Swallowing Safety after Remote sub-total Esophagectomy: How Important is Tongue Pressure?

The factors related to oropharyngeal dysphagia after remote esophagectomy (greater than five months) remain unclear. This study aimed to assess patient perception of dysphagia, maximum anterior isometric pressure (MAIP), maximum posterior isometric pressure (MPIP), lingual swallowing pressure (LSP) and radiographic physiological components of the oral and pharyngeal phases of swallowing in patients who are post remote sub-total esophagectomy (SE). Patient perception of dysphagia was assessed using the Eating Assessment Tool (EAT-10). MAIP, MPIP, and LSP were measured using the Iowa Oral Performance Instrument. Videofluoroscopy was used to assess the physiologic components of swallowing with the Modified Barium Swallow Impairment Profile (MBSImP) and the Penetration-Aspiration Scale (PAS). Ten patients were included in the study (53.2% male; mean age 54.5 ± 18.0). The mean postoperative time was 30 months (range, 5.0-72 months). Seven patients had elevated EAT-10 scores (> 3). All patients demonstrated impaired oropharyngeal swallowing on at least three MBSImP components (range 3-12) and two patients aspirated (PAS 8). There was a significant difference in MAIP values when comparing patients with normal versus impaired laryngeal elevation and epiglottic movement (p < 0.001). MPIP values were significantly different in patients with normal versus impaired epiglottic movement as well as normal versus elevated PAS scores (p < 0.001). Decreased lingual pressure and physiological changes in swallowing coexist after SE. Our results indicate that the decrease in tongue strength may be one of the factors related to unsafe swallow. The assessment of lingual pressure provides diagnostic value and should be incorporated as part of a comprehensive assessment in this population.

Prognosis value of heat-shock proteins in esophageal and esophagogastric cancer: A systematic review and meta-analysis.

BACKGROUND: Heat shock proteins (HSPs) are molecular chaperones that play an important role in cellular protection against stress events and have been reported to be overexpressed in many cancers. The prognostic significance of HSPs and their regulatory factors, such as heat shock factor 1 (HSF1) and CHIP, are poorly understood. AIM: To investigate the relationship between HSP expression and prognosis in esophageal and esophagogastric cancer. METHODS: A systematic review was conducted in accordance with PRISMA recommendations (PROSPERO: CRD42022370653), on Embase, PubMed, Cochrane, and LILACS. Cohort, case-control, and cross-sectional studies of patients with esophagus or esophagogastric cancer were included. HSP-positive patients were compared with HSP-negative, and the endpoints analyzed were lymph node metastasis, tumor depth, distant metastasis, and overall survival (OS). HSPs were stratified according to the HSP family, and the summary risk difference (RD) was calculated using a random-effect model. RESULTS: The final selection comprised 27 studies, including esophageal squamous cell carcinoma (21), esophagogastric adenocarcinoma (5), and mixed neoplasms (1). The pooled sample size was 3465 patients. HSP40 and 60 were associated with a higher 3-year OS [HSP40: RD = 0.22; 95% confidence interval (CI): 0.09-0.35; HSP60: RD = 0.33; 95%CI: 0.17-0.50], while HSF1 was associated with a poor 3-year OS (RD = -0.22; 95%CI: -0.32 to -0.12). The other HSP families were not associated with long-term survival. HSF1 was associated with a higher probability of lymph node metastasis (RD = -0.16; 95%CI: -0.29 to -0.04). HSP40 was associated with a lower probability of lymph node dissemination (RD = 0.18; 95%CI: 0.03-0.33). The expression of other HSP families was not significantly related to tumor depth and lymph node or distant metastasis. CONCLUSION: The expression levels of certain families of HSP, such as HSP40 and 60 and HSF1, are associated with long-term survival and lymph node dissemination in patients with esophageal and esophagogastric cancer.

Esófago de Barrett: Actualización en el diagnóstico y tratamiento / Barrett's Esophagus: Update on the Diagnosis and Treatment. Review

El esófago de Barrett (EB) se define como la condición en la cual una mucosa columnar metaplásica predispuesta a neoplasia reemplaza la mucosa escamosa del esófago distal. La guías actuales recomiendan que el diagnóstico requiere el hallazgo de metaplasia intestinal (MI) con células caliciformes de al menos 1 cm de longitud. El EB afecta aproximadamente al 1% de la población general y hasta en 14% de los pacientes con enfermedad por reflujo gastroesofágico (ERGE). El EB es precursor del adenocarcinoma esofágico (ACE), neoplasia en aumento en países occidentales. Los principales factores de riesgo descritos para ACE asociado a EB son: sexo masculino, edad > 50 años, obesidad central y tabaquismo. El riesgo anual de ACE en EB sin displasia, displasia de bajo (DBG) y alto grado es 0,1-0,3%, 0,5% y 5-8%, respectivamente. El tratamiento del EB no displásico consiste en un cambio de estilo de vida saludable, quimioprevención mediante inhibidores de la bomba de protones y vigilancia endoscópica cada 3 a 5 años. Se recomienda que a partir de la presencia de DBG los pacientes sean referidos a un centro experto para la confirmación del diagnóstico, estadio y así definir su manejo. En pacientes con EB y displasia o cáncer incipiente, el tratamiento endoscópico consiste en la resección y ablación, con un éxito cercano al 90%. El principal evento adverso es la estenosis esofágica que es manejada endoscópicamente.

Barrett's esophagus (BE) is the condition in which a metaplastic columnar mucosa predisposed to neoplasia replaces the squamous mucosa of the distal esophagus. The current guidelines recommends that diagnosis requires the finding of intestinal metaplasia (IM) with goblet cells of at least 1 cm in length. BE affects approximately 1% of the general population and up to 14% of patients with gastroesophageal reflux disease (GERD). BE is a precursor of esophageal adenocarcinoma (EAC), which has increased in western countries. The main risk factors described for EAC associated with BE are male sex, age > 50 years, central obesity and tobacco use. Annual risk of EAC in patients with BE without dysplasia, low grade (LGD) and high-grade dysplasia is 0,1-0,3%, 0,5% y 5-8%, respectively. Treatment of non-dysplastic BE consists mainly of a healthy lifestyle change, chemoprevention with proton pump inhibitors and surveillance endoscopy every 3 to 5 years. It is recommended that from the presence of LGD patients are referred to an expert center for confirmation of the diagnosis, stage and thus define their management. In patients with BE and dysplasia or early-stage cancer, endoscopic therapy with resection and ablation is successful in about 90% of the patients. The main adverse event is esophageal stricture, which is managed endoscopically.

