time to death from the date of diagnosis or mid-monitor period of December 2005. Sixty-one patients were treated with chemoradiation therapy alone while twenty-seven patients were treated with chemoradiation therapy in addition to surgery as for curative intention. As for radiation therapy, 5,000-5,500 cGY was used. 5-Fluouracil and cisplatin were used for chemotherapy. The primary end point was overall survival time. The secondary end point was overall progression free survival time. RESULTS: There was no significant difference in tissue type, location and clinical staging, but the median age was significantly younger in the group treated with surgery (63.4 years) than the group treated without surgery (68.8 years). Median period analyzed was 17.3 months. Five year survival rate for the group with chemoradiation alone was 7.4% and 4% for the group with surgery. The median survival rate was 11+/-3 months for the group with chemoradiation alone and 10+/-6 months for the group with surgery, in which there was no statistical difference (p=0.697). CONCLUSIONS: There was no significant increase in survival rate in patients who were treated by chemoradiation with surgery compared with chemoradiation alone. Further analysis in terms of prospective study is needed.

Treatment of Esophageal Cancer / 대한소화기학회지

Esophageal cancer is usually detected in the advanced stage due to its anatomical characteristics. Recently, early esophageal cancers are detected more frequently with the nationwide screening of digestive tract cancer and development of new endoscopic technology in Korea. From the treatment view point, esophageal cancer can be categorized into early, locally advanced resectable, locally advanced unresectable, and metastatic esophageal cancer. Traditionally, surgery has been the mainstay of treatment for resectable esophageal cancer. However, endoscopic resection can be another therapeutic option in selected early esophageal cancer cases. Although most studies with preoperative chemoradiotherapy and subsequent surgery in locally advanced resectable cancer could not demonstrate definite survival benefit, many authorities prefer this multimodality approach to surgery alone. Best supportive care is always necessary for those with unresectable esophageal cancer, and palliation for dysphagia can be considered according to the patients' status. For the best management of esophageal cancer, the development of diagnostic method for more accurate staging should be followed.

Cáncer de esófago aspectos clínicos y manejo quirúrgico / Esophageal cancer clinical and surgical management

El presente trabajo permite evaluar la casuística de pacientes admitidos al Departamento de Tórax del INEN con el diagnóstico de cáncer de esófago con confirmación histológica, a quienes se les registró las sintomatología de inicio, tiempo de enfermedad, signos clínicos en la primera consulta, estudio radiológicos incluyendo radiografía de tórax y tránsito esofágico baritado, esofagoscopía, perfil hematológico y bioquímico, performance clínico y estadio clínico de la enfermedad. Se consigna la localización topográfica del tumor, extensión del mismo, valoración del compromiso tumoral en la vecindad mediante tomografía computada de tórax. Se analiza la modalidad terapéutica diseñada de acuerdo al estadío clínico de la enfermedad. Solamente el 10% de los pacientes operados, constituye el grupo de pacientes con enfermedad temprana, quienes fueron sometidos a esofagectomía utilizando diferentes técnicas operatorias, para la remoción del tumor, ganglios regionales y reconstrucción de neoesófago. Mediante la utilización de análisis estadísticos se evalúa la sobrevida a 5 años.

The present work allows to evaluate the casuistic of patients admitted to hte Department of Thorax of the INEN with the diagnosis of esophagus cancer with histologic confirmation to who were registered the beginning symptoms, time of illness clinical sings in the first consultation, radiological study including thorax x-ray and traffic esophageal swallow, esophagoscopy, hematological and biochemical profile, clinical performance and clinical stage of the illnes. The topographical localization of the tumor, extension of the same one, valuation of the commitment tumoral in the vicinity by means of computed tomography of thorax is consigned. The therapeutic modality is analyzed designed according to the clinical staging of the illnes. Only the 10% of the operated patients, it constitutes the group of patient with early illness who you/they were subjected to esophagectomy using different technical operative, for the removal of the tumor, regional ganglion and reconstruction of the neoesophagus. By means of the use of statistical analysis the survival is evaluated to 5 years.

