Chemotherapy For Esophageal Cancer Research Articles

Prognostic value of systemic inflammation score in patients with esophageal cancer

Prognostic value of systemic inflammation score in patients with esophageal cancer

Study on the biomechanical properties of 3D printed blended esophageal stents with different structural parameters based on patient CT

Introduction: Esophageal stenting is a widely used treatment for esophageal diseases, which can also be used for adjuvant therapy and feeding after chemotherapy for esophageal cancer. The structural parameters of the stent have a significant impact on its mechanical properties and patient comfort.Methods: In the present work, we reconstructed the esophagus model based on the patient’s computed tomography (CT) data, and designed stents with different structural parameters. We used 3D printing technology to achieve rapid production of the designed stents by using Thermoplastic polyurethane (TPU)/Poly-ε-caprolactone (PCL) blends as the materials. The mechanical properties and effects on the esophagus of polymer stents with four different structural parameters of diameter, wall thickness, length and flaring were investigated by in vitro tests of radial compression and migration of the stents, as well as by finite element simulations of the stent implantation process in the esophagus and of the stent migration process. An artificial neural network model was established to predict the radial force of the stent and the maximum equivalent stress of the esophagus during implantation based on these four structural parameters.Results: The results show that wall thickness was the structural parameter that had the greatest impact on the radial force of the stent (statistically significant, p < 0.01), and flaring was the structural parameter that had the greatest impact on the maximum equivalent stress of the esophageal wall after stent implantation (statistically significant, p < 0.01). No. 6 stent had a maximum radial force of 18.07 N, which exceeded that of commercial esophageal stents and had good mechanical properties. And the maximum equivalent force on the esophagus caused by its implantation was only 30.39 kPa, which can improve patient comfort. The predicted values of the constructed back propagation (BP) neural network model had an error of less than 10% from the true values, and the overall prediction accuracies were both above 97%, which can provide guidance for optimizing the design of the stent and for clinical research.Discussion: 3D printing technology presents a wide range of applications for the rapid fabrication of personalized TPU/PCL blend stents that are more suitable for individual patients.

Radiomics Features Using Dual-energy CT for Lymph Nodes After Preoperative Chemotherapy for Esophageal Cancer.

Progress has been made in a triplet preoperative chemotherapy regimen for advanced esophageal cancer. We performed a preliminary investigation of the radiomics features of pathological lymph node metastasis after neoadjuvant chemotherapy using dual-energy computed tomography (DECT). From January to December 2022, 36 lymph nodes from 10 patients with advanced esophageal cancer who underwent contrast-enhanced DECT after neoadjuvant chemotherapy and radical surgery in our department were studied. Radiomics features were extracted from iodine-based material decomposition images at the portal venous phase constructed by DECT using MATLAB analysis software. Receiver operating characteristic (ROC) analysis and cut-off values were determined for the presence or absence of pathological metastasis. ROC for the short axis of the pathologically positive lymph nodes showed an AUC of 0.713. Long run emphasis (LRE) within gray-level run-length matrix (GLRLM) was confirmed with a high AUC of 0.812. Sensitivity and specificity for lymph nodes with a short axis >10 mm were 0.222 and 1, respectively. Sensitivity and specificity for LRE within GLRLM were 0.722 and 0.833, respectively. Sensitivity and specificity for small zone emphasis (SZE) within gray-level size zone matrix (GLSZM) were 0.889 and 0.667, and zone percentage (ZP) values within GLSZM were 0.722 and 0.778, respectively. Discrimination of existing metastases using radiomics showed significantly higher sensitivity compared to lymph node short axis >10 mm (odds ratios of LRE, SZE, and ZP: 9.1, 28, and 9.1, respectively). Evaluation of radiomics analysis using DECT may enable a more detailed evaluation of lymph node metastasis after neoadjuvant chemotherapy.

Complete ocular tilt reaction with subjective visual vertical tilt in a patient with a medial prefrontal cortex lesion: a case report

A 61-year-old male patient undergoing chemotherapy for esophageal cancer presented with symptoms of rightward tilting while both sitting and walking. A neurological examination revealed a head tilt, skew deviation with hypertrophy of the left eye, and a rightward shift in his gait. No spontaneous nystagmus was observed, and the vestibulo-ocular reflex was normal. Magnetic resonance imaging of the head revealed a suspected metastatic lesion in the right medial prefrontal cortex. Following the initiation of levetiracetam treatment, the patient demonstrated marked improvement, with the resolution of both head tilt and skew deviation within