The impact of sarcopenia on esophagectomy for cancer: a systematic review and meta-analysis.

BACKGROUND: Esophagectomy is the gold-standard treatment for locally advanced esophageal cancer but has high morbimortality rates. Sarcopenia is a common comorbidity in cancer patients. The exact burden of sarcopenia in esophagectomy outcomes remains unclear. Therefore, this systematic review and meta-analysis were performed to establish the impact of sarcopenia on postoperative outcomes of esophagectomy for cancer. METHODS: We performed a systematic review and meta-analysis comparing sarcopenic with non-sarcopenic patients before esophagectomy for cancer (Registration number: CRD42021270332). An electronic search was conducted on Embase, PubMed, Cochrane, and LILACS, alongside a manual search of the references. The inclusion criteria were cohorts, case series, and clinical trials; adult patients; studies evaluating patients with sarcopenia undergoing esophagectomy or gastroesophagectomy for cancer; and studies that analyze relevant outcomes. The exclusion criteria were letters, editorials, congress abstracts, case reports, reviews, cross-sectional studies, patients undergoing surgery for benign conditions, and animal studies. The meta-analysis was synthesized with forest plots. RESULTS: The meta-analysis included 40 studies. Sarcopenia was significantly associated with increased postoperative complications (RD: 0.08; 95% CI: 0.02 to 0.14), severe complications (RD: 0.11; 95% CI: 0.04 to 0.19), and pneumonia (RD: 0.13; 95% CI: 0.09 to 0.18). Patients with sarcopenia had a lower probability of survival at a 3-year follow-up (RD: -0.16; 95% CI: -0.23 to -0.10). CONCLUSION: Preoperative sarcopenia imposes a higher risk for overall complications and severe complications. Besides, patients with sarcopenia had a lower chance of long-term survival.

Self-expandable metallic stent-induced esophagorespiratory fistulas in patients with advanced esophageal cancer.

BACKGROUND/AIMS: Self-expandable metallic stents (SEMSs) are widely adopted for the palliation of dysphagia in patients with malignant esophageal strictures. An important adverse event is the development of SEMS-induced esophagorespiratory fistulas (SEMS-ERFs). This study aimed to assess the risk factors related to the development of SEMS-ERF after SEMS placement in patients with esophageal cancer. METHODS: This retrospective study was performed at the Instituto do Cancer do Estado de São Paulo. All patients with malignant esophageal strictures who underwent esophageal SEMS placement between 2009 and 2019 were included in the study. RESULTS: Of the 335 patients, 37 (11.0%) developed SEMS-ERF, with a median time of 129 days after SEMS placement. Stent flare of 28 mm (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.15-5.51; p=0.02) and post-stent chemotherapy (HR, 2.0; 95% CI, 1.01-4.00; p=0.05) were associated with an increased risk of developing SEMS-ERF, while lower-third tumors were a protective factor (HR, 0.5; 95% CI, 0.26-0.85; p=0.01). No difference was observed in overall survival. CONCLUSION: The incidence of SEMS-ERFs was 11%, with a median time of 129 days after SEMS placement. Post-stent chemotherapy and a 28 mm stent flare were associated with a higher risk of SEMS-ERF.

Curva de aprendizagem de dissecção endoscópica de submucosa por endoscopistas ocidentais treinados no Japão: Experiência na América Latina / Learning curve in esophageal endoscopic submucosal dissection by western endoscospists trained in japan: experience in latin america

ABSTRACT Background: Esophageal endoscopic submucosal dissection (EESD) is a complex and time-consuming procedure at which training are mainly available in Japan. There is a paucity of data concerning the learning curve to master EESD by Western endoscopists. Objective: This study aimed to assess the learning curve effect on patient's clinical outcome for EESD. Methods: This is a retrospective observational study. Enrolling patients that underwent EESD from 2009 to 2021. The analysis was divided into two periods; T1: case 1 to 49 and T2: case 50 to 98. The following features were analyzed for each group: patients and tumors characteristics, en-bloc, complete and curative resection rates, procedure duration and adverse events rate. Results: Ninety-eight EESD procedures were performed. Mean procedure time was 111.8 min and 103.6 min for T1 and T2, respectively (P=0.004). En bloc resection rate was 93.8% and 97.9% for T1 and T2, respectively (P=0.307). Complete resection rate was 79.5% and 85.7% for T1 and T2, respectively (P=0.424). Curative resection rate was 65.3% and 71.4% for T1 and T2, respectively (P=0.258). Four patients had complications; three during T1 period and one during T2 period. Overall mortality rate: 0%. Conclusion: The esophageal endoscopic submucosal dissection could be performed effectively and safely by an adequately trained Western endoscopist.

RESUMO Contexto: A dissecção endoscópica da submucosa do esôfago (DSEE) é um procedimento complexo, cujo treinamento está disponível principalmente no Japão. Há uma escassez de dados sobre a curva de aprendizado para se capacitar na realização da DSEE por endoscopistas ocidentais. Objetivo: Este estudo teve como objetivo avaliar o efeito da curva de aprendizado no resultado clínico dos pacientes submetidos a DSEE. Métodos: Trata-se de um estudo observacional retrospectivo. Foram incluídos pacientes submetidos a DSEE no período de 2009 a 2021. A análise foi dividida em dois períodos; T1: caso 1 a 49 e T2: caso 50 a 98. Os seguintes parâmetros foram analisados para cada grupo: características clínicas dos pacientes e dos tumores de esôfago, taxas de ressecção em bloco, completa e curativa, duração do procedimento e taxa de eventos adversos. Resultados: Noventa e oito procedimentos de DSEE foram realizados. O tempo médio do procedimento foi de 111,8 min e 103,6 min nos períodos T1 e T2, respectivamente (P=0,004). A taxa de ressecção em bloco foi de 93,8% e 97,9% nos períodos T1 e T2, respectivamente (P=0,307). A taxa de ressecção completa foi de 79,5% e 85,7% nos períodos T1 e T2, respectivamente (P=0,424). A taxa de ressecção curativa foi de 65,3% e 71,4% para T1 e T2, respectivamente (P=0,258). Quatro pacientes tiveram complicações; três durante o período T1 e um durante o período T2. Taxa de mortalidade geral: 0%. Conclusão: A DSEE pode ser realizada de forma eficaz e segura por um endoscopista ocidental adequadamente treinado.

