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The clinical study of time optimizing of Photodynamic Therapy on esophageal and/ or gastric cardiac cancer

The clinical study of time optimizing of Photodynamic Therap...

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中国首届国际食管癌学术会议暨第七届全国食管癌学术会议

作者： FENG Xiaoshan, GAO Shegan, GUO Lin, CHEN Jianmin, DONG Jiantang, CHEN Shuchang, WANG Hongyan, WANG Lidong Oncology Department, The First Affiliated Hospital of Henan University of Science and Technology Laboratory for Cancer Research, College of Medicine, Zhengzhou University

Objective To evaluate the clinical efficacy and adverse effects of Photodynamic Therapy (PDT) on esophageal and/or gastric cardiac cancer during time optimizing for employing laser irradiation. Methods 40 patients with advanced esophageal and/or gastric cardiac cancer were divided into group A and group B ad lib. Following intravenous administration of photofrin at dose of 2 mg/kg. b. w. as the photosensitizer, 630nm laser irradiation ( DIOMED) with 400 mW/cm was applied on each part of tumor for 750 seconds through cylinder diffusing quartz fibers localizing in the biopsy channel of a flexible endo-scope at 24th and 48th for group A and at 48th and 72nd for group B respectively. Results The total rates (CR + PR) of effective were 85% and 75% respectively in two groups after PDT with P >0.05;the relieve rates of lumen obstruction were 90% and 60% respectively with statistical significance (P <0.05);the frequency of adverse effects were 44. 2% and 15. 8% respectively with P <0. 01. Conclusions The therapy of photofrin PDT was effective in improving life quality of patients with advanced esophageal and/ or gastric cardiac cancer and the time optimizing for employing laser irradiation was of great importance.

关键词： The clinical study of time optimizing of Photodynamic Therapy on esophageal and PDT or gastric cardiac cancer

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Intraoperative radiotherapy for esophageal carcinoma patients A clinical analysis of thirty cases

Intraoperative radiotherapy for esophageal carcinoma patient...

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中国首届国际食管癌学术会议暨第七届全国食管癌学术会议

Objective To analyze the operative - related complications and 5 - year survival rates of the 30 esophageal carcinoma patients who underwent intraoperative radiotherapy (IORT) and esophagectomy for trial group comparing to another 30 patients randomly chosen as the control group (esophagectomy only) . Methods Comparison and follow - up for both trial and control groups in the aspects of postoperative complications and 5 - year survival rates. Results perioperative complications were found as following: two cases of regional lung infection, one case of postoperative anastomotic leakage and one case of inci-sional infection in the IORT group;one anastomotic leakage and one intrathoracic empyema in the control group. All the complications were healed ultimately in both groups with no perioperative death. Two cases of radiation pneumonia were found in the IORT group with no intrathoracic regional recurrence during follow - up period (one patient died of complicated broncheosophageal fistula 24 months and the other patient died of diffused bilateral lung metastasis 26 months) after IORT. Meanwhile 5 patients died of tumor recurrence subsequently within 30 months after surgery only in the control group. 5 - year survival rate was 31. 59 % (6/19) in the IORT group, and 24. 08 % (6/24) in the control group. Conclusion All the intrathoracic esophageal carcinoma patients without distant metastasis and surgical contraindication can be accepted to perform the esophagectomy and intraoperative radiotherapy simultaneously. Intraoperative radiotherapy can reduce the regional recurrence with no increase of surgical - related complications and death rate. But intraoperative radiotherapy may leads to occurrence of the severe radiation - caused pneumonia unfortunately. Intraoperative radiotherapy may improve the survival rate of the esophageal carcinoma patients comparing to the surgery only group if the lung and bronchus can be properly protected during the procedure.

关键词： Intraoperative radiotherapy for esophageal carcinoma patients A clinical analysis of thirty cases

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The preliminary report of 7 - day continuous accelerated irradiation in patients with esophageal carcinoma

The preliminary report of 7 - day continuous accelerated irr...

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中国首届国际食管癌学术会议暨第七届全国食管癌学术会议

作者： GAO Xian - shu, ZHOU Zhi - guo, QIAO Xue - ying, YANG Xiang - ran, ZHANG Jun, WAN Jun. Department of Radiation Oncology, 4th Hospital of Hebei Medical University