Terapia neoadyuvante en cáncer de esófago / Neoadjuvant therapy for esophageal cancer

El cáncer de esófago sigue siendo una patología pésimo pronóstico, principalmente por lo tardío del diagnóstico y el consiguiente tratamiento en estadios avanzados. En este artículo se revisa la terapia del cáncer de esófago con especial énfasis en la terapia neoadyuvante. Se mencionan los resultados con cada tipo de terapia en cuanto a su influencia sobre la sobrevida, mortalidad operatoria, y toxicidad de los esquemas. La radioterapia preoperatoria no mejora la sobrevida de los pacientes con cáncer de esófago. Si lo hacen la quimioterapia y la radioquimioterapia (QMRDT) neoadyuvantes, pero con una toxicidad no despreciable. Se concluye que la QMRDT es actualmente la mejor terapia neoadyuvante.

Endocavitary radiotherapy in carcinoma oesophagus.

Radiation therapy is often used in an attempt to palliate or cure oesophageal neoplasms. However, the radiation tolerance of the normal structures around the oesophagus (heart, lung and spinal cord) restricts the radiation dose that can be delivered. We used a nasogastric catheter to deliver High Dose Intra-luminal Iridium-192 irradiation for carcinoma of the oesophagus using HDR-Varisource machine. This technique for treatment of carcinoma of the oesophagus can help overcome the dose restraints. The external beam radiation dose was about 46 Gy and the intra luminal dose was 5 Gy at 1 cm from central axis. These after loading procedures are simple, fast and accurate and can be used to boost external radiation therapy doses. Since the intra luminal boost delivers a high-localized dose with little side effects, this simple technique should be used to obtain palliation, delay tumour progression, reduce overall treatment time and attempt to improve survival in patients with oesophageal neoplasm. Intra luminal brachytherapy helps achieve good palliation in these neoplasms.

Small cell carcinoma of the esophagus

Primary Small Cell Carcinoma [SCC] of the esophagus is a rare but very malignant tumor characterized by early dissemination and poor prognosis if untreated. It is similar in appearance and behavior to its counterpart of the lung. Combination chemotherapy is the mainstay of treatment, though the standard treatment for esophageal SCC has not been defined yet due to the paucity of cases. The prognosis is generally dismal regardless of treatment. This patient of small cell carcinoma esophagus presented with liver and lung metastases and was treated with palliative radiotherapy and combination chemotherapy

Response to chemoradiation in patients with squamous cell carcinoma of esophagus treated at Shohada-e-Tajrish hospital

Esophageal carcinoma is among the first ten common malignancies worldwide, with a high prevalence in Iran. Previously, surgery or radiotherapy were the only modalities of therapy; however, due to unsatisfactory outcomes, other therapeutic approaches such as chemoradiation are now under assessment as the first line treatment. Preliminary results have shown reduced local recurrence and better survival. It was a quasi experimental study. Patients with squamous cell carcinoma of esophagus who had the following criteria were enrolled: lack of previous therapy, no metastasis, performance status of 0-2, and normal liver, kidney and bone marrow function tests. Chemoradiation was carried out through one of the following regimens: 1- Cisplatin 40mg/m2/weekly + 50-60Gy radiation; or, 2- Cisplatin 75mg/m2 for the first day + 5-FU 1000mg/m2 for the first 4 days of weeks 1, 5, 9, and 13 + 50Gy radiation. Following the therapy, biopsies of suspected lesions and CT scan of local lymph nodes were obtained to evaluate the response rate. Of 39 patients with non-metastatic squamous cell carcinoma of esophagus who had been referred to our unit during a 5-year period [1998-2003], 30 met the inclusion criteria. The study population included 23 males and 7 females with a mean age of 65 years [35-77 years]. Tumor location was as follows: upper third of esophagus in 6, middle third in 12, and lower third in 12 patients. Twenty-one patients were put on the first protocol and the remaining nine patients on the second regimen. There were 2 deaths, one due to fever and neutropenia, and the other of uncertain cause. Clinical response to therapy was reported in 23 [76.6%] patients. Chemoradiation showed a low complication rate and high efficacy. It can be safely recommended for inoperable patients. Further clinical trials are necessary before definite recommendations can be made