Diagnóstico y tratamiento de los tumores de la unión esofagogástrica. Experiencia en el Instituto Nacional de Cancerología / Diagnosis and treatment of esophagogastric junction tumors. Experience at the National Cancer Institute

Introducción. El diagnóstico adecuado de los tumores de la unión esofagogástrica es esencial para el tratamiento de estos pacientes. La clasificación propuesta por Siewert-Stein define las características propias, factores de riesgo y estrategias quirúrgicas según la localización. El objetivo de este estudio fue describir las características de los pacientes con adenocarcinoma de la unión esofagogástrica tratados en nuestra institución. Métodos. Estudio retrospectivo, descriptivo, de corte longitudinal, que incluyó los pacientes con diagnóstico de adenocarcinoma de la unión esofagogástrica intervenidos quirúrgicamente en el Instituto Nacional de Cancerología, Bogotá, D.C., Colombia, entre enero de 2012 y mayo de 2017. Resultados. Se operaron 59 pacientes (84,7 % hombres), con una edad media de 62,5 años. En su orden de frecuencia los tumores fueron tipo II (57,6 %), tipo III (30,7 %) y tipo I (11,9 %). El 74,6 % recibieron neoadyuvancia y se realizó gastrectomía total en el 73 % de los pacientes. La concordancia diagnóstica moderada con índice Kappa fue de 0,56, difiriendo con la endoscópica en 33,9 %. El 10,2 % de los pacientes presentó algún tipo de complicación intraoperatoria. La supervivencia a tres años en los tumores tipo II fue del 89,6 % y del 100 % en aquellos con respuesta patológica completa. Conclusión. Es necesario el uso de diferentes estrategias para un proceso diagnóstico adecuado en los tumores de la unión esofagogástrica. En esta serie, los pacientes Siewert II, aquellos que recibieron neoadyuvancia y los que obtuvieron una respuesta patológica completa, tuvieron una mejor supervivencia a tres años

Introduction: Proper diagnosis of gastroesophageal junction tumors is essential for the treatment of these patients. The classification proposed by Siewert-Stein defines its own characteristics, risk factors and surgical strategies according to the location. This study describes the characteristics of patients with adenocarcinoma of the esophagogastric junction treated at our institution. Methods. Retrospective, descriptive, longitudinal study, which includes patients diagnosed with adenocarcinoma of the esophagogastric junction who underwent surgery at the National Cancer Institute in Bogotá, Colombia, between January 2012 and May 2017. Results. Fifty-nine patients (84.7% men) were operated on, with a mean age of 62.5 years. In their order of frequency, the tumors were type II (57.6%), type III (30.7%) and type I (11.9%). 74.6% received neoadjuvant therapy and total gastrectomy was performed in 73% of the cases. The moderate diagnostic concordance with the Kappa index was 0.56, differing from the endoscopic one in 33.9%. 10.2% of the patients presented some type of intraoperative complication. Three-year survival in type II tumors was 89.6% and 100% in those with complete pathologic response. Conclusion. The use of different strategies is necessary for an adequate diagnostic process in tumors of the esophagogastric junction. In this series, Siewert II patients, those who received neoadjuvant therapy, and those who obtained a complete pathological response had a better three-year survival

Does neoadjuvant chemoradiotherapy for esophageal and gastroesophageal junction cancer patients affect postoperative outcomes? a study using the becker tumor regression grade system and lymph node regression / A radioterapia e quimioterapia neoadjuvantes para pacientes com câncer de esôfago e junção gastro-esofágica afetam os resultados pós-operatórios? um estudo usando o sistema de regressão tumoral de becker e regressão de linfonodos

ABSTRACT BACKGROUND: The effect of neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced esophageal cancer can be determined by assessing the Becker tumor regression grade in the primary tumor, as well as in lymph nodes. AIMS: The aim of this study was to investigate the anatomopathological changes caused by neoadjuvant chemoradiotherapy and their impact on clinical parameters. Specifically, we analyzed the Becker tumor regression grade, lymph node status, and regression changes and evaluated their association with the Clavien-Dindo classification of surgical complications and overall patient survival. METHODS: This is a retrospective and observational study including 139 patients diagnosed with adenocarcinoma or squamous cell carcinoma of the esophagus and treated with either neoadjuvant chemoradiotherapy followed by surgery or surgery alone. For the 94 patients who underwent neoadjuvant chemoradiotherapy, we evaluated tumor regression by Becker tumor regression grade in primary tumors. We also analyzed lymph node status and regression changes on lymph nodes with or without metastases. Overall survival analysis was performed using Kaplan-Meier curves. RESULTS: Becker tumor regression grade is associated with lower lymphatic permeation (p<0.01) and vascular invasion (p<0.001), but not with lymph node regression rate (p=0.10). Clavien-Dindo classification was associated neither with lymph node regression rate (odds ratio=0.784, p=0.795) nor with tumor regression grade (p=0.68). Patients who presented with lymphatic permeation and vascular invasion had statistically significantly lower median survival (17 vs. 30 months, p=0.006 for lymphatic permeation, and 14 vs. 29 months, p=0.024 for vascular invasion). CONCLUSION: In our series, we were unable to demonstrate an association between Becker tumor regression grade and lymph node regression rate with any postoperative complications. Patients with lower lymphatic permeation and vascular invasion have higher overall survival, correlating with a better response in the Becker tumor regression grade system.