Objective Toxicity of 7 -day continuous accelerated irradiation schedule (CAIR) was e-valuated and compared with late course accelerated hyperfractionation radiotherapy schedule ( LCAF) for esophageal carcinoma in a randomized trial. Methods Fifty - seven patients with squamous cell carcinoma of esophagus were randomly entered into two groups: 29 to the CAIR group and 28 to the LCAF group. In CAIR group dose per fraction of 2. 0Gy was given once a day at 24 h intervals and the overall treatment time was 4.2 weeks (30 days). The patients in the LCAF group received conventional fractionation radiotherapy, 2Gy/fraction, to a dose of 30Gy in 15 fractions during 3 weeks, followed by accelerated fractionation radiotherapy, b. i. d. , at 1. 5 Gy/fraction, with a minimal interval of 6 h between fractions, and the overall treatment time was 5 weeks. The total dose was 60Gy in both groups. Results More serious a-cute esophagitis was observed in CAIR group than that in LCAF group, and the grade Ⅲof esophagitis were 31.0% and 14.3% respectively. The late effects did not increase in CAIR group than LCAF group, the grade Ⅴof esophageal late effect were 10. 3% and 7.1% , and the 1 -year survival rates were 66.14% and 64.72% in CAIR group and LCAF group. Conclusion Although the higher incidences of severe acute reactions were observed in CAIR group, the patients could tolerate the effects and complete this treatment.

关键词： The preliminary report of 7 day continuous accelerated irradiation in patients with esophageal carcinoma

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The study of prognostic factors in patients with middle and advanced esophageal carcinoma treated by radiotherapy alone

The study of prognostic factors in patients with middle and ...

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中国首届国际食管癌学术会议暨第七届全国食管癌学术会议

作者： ZHU Shu - chai , LI Ren , WANG Yu - xiang ,Li Juan Department of Radiation Oncology ,Fourth Hospital ,Hebei Medical University, China

Objective To evaluate the prognostic factors in patients with middle and advanced esophage-al carcinoma treated by radiotherapy alone and provide reference endpoint for individual treatment regimen. Methods A retrospective analysis was performed on 500 middle and advanced esophageal carcinoma patients were treated by radiotherapy alone in Fourth Hospital, Hebei Medical University. Male 318, female 182, the median age 56.5 years old. The lesion in upper - ,middle - , and lower - thoracic sections were 195cases, 277cases, 28cases , respectively. 6MV X - ray was delivered with conventional fractionation or accelerated hyperfractionation irradiation . Kaplan - Meier method was used in univariate analysis and the logrank test to inspect into possible difference. Cox stepwise regression model and prognosis index (PI) model were used in multivariate analysis for prognosis evaluation. Result The overall survivals at 1 - ,3 - ,and 5 - years were 70.06% ,32.62% ,and 20. 81% ,respectively. There were significant difference on survival with traditional prognosis factors, chest CT scanning relevant factors, and the treatment relevant factors analyzed by Kaplan - Meier method. In the multivariate analysis, metastatic lymph node, CT scan showing maximum tumor diameter , voice unable , length of lesion in chest CT, maximum tumor infiltration depth , location of lesion, total time of treatment , immediate effect and lately effect were independent prognosis factors for overall survival . The prognosis index (PI) value could sensitively predict the long term survival of esophageal cancer. Conclusion We consider the chest CT scan could provide more accurately information for evaluation the prognosis of esophageal cancer treated by radiotherapy alone.

关键词： The study of prognostic factors in patients with middle and advanced esophageal carcinoma treated by radiotherapy alone

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Contrast of mtdna variation in esophageal cancer between patients from high risk area and normal risk

Contrast of mtdna variation in esophageal cancer between pat...

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中国首届国际食管癌学术会议暨第七届全国食管癌学术会议

作者： Qian Song, Jun Zhao, Jing Lu, Ziyou Cui, Ziming Dong. Department of Pathophysiology, Medical college of Zhengzhou University.

Background There is a high risk for esophageal cancer in China, especially in north of Henan province. People did a lot of work to detect why and how cancer happened on nuclear DNA, such as: the activation of oncogene, the inactivation of cancer suppressive gene. Recently , researchs have began to reach genetic substance outside nDNA,that is mtDNA. mtDNA is a kind of ringed double -chain DNA molecule that consists of 16569 bp. Its genome has two parts: control region and coding region. There is no intron in mtDNA. The replication origination and transcription promoter of mtDNA lie in the control region - - D - Loop region, which controls the replication and transcription of mtDNA. The coding region codes 13 kinds of protein submits which are required in OXPHOS. It also codes 22 kinds of tR-NA and 2 kinds of rRNA which are required to produce ATP. OXPHOS provides body more than 90% energy, which is conserved as ATP. Somatic mtDNA mutations have been found in cancers of head and neck, breast , lung, gastric, esophageal, hepatic, pancreatic, colorectal, bladder, prostate, ovarian and renal carcinoma, the control region - - D - loop region is a hot mutation region. Mutations in this region may interrupt the mitochondrial function and play an important role in causing cancers. Two recent reports investigated the frequency of D - loop region mutation in esophageal cancer. In Japan, a place with normal risk of esophageal cancer, a study showed that D - loop region mutation rate in esophageal was only 5% (2/37) of specimens analyzed. But another study in Japan showed that HV - 1 and HV -2 in D -loop region mutation rate in esophageal was 34% ( 13/38). Objective One of objectives of our study is to find the mtDNA D - loop region variations in esophageal cancer. Many researches have argued that there is a close relationship between mtDNA variation and the origination of tumor. So we contrast the variations in esophageal cancer between patients from high risk area and normal r

关键词： mtDNA Contrast of mtdna variation in esophageal cancer between patients from high risk area and normal risk

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Immunohistochemical analysis of p53 in esophageal cancer from southern China

Immunohistochemical analysis of p53 in esophageal cancer fro...