RESUMO RACIONAL: O efeito da quimioradioterapia neoadjuvante em pacientes com câncer de esôfago localmente avançado pode ser determinado pela avaliação do grau de regressão tumoral de Becker no tumor primário, bem como nos linfonodos. OBJETIVOS: Investigar as alterações anatomopatológicas causadas pela quimioradioterapia neoadjuvante e seu impacto nos parâmetros clínicos. Especificamente, analisamos o grau de regressão tumoral de Becker, o status linfonodal e as alterações de regressão e avaliamos sua associação com a Classificação Clavien-Dindo de complicações cirúrgicas e a sobrevida geral dos pacientes. MÉTODOS: Estudo retrospectivo e observacional incluindo 139 pacientes diagnosticados com carcinoma espinocelular de esôfago ou adenocarcinoma da junção esofagogástrica, tratados com quimioradioterapia neoadjuvante seguido de cirurgia ou cirurgia isolada. Para os 94 pacientes submetidos a quimioradioterapia neoadjuvante, avaliamos a grau de regressão tumoral de Becker em tumores primários. Também analisamos o status linfonodal e as alterações de regressão em linfonodos com ou sem metástases. A análise de sobrevida global foi realizada usando curvas de Kaplan-Meier. RESULTADOS: O grau de regressão tumoral de Becker está associado a menor permeação linfática (p<0,01) e invasão vascular (p<0,001), mas não à taxa de regressão linfonodal (p=0,10). A classificação de Clavien-Dindo não foi associada à taxa de regressão linfonodal (OR=0,784; p=0,795) nem ao grau de grau de regressão tumoral (p=0,68). Os pacientes que apresentavam permeação linfática e invasão vascular tiveram sobrevida mediana menor estatisticamente significativa (17 vs 30 meses; p=0,006 para a permeação linfátiva e 14 vs 29 meses; p=0,024, para a invasão vascular, respectivamente). CONCLUSÕES: Em nossa série não conseguimos demonstrar associação entre grau de regressão tumoral de Becker e taxa de regressão linfonodal com quaisquer complicações pós-operatórias. Pacientes com menor permeação linfática e invasão vascular apresentam maior sobrevida global, correlacionando-se com uma melhor resposta no sistema Becker.

Early postoperative outcomes of the esophagectomy minimally invasive in esophageal cancer / Resultados pós-operatórios precoces da esofagectomia minimamente invasiva no câncer do esôfago

ABSTRACT BACKGROUND: The incidence of esophageal cancer is high in some regions and the surgical treatment requires reference centers, with high volume, to make surgery feasible. AIMS: To evaluate patients undergoing minimally invasive esophagectomy by thoracoscopy in prone position for the treatment of esophageal cancer and to recognize the experience acquired over time in our service after the introduction of this technique. METHODS: From January 2012 to August 2021, all patients who underwent the minimally invasive esophagectomy for esophageal cancer were retrospectively analyzed. In order to assess the factors associated with the predefined outcomes as fistula, pneumonia, and intrahospital death, we performed univariate and multivariate logistic regression analyses, accounting for age as an important factor. RESULTS: Sixty-six patients were studied, with mean age of 59.5 years. The main histological type was squamous cell carcinoma (81.8%). The incidence of postoperative pneumonia and fistula was 38% and 33.3%, respectively. Eight patients died during this period. The patient's age, T and N stages, the year the procedure was performed, and postoperative pneumonia development were factors that influenced postoperative death. There was a 24% reduction in the chance of mortality each year, associated with the learning curve of our service. CONCLUSIONS: The present study presented the importance of the team's experience and the concentration of the treatment of patients with esophageal cancer in reference centers, allowing to significantly improve the postoperative outcomes.

RESUMO RACIONAL: A incidência do câncer de esôfago é elevada em algumas regiões e o tratamento cirúrgico requer centros de referência com alto volume para viabilizar a cirurgia. OBJETIVOS: Avaliar os pacientes submetidos à esofagectomia minimamente invasiva, por toracoscopia na posição prona, para o tratamento do câncer de esôfago e conhecer a experiência adquirida ao longo do tempo em nosso serviço após a introdução desta técnica. MÉTODOS: De janeiro de 2012 a agosto de 2021, foram analisados retrospectivamente todos os pacientes submetidos à esofagectomia minimamente invasiva para câncer de esôfago. Para avaliar os fatores associados aos desfechos predefinidos de fístula, pneumonia e óbito intra-hospitalar, realizamos análises de regressão logística univariada e multivariada considerando a idade como fator importante. RESULTADOS: Foram estudados 66 pacientes, com idade média de 59,5 anos. O tipo histológico mais frequente foi carcinoma espinocelular (81,8%). A incidência de pneumonia pós-operatória e fístula foi de 38% e 33,3%, respectivamente. Oito pacientes morreram durante este período. A idade do paciente, os estágios T e N, o ano da realização do procedimento e o desenvolvimento de pneumonia pós-operatória foram fatores que influenciaram o óbito. Houve uma redução de 24% na chance de mortalidade, ano a ano, associada à curva de aprendizado do nosso serviço. CONCLUSÕES: O presente estudo mostrou a importância da experiência da equipe e da concentração do tratamento de pacientes com câncer de esôfago em centros de referência, possibilitando melhorar significativamente o resultado pós-operatório.

Prognostic Value of Bone Marrow Uptake Using 18F-FDG PET/CT Scans in Solid Neoplasms.

BACKGROUND: Fluorine-18-fluorodeoxyglucose positron emission tomography/computerized tomography (18F-FDG PET/CT) uptake is known to increase in infective and inflammatory conditions. Systemic inflammation plays a role in oncologic prognosis. Consequently, bone marrow increased uptake in oncology patients could potentially depict the systemic cancer burden. METHODS: A single institute cohort analysis and a systematic review were performed, evaluating the prognostic role of 18F-FDG uptake in the bone marrow in solid neoplasms before treatment. The cohort included 113 esophageal cancer patients (adenocarcinoma or squamous cell carcinoma). The systematic review was based on 18 studies evaluating solid neoplasms, including gynecological, lung, pleura, breast, pancreas, head and neck, esophagus, stomach, colorectal, and anus. RESULTS: Bone marrow 18F-FDG uptake in esophageal cancer was not correlated with staging, pathological response, and survival. High bone marrow uptake was related to advanced staging in colorectal, head and neck, and breast cancer, but not in lung cancer. Bone marrow 18F-FDG uptake was significantly associated with survival rates for lung, head and neck, breast, gastric, colorectal, pancreatic, and gynecological neoplasms but was not significantly associated with survival in pediatric neuroblastoma and esophageal cancer. CONCLUSION: 18F-FDG bone marrow uptake in PET/CT has prognostic value in several solid neoplasms, including lung, gastric, colorectal, head and neck, breast, pancreas, and gynecological cancers. However, future studies are still needed to define the role of bone marrow role in cancer prognostication.

18F-FDG-PET/CT-measured parameters as potential predictors of residual disease after neoadjuvant chemoradiotherapy in patients with esophageal carcinoma.

Objective: To evaluate the maximum and mean standardized uptake values, together with the metabolic tumor value and the total lesion glycolysis, at the primary tumor site, as determined by 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG-PET/CT), performed before and after neoadjuvant chemoradiotherapy (nCRT), as predictors of residual disease (RD) in patients with esophageal cancer. Materials and Methods: The standardized uptake values and the volumetric parameters (metabolic tumor value and total lesion glycolysis) were determined by 18F-FDG-PET/CT to identify RD in 39 patients before and after nCRT for esophageal carcinoma. We used receiver operating characteristic curves to analyze the diagnostic performance of 18F-FDG-PET/CT parameters in the definition of RD. The standard of reference was histopathological analysis of the surgical specimen. Results: Eighteen patients (46%) presented RD after nCRT. Statistically significant areas under the curve (approximately 0.72) for predicting RD were obtained for all four of the variables evaluated after nCRT. Considering the presence of visually detectable uptake (higher than the background level) at the primary tumor site after nCRT as a positive result, we achieved a sensitivity of 94% and a specificity of 48% for the detection of RD. Conclusion: The use of 18F-FDG-PET/CT can facilitate the detection of RD after nCRT in patients with esophageal cancer.

Objetivo: Avaliar os valores máximo e médio de captação padronizada, o valor metabólico do tumor e a glicólise total da lesão do local do tumor primário, medidos no estudo de 18F-FDG-PET/CT realizado antes e depois da quimiorradioterapia neoadjuvante (nQRT) em pacientes com câncer de esôfago, como preditores de doença residual (DR). Materiais e Métodos: Os valores máximo e médio de captação padronizada e os parâmetros volumétricos (valor metabólico do tumor e glicólise total da lesão) da 18F-FDG-PET/CT realizada em 39 pacientes antes e após a nQRT para carcinoma de esôfago foram avaliados para RD. Usamos curvas receiver operating characteristic (ROC) para analisar o desempenho diagnóstico dos parâmetros 18F-FDG-PET/CT na definição de RD. O estudo anatomopatológico foi utilizado como padrão ouro. Resultados: Dezoito pacientes (46%) apresentaram DR após a nQRT. Áreas estatisticamente significativas sob a curva ROC para predizer DR foram obtidas para as quatro variáveis nos estudos realizados após a nQRT, com áreas sob a curva ROC semelhantes em torno de 0,72. Considerando a presença de captação visualmente detectável (captação maior que o background) no local da lesão primária após a nQRT como resultado positivo, teríamos uma sensibilidade de 94% e uma especificidade de 48% para detecção de DR. Conclusão: A 18F-FDG-PET/CT pode ser útil para detectar a presença de doença neoplásica residual no câncer de esôfago após a nQRT.

18F-FDG-PET/CT-measured parameters as potential predictors of residual disease after neoadjuvant chemoradiotherapy in patients with esophageal carcinoma / 18F-FDG-PET/CT após quimiorradioterapia neoadjuvante em pacientes com carcinoma de esôfago como potencial preditor de doença residual

Abstract Objective: To evaluate the maximum and mean standardized uptake values, together with the metabolic tumor value and the total lesion glycolysis, at the primary tumor site, as determined by 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG-PET/CT), performed before and after neoadjuvant chemoradiotherapy (nCRT), as predictors of residual disease (RD) in patients with esophageal cancer. Materials and Methods: The standardized uptake values and the volumetric parameters (metabolic tumor value and total lesion glycolysis) were determined by 18F-FDG-PET/CT to identify RD in 39 patients before and after nCRT for esophageal carcinoma. We used receiver operating characteristic curves to analyze the diagnostic performance of 18F-FDG-PET/CT parameters in the definition of RD. The standard of reference was histopathological analysis of the surgical specimen. Results: Eighteen patients (46%) presented RD after nCRT. Statistically significant areas under the curve (approximately 0.72) for predicting RD were obtained for all four of the variables evaluated after nCRT. Considering the presence of visually detectable uptake (higher than the background level) at the primary tumor site after nCRT as a positive result, we achieved a sensitivity of 94% and a specificity of 48% for the detection of RD. Conclusion: The use of 18F-FDG-PET/CT can facilitate the detection of RD after nCRT in patients with esophageal cancer.

Resumo Objetivo: Avaliar os valores máximo e médio de captação padronizada, o valor metabólico do tumor e a glicólise total da lesão do local do tumor primário, medidos no estudo de 18F-FDG-PET/CT realizado antes e depois da quimiorradioterapia neoadjuvante (nQRT) em pacientes com câncer de esôfago, como preditores de doença residual (DR). Materiais e Métodos: Os valores máximo e médio de captação padronizada e os parâmetros volumétricos (valor metabólico do tumor e glicólise total da lesão) da 18F-FDG-PET/CT realizada em 39 pacientes antes e após a nQRT para carcinoma de esôfago foram avaliados para RD. Usamos curvas receiver operating characteristic (ROC) para analisar o desempenho diagnóstico dos parâmetros 18F-FDG-PET/CT na definição de RD. O estudo anatomopatológico foi utilizado como padrão ouro. Resultados: Dezoito pacientes (46%) apresentaram DR após a nQRT. Áreas estatisticamente significativas sob a curva ROC para predizer DR foram obtidas para as quatro variáveis nos estudos realizados após a nQRT, com áreas sob a curva ROC semelhantes em torno de 0,72. Considerando a presença de captação visualmente detectável (captação maior que o background) no local da lesão primária após a nQRT como resultado positivo, teríamos uma sensibilidade de 94% e uma especificidade de 48% para detecção de DR. Conclusão: A 18F-FDG-PET/CT pode ser útil para detectar a presença de doença neoplásica residual no câncer de esôfago após a nQRT.