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中国首届国际食管癌学术会议暨第七届全国食管癌学术会议

作者： Xiao - Ping Huang Tie - Hua Rong Hao Long Qiu - Liang Wu Duo - Rong Xu Zhi - Chao Lin National Laboratory of Tumor Biology, Cancer Center, Sun Yat - Sen University Department of Hematology, the First Affiliated Hospital, Sun Yat -Sen University

Objectives: Mutations of p53 are the most common genetic changes found in human cancers, especially in the genesis and development of esophageal cancer. However, little reports showed p53 changes in esophageal cancer from southern China. The purpose of the present study is to examine the expression status of p53 in esophageal cancer and the possible relationship between p53 and esophageal cancer from southern China. Methods: In this study, we detected via immunohistochemical analysis the p53 expression in 50 esophageal squamous cell carcinomas from southern China. We also analyzed the relationship between p53 expression and the clinical/pathological parameters of esophageal cancer from southern China. Results: 66% (33/50) cases showed increased p53 expression in esophageal squamous cell carcinomas. In the normal mucosa of most cases we found no p53 positive staining. In most cases, p53 positive and negative staining mixed together in the cancerous nests. In some tumors, we detected an area without detectable p53 whereas another area of the same tumor showed a high p53 expression. Distinct p53 expression level was found in the well versus poor differentiated carcinomas. In carcinomas forming large cancer nest with central keratinisation, p53 positive cells were observed predominantly in the periphery of these nests but not in central areas where cells are well differentiated. In addition, we observed p53 positive labeling in esophageal cancer cells invaded into muscular layers. Chi square test was used in statistical analysis for the relationship between the expression status of p53 and clinical/pathological parameters. no significant difference was found between the alterations of p53 and the clinical/ pathological data in esophageal squamous cell carcinomas from southern China. Conclusions: The results suggested that p53 was involved in the genesis and/or development of esophageal cancer. The results confirmed previous reports that p53 expression in esophageal canc

关键词： Immunohistochemical analysis of p53 in esophageal cancer from southern China

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Use of endoscopic ultrasonography for preoperative stage of esophageal cancer

Use of endoscopic ultrasonography for preoperative stage of ...

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中国首届国际食管癌学术会议暨第七届全国食管癌学术会议

作者： Hu Yi Fu Jian - Hua Rong Tie - Hua Xu Guo - Liang Li Xiao - Dong Zhang Peng - Yuan Yang Hong Zhu Zhi-Hua Zhang Shi-Yi Department of Thoracic Surgery, Cancer Center, Sun Yat - sen University, Guangzhou, Guangdong, P. R. China Department of Endoscope, Cancer Center, Sun Yat -sen University, Guangzhou, Guangdong, P. R. China

BACKGROUND & OBJECTIVE Esophageal cancer stage is the key to choose the most efficiency therapy plan. Endoscopic Ultrasonography(EUS) is the most accuracy diagnosis technique for the TN stage of esophageal cancer. Now it is used commenly in foreign countries, but seldom in China. This study is to evaluate the use of EUS for preoperative esophageal cancer. METHODS From July 2002 to January 2004, 72 patients were examined preoperatively with EUS. The EUS findings were compared with surgical histologic findings in all cases. RESULTS ①The accuracy rates of T - stage, N - stage and TN - stage by EUS are 80.6% (58/72), 88.9% (64/72), 72.2% (52/72), respectively. ②The accuracy rates of each stage: T-stage: T0 50.0% (2/4), T1 75.0% (3/4), T2 70.6% (12/17) , T3 90. 0% (36/40) , T4 71.4% (5/7);N - stage: N0 92. 3% (36/39) , N1 84. 8% (28/33), of which the accuracy rates of mediastinum and abdomen lymph node are 90. 0% and 64. 5%. ③The association of EUS - stage and surgical histologic stage: T - stage, association coefficient =0.687, P < 0.001, X2 = 34.0;N-stage, association coefficient =0. 878, P<0.001, X2 =43.4. Both are of statistic signification. ④There are 22 cases which can not be staged correctly: T - stage 14 cases, of which 8 cases were due to not distinguishing T2 and T3 correctly;N - stage 8 cases, of which, 5 cases were due to not distinguishing lymphadenitis and metastatic lymph nodes correctly . CONCLUSION The accuracy rate of EUS is high for preoperative stage of esophageal cancer, especially for T3 and mediastinum lymph node. To distinguish T2 and T3, lymphadenitis and metastatic lymph nodes correctly and to diagnose abdomen lymph node can improve the diagnosis accuracy rate of EUS.