Caracterización de pacientes con tumores esofágicos atendidos en el Hospital Celestino Hernández Robau (2016-2017) / Characterization of patients with esophageal tumors treated at the Celestino Hernández Robau Hospital (2016-2017)

RESUMEN Fundamento el cáncer de esófago es una de las neoplasias más agresivas del tubo digestivo, y se asocia a alta morbilidad y mortalidad; similar al cáncer de pulmón, hígado, páncreas y estómago. Su incidencia presenta grandes variaciones geográficas. La supervivencia es individualizada y depende del estadio de la enfermedad. Objetivo caracterizar los pacientes con diagnóstico de tumores de esófago registrados en la consulta multidisciplinaria de vías digestivas. Métodos estudio descriptivo longitudinal y de seguimiento prospectivo de una serie de pacientes adultos con diagnóstico de cáncer de esófago registrados en la consulta multidisciplinaria de vías digestivas (N=57), del Hospital Universitario Celestino Hernández Robau, de Villa Clara, en el período enero/2016 a diciembre/2017. Las variables analizadas fueron: edad, sexo, color de piel, factores de riesgo, tipo histológico, localización anatómica del tumor y tiempo del padecimiento. Resultados existió predominio de pacientes masculinos con diagnóstico de cáncer de esófago (89,5 %); así como de los mayores de 60 años (63,2 %) y color blanco de la piel. Los factores de riesgo más frecuentes fueron el tabaquismo y alcoholismo, con 85,9 % y 66,6 % respectivamente. La variedad histológica más observada fue el carcinoma epidermoide, siendo la principal localización el tercio medio del esófago. En el 71,9 % de los casos transcurrieron más de tres meses desde el inicio de los síntomas hasta el diagnóstico. Conclusión el diagnóstico de cáncer de esófago no se realiza de manera inmediata a la aparición de los síntomas, lo que limita las opciones terapéuticas y la supervivencia de los pacientes.

ABSTRACT Background esophageal cancer is one of the most aggressive neoplasms of the digestive tract, and is associated with high morbidity and mortality; similar to cancer of the lung, liver, pancreas and stomach. Its incidence presents great geographical variations. Survival is individualized and depends on the stage of the disease. Objective to characterize the patients diagnosed with esophageal tumors registered in the digestive tracts multidisciplinary medical office. Methods longitudinal descriptive study and prospective follow-up of a series of adult patients diagnosed with esophageal cancer registered in the multidisciplinary consultation of digestive tracts (N=57), of the Celestino Hernández Robau University Hospital, Villa Clara, from January /2016 to December/2017. The analyzed variables: age, sex, skin color, risk factors, histological type, anatomical location of the tumor and time of the disease. Results there was a predominance of male patients diagnosed with esophageal cancer (89.5%); as well as those over 60 years of age (63.2%) and white skin color. The most frequent risk factors were smoking and alcoholism, with 85.9% and 66.6% respectively. The most observed histological variety was squamous cell carcinoma, the main location being the middle third of the esophagus. In 71.9% of cases, more than three months elapsed from the onset of symptoms to diagnosis. Conclusion the diagnosis of esophageal cancer is not made immediately after the onset of symptoms, which limits therapeutic options and patient survival.

European clinical practice guidelines on the use of chemotherapy for advanced oesophageal and gastric cancers: a critical review using the AGREE II and the AGREE-REX instruments.

PURPOSE: To assess the methodological quality of all relevant and recent European clinical practice guidelines (CPGs) for advanced oesophageal and gastric cancers, and to synthesise their recommendations on the use of chemotherapy. METHODS: We searched PubMed, EMBASE, guidelines repositories, and other sources from 2010 onwards. We appraised quality using AGREE-II and AGREE-REX. RESULTS: 11 CPGs were included (five high, five low, and one moderate quality). Most guidelines showed deficiencies in the domain "applicability", with only three scoring above 60%. Nine did not report having sought the views and preferences of the target population. The lowest scores for AGREE-REX were item Values and Preferences of Target Users (1.6; SD 1.3), and item Values and Preferences of Policy/Decision-Makers (1.8; SD 1.7). The domain Clinical Applicability got the highest score and the domain Implementability got the lowest. CONCLUSIONS: An urgent area of research is how to develop credible and implementable recommendations on the clinical use of CT for advanced oesophageal and gastric cancer. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42021236753).

O prognóstico dos diferentes subtipos de carcinomas de esôfago neuroendócrinos: um estudo de base populacional / The prognosis of the different esophageal neuroendocrine carcinoma subtypes: a population-based study

ABSTRACT Background Neuroendocrine neoplasms are extremely rare and account for 0.4% to 2% of all malignant esophageal neoplasms. The burden of the neuroendocrine histological type on the patients' prognosis and survival is poorly debated. This study aimed to compare the survival rates of primary neuroendocrine neoplasms compared with adenocarcinoma and squamous cell carcinoma of the esophagus. Methods This is a retrospective cohort from the Surveillance, Epidemiology, and End Results Program database. Overall survival and cancer-specific survival were evaluated with Kaplan-Meier curves and logrank tests. Proportional Cox regression models were used to evaluate variables related to overall survival. Results After eligibility criteria, 66,528 patients were selected. The mean follow-up was 22.6 months (SD 35.6). Adenocarcinoma was predominant (62%), followed by squamous cell carcinoma (36%). Large cell carcinoma, small cell carcinoma, and mixed adenoneuroendocrine carcinoma each account for less than 1% each. On the long-term overall survival analysis, esophageal adenocarcinoma showed a better prognosis than all the other histologic types (P-value for logrank test <0.001). With adenocarcinoma as a reference, HR was 1.32 for large cell carcinoma (95%CI 1.2 to 1.45) and 1.37 for small cell carcinoma (95%CI 1.23 to 1.53). The HR was 1.22 for squamous cell carcinoma (95%CI: 1.2 to 1.24); and 1.3 for adenoneuroendocrine carcinoma (95%CI 1.01 to 1.66). For multivariate Cox regression analysis, besides age and stage, the neuroendocrine subtypes large cell carcinoma and small cell carcinoma were considered independent prognostic variables. Conclusion In the esophagus, large cell carcinoma and small cell carcinoma show poorer long-term survival rates than squamous cell carcinoma and adenocarcinoma.