关键词： Use of endoscopic ultrasonography for preoperative stage of esophageal cancer

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Selective Three-field Lymphadenectomy for Thoracic Esophageal Squamous Carcinoma

Selective Three-field Lymphadenectomy for Thoracic Esophagea...

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中国首届国际食管癌学术会议暨第七届全国食管癌学术会议

作者： Wentao Fang Wenhu Chen Yong Chen Yuzhou Shen Yong Jiang Shanghai Chest Hospital, Shanghai, China

目的研究胸段食管鳞癌的淋巴结转移规律,探讨合适的淋巴结清扫范围。方法87例胸段食管鳞癌患者接受食管次全切除术,根据术前食管腔内超声和颈部超声检查结果选择性进行胸腹二野或颈胸腹三野淋巴结清扫。结果35例(40.2%)术前超声发现颈... 详细信息

目的研究胸段食管鳞癌的淋巴结转移规律,探讨合适的淋巴结清扫范围。方法87例胸段食管鳞癌患者接受食管次全切除术,根据术前食管腔内超声和颈部超声检查结果选择性进行胸腹二野或颈胸腹三野淋巴结清扫。结果35例(40.2%)术前超声发现颈部淋巴结肿大(>0.5cm)并行三野清扫,原发肿瘤位于胸上段食管者中接受三野清扫的比例(66.7%)显著高于中、下段肿瘤(30.2%,p=0.002),三野清扫术扫除淋巴结组数(13.7组)显著多于二野清扫术(10.5组,p<0.001),术后病理证实三野清扫组转移淋巴结检出组数(1.5组)显著多于二野清扫组(0.8组,p=0.009)。颈淋巴结转移(pM1-LN)17例(占全组的19.5%和三野清扫组的48.6%),区域淋巴结转移者(pN1)颈淋巴结阳性比例(31.3%)显著高于未转移者(pN0,5.1%,p=0.002)。55.2%患者证实为pN1,胸上段肿瘤pN1比例(37.5%)显著低于胸中段(62.3%)或胸下段肿瘤(60%,p=0.041),若将pM1-LN归入pN1则胸上段肿瘤的淋巴结转移率(45.8%)与胸中下段肿瘤无显著差异(63.5%,p=0.135)。上、中、下纵隔及上腹部的淋巴结转移率分别为25.3%、23%、5.7%和24.1%,胸上段肿瘤上纵隔淋巴结转移率(33%)高于胸中段(24.5%)及胸下段肿瘤(10%,p=0.354)但无显著差异,胸中段肿瘤中纵隔淋巴结转移率(30.2%)显著高于胸上、下段肿瘤(11.8%,p=0.046),胸下段肿瘤下纵隔(20%)和上腹部淋巴结转移率(50%)显著高于胸上、中段肿瘤(3.9%,p=0.040;20.8%,p=0.042),颈淋巴结转移与上纵隔(p<0.001)及中纵隔淋巴结转移(p=0.009)显著相关,但与下纵隔及上腹部淋巴结转移无关。胸上、中、下段肿瘤的根治性切除率分别为73.9%、86.3%和100%,三野清扫术后并发症发生率(60%)显著高于二野清扫术(34.6%,p=0.020),死亡率亦较高但未达到统计学显著性(6.3%vs.0%,p=0.071),三野清扫术喉返神经损伤发生率高于二野清扫术(22.9%vs.9.6%,p=0.089),且喉返神经损伤与吻合口瘘显著相关(53.8%vs.13.5%,p=0.001)。结论颈淋巴结转移在胸段食管鳞癌中十分常见,其发生率与纵隔及上腹部等区域淋巴结转移率相似,胸上段食管癌转移至颈部及上纵隔淋巴结频率最高,一如胸中段肿瘤转移至中纵隔淋巴结或胸下段肿瘤转移至下纵隔及上腹部淋巴结,因此颈淋巴结应视作胸段食管癌的区域淋巴结。对肿瘤位于胸上段食管、或上纵隔及中纵隔淋巴结已发生转移的患者应行颈清扫以提高手术的彻底性。由于三野清扫术并发症高于二野清扫,故应选择性用于上述有指征的患者,作者的经验表明以食管腔内超声及颈部超声指导进行选择性三野清扫有助于在降低手术风险的同时提高手术的根治效果。

关键词：三野清扫术胸下段淋巴结转移率上腹部胸上段食管癌 Selective Three-field Lymphadenectomy for Thoracic Esophageal Squamous Carcinoma 三野淋巴结清扫区域淋巴结转移胸中段胸段食管鳞癌

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