RESUMO Contexto As neoplasias neuroendócrinas são extremamente raras e representam 0,4% a 2% de todas as neoplasias malignas do esôfago. A determinação prognóstica e avaliação de sobrevida para o tipo histológico neuroendócrino é pouco debatida. Este estudo teve como objetivo comparar as taxas de sobrevida de neoplasias neuroendócrinas primárias comparadas com adenocarcinoma e carcinoma espinocelular de esôfago. Métodos Este é um estudo coorte retrospectivo do banco de dados do Surveillance, Epidemiology, and End Results Program. A sobrevida global e a sobrevida específica do câncer foram avaliadas com curvas de Kaplan-Meier e testes de logrank. Modelos de regressão de Cox proporcional foram utilizados para avaliar as variáveis relacionadas à sobrevida global. Resultados Após critérios de elegibilidade, foram selecionados 66,528 pacientes. O seguimento médio foi de 22,6 meses (DP 35,6). O adenocarcinoma foi predominante (62%), seguido pelo carcinoma espinocelular (36%). Carcinoma de grandes células, carcinoma de pequenas células e carcinoma adenoneuroendócrino misto representam menos de 1% cada. Na análise de sobrevida global, o adenocarcinoma de esôfago apresentou um prognóstico melhor do que todos os outros tipos histológicos (P valor para teste de logrank < 0,001). Com adenocarcinoma como referência, HR foi de 1,32 para carcinoma de grandes células (IC95% 1,2 a 1,45) e 1,37 para carcinoma de pequenas células (IC95% 1,23 a 1,53). O HR foi de 1,22 para carcinoma espinocelular (IC95%: 1,2 a 1,24); e 1,3 para carcinoma adenoneuroendócrino (IC95% 1,01 a 1,66). Para a análise multivariada da regressão de Cox, além da idade e do estadiamento, os subtipos neuroendócrinos carcinoma de grandes células e carcinoma de pequenas células foram considerados variáveis prognósticas independentes. Conclusão No esôfago, o carcinoma de grandes células e o carcinoma de pequenas células apresentam menores taxas de sobrevida a longo prazo do que o carcinoma espinocelular e o adenocarcinoma.

The esophageal, gastric, and colorectal tumors and the esophagogastroduodenoscopies and colonoscopies by the brazilian unified health system: what is the importance? / Os tumores esofágicos, gástricos e colorretais e as esofagogastroduodenoscopias e colonoscopias pelo sistema único de saúde (sus): qual a importância?

ABSTRACT - BACKGROUND: Esophagogastroduodenoscopies and colonoscopies are the main diagnostic examinations for esophageal, stomach, and colorectal tumors. AIM: This study aimed to evaluate the estimates of the incidence of esophageal, stomach, and colorectal cancer; population growth; and esophagogastroduodenoscopies and colonoscopies performed by the Unified Health System (SUS), from 2010 to 2018, in the five regions of the country, and to analyze the relationship between these values. RESULTS: The colorectal tumor had a significant elevation, while the esophageal and gastric maintained the incidences. In the five regions, there was a significant increase in the number of colonoscopies; however, this increase did not follow the increase in the population in the North and Northeast regions. There was no significant increase in the number of esophagogastroduodenoscopies in the North, Northeast, Midwest, and South regions, and in the North region there was a decrease. In the Northeast region, there was a decreasing number, and in the South and Midwest regions, the number of examinations remained stable in the period. The Southeast region recorded an increase in the number of examinations following the population growth. CONCLUSION: The current number of esophagogastroduodenoscopies and colonoscopies performed by the SUS did not follow the population growth, in order to attend the population and diagnose esophageal, stomach, and colorectal tumors. Therefore, the country needs to have adequate and strategic planning on how it will meet the demand for these tests and serve the population well, incorporating new technologies.

RESUMO - RACIONAL: Os tumores de esôfago, estômago e colorretal têm como principal exame diagnóstico as esofagogastroduodenoscopias e colonoscopias. OBJETIVO: Avaliar as estimativas de incidências de câncer de esôfago, estômago e colorretal, o crescimento populacional, e as esofagogastroduodenoscopias e colonoscopias realizadas pelo Sistema Único de Saúde (SUS) de 2010 a 2018, nas cinco regiões do país e a relação entre esses valores. RESULTADOS: O tumor colorretal teve elevação significativa, enquanto os esofágicos e gástricos mantiveram as incidências. Nas cinco regiões foi registrado elevação significativa do número de colonoscopias, entretanto, essa elevação não acompanhou a elevação da população nas regiões Norte e Nordeste. Não ocorreu elevação significativa do número de esofagogastroduodenoscopias nas regiões Norte, Nordeste, Centro-Oeste e Sul e na região Norte ocorreu diminuição. Na região Nordeste ocorreu número decrescente e nas regiões Sul e Centro-Oeste o número de exames manteve-se estável no período. A região Sudeste registrou elevação do número de exames acompanhando o crescimento população. CONCLUSÃO: O número atual de esofagogastroduodenoscopias e colonoscopias realizadas pelo SUS, não acompanhou o crescimento populacional, para atender a população e diagnosticar os tumores de esôfago, estômago e colorretais. Portanto, o país necessita ter um planejamento adequado e estratégico de como irá suprir a demanda desses exames e bem atender a população, incorporando as novas tecnologias.

Thylenetetrahydrofolate reductase gene polymorphisms and susceptibility to esophageal cancer: a case-control study / Polimorfismos do gene metilenotetrahidrofolato redutase e suscetibilidade ao câncer de esôfago: estudo caso-controle

ABSTRACT BACKGROUND: The enzyme methylenetetrahydrofolate reductase is engaged in DNA synthesis through folate metabolism. Inhibiting the activity of this enzyme increases the susceptibility to mutations, and damage and aberrant DNA methylation, which alters the gene expression of tumor suppressors and proto-oncogenes, potential risk factors for esophageal cancer. AIMS: This study aimed to investigate the association between methylenetetrahydrofolate reductase 677C>T and methylenetetrahydrofolate reductase 1298A>C polymorphisms and susceptibility to esophageal cancer, by assessing the distribution of genotypes and haplotypes between cases and controls, as well as to investigate the association of polymorphisms with clinical and epidemiological characteristics and survival. METHODS: A total of 109 esophageal cancer patients who underwent esophagectomy were evaluated, while 102 subjects constitute the control group. Genomic DNA was isolated from the peripheral blood buffy coat followed by amplification by polymerase chain reaction and real-time analysis. Logistic regression was used to assess associations between polymorphisms and the risk of developing esophageal cancer. RESULTS: There was no association for methylenetetrahydrofolate reductase 677C>T and methylenetetrahydrofolate reductase 1298A>C polymorphisms and haplotypes, with esophageal cancer susceptibility. Esophageal cancer patients carrying methylenetetrahydrofolate reductase 677TT polymorphism had higher risk of death from the disease. For polymorphic homozygote TT genotype, the risk of death significantly increased compared to wild-type genotype methylenetetrahydrofolate reductase 677CC (reference) cases (p=0.045; RR=2.22, 95%CI 1.02-4.83). CONCLUSIONS: There was no association between methylenetetrahydrofolate reductase 677C>T and methylenetetrahydrofolate reductase 1298A>C polymorphisms and esophageal cancer susceptibility risk. Polymorphic homozygote genotype methylenetetrahydrofolate reductase 677TT was associated with higher risk of death after surgical treatment for esophageal cancer.

RESUMO RACIONAL: A enzima metilenotetrahidrofolato redutase está envolvida na síntese de DNA através do metabolismo do folato. A inibição da sua atividade aumenta a suscetibilidade a mutações, danos e metilação aberrante do DNA, o que altera a expressão gênica de supressores tumorais e proto-oncogenes, potenciais fatores de risco para câncer de esôfago. OBJETIVOS: Investigar a associação entre os polimorfismos metilenotetrahidrofolato redutase 677C>T e metilenotetrahidrofolato redutase 1298A>C e a suscetibilidade ao câncer de esôfago, avaliando a distribuição de genótipos e haplótipos entre casos e controles, bem como investigar a associação de polimorfismos com características clínicas, epidemiológicas e sobrevida. MÉTODOS: Avaliaram-se 109 pacientes com câncer de esôfago submetidos à esofagectomia, enquanto 102 indivíduos constituaram o grupo controle. O DNA genômico do sangue periférico foi isolado e submetido à amplificação por reação em cadeia da polimerase em tempo real. A associação entre os polimorfismos e o risco de desenvolver câncer de esôfago foi avaliada por regressão logística. RESULTADOS: Não houve associação dos polimorfismos e haplótipos metilenotetrahidrofolato redutase 677C>T e metilenotetrahidrofolato redutase 1298A>C com a suscetibilidade ao câncer de esôfago. Pacientes com câncer de esôfago portadores do polimorfismo metilenotetrahidrofolato redutase 677TT apresentaram maior risco de morte pela doença. Para o genótipo TT homozigoto polimórfico, o risco de morte aumentou significativamente em comparação com os casos do genótipo selvagem metilenotetrahidrofolato redutase 677CC (referência) (p=0,045; RR=2,22, IC95% 1,02-4,83). CONCLUSÕES: Não houve associação entre os polimorfismos metilenotetrahidrofolato redutase 677C>T e metilenotetrahidrofolato redutase 1298A>C e o risco de suscetibilidade ao câncer de esôfago. O genótipo homozigoto polimórfico metilenotetrahidrofolato redutase 677TT associou-se a um maior risco de óbito após tratamento cirúrgico para câncer de esôfago.

Characterization of the psychological typology in esophageal cancer patients / Caracterização da tipologia psicológica em pacientes com câncer de esôfago

ABSTRACT BACKGROUND: Esophageal cancer is an environment-related disease, and the most important risk factors are alcohol intake and smoking, in addition to gastroesophageal reflux in obese patients. The characterization of the patients' personality can contribute to the perception of how everyone adapts to the social environment and what relationship one can establish with themselves and with others. AIM: The aim of this study was to identify the psychological typology in patients with esophageal cancer. METHODS: The psychological typology of patients was defined using the Typological Assessment Questionnaire. In addition, the aspects of psychological assessment were studied to access the particularities of each patient, especially their reaction to the diagnosis and the meaning attributed to the disease. RESULTS: A total of 90 patients with esophageal cancer, aged over 18 years, who completed high school, and were interviewed at the first medical appointment, were included. The introverted attitude was predominant (83.33%). The most common psychological type was introverted sensation, with feeling as a secondary function (43.3%), and the second most frequent was introverted feeling, with sensation as a secondary function (24.4%). From this psychological assessment, a variety of defensive mechanisms were found to minimize distress. Most patients made use of adaptive defenses in the face of the illness process. CONCLUSION: The identification of the psychological typology allows the most effective assistance in directing the peculiar needs of each patient. In addition, it contributes to the care team to individualize treatments based on specific psychological characteristics.

RESUMO RACIONAL: O câncer de esôfago é uma doença relacionada ao meio ambiente, e os fatores de risco mais importantes são a ingestão de álcool e tabagismo, além do refluxo gastroesofágico em pacientes obesos. A caracterização da personalidade do paciente contribui para a percepção de como cada indivíduo se adapta ao meio social e que relação pode estabelecer consigo mesmo e com os outros. OBJETIVO: Identificar a tipologia psicológica em pacientes com câncer de esôfago. MÉTODOS: Definiu-se a tipologia psicológica utilizando o Questionário de Avaliação Tipológica. Estudaram-se os aspectos da avaliação psicológica para acessar as particularidades de cada um dos pacientes, principalmente no que diz respeito à sua reação ao diagnóstico e ao significado atribuído à doença. RESULTADOS: Foram incluídos noventa pacientes, com mais de 18 anos, ensino médio completo, diagnóstico de câncer de esôfago e que foram entrevistados na primeira consulta médica. A atitude introvertida foi a preponderante (83,33%). O tipo psicológico mais comum foi introvertido — sensação, tendo o sentimento como função secundária (43,3%), e introvertido — sentimento com sensação como função secundária foi o segundo tipo mais frequente (24,4%). A partir dessa avaliação psicológica, encontrou-se uma variedade de mecanismos defensivos para minimizar a angústia. A maioria dos pacientes fez uso de defesas adaptativas diante do processo de adoecimento. CONCLUSÕES: A identificação da tipologia psicológica permite o auxílio mais eficaz no direcionamento das necessidades peculiares de cada indivíduo. Além disso, contribui com a equipe de atendimento a fim de individualizar os tratamentos com base nas características psicológicas específicas.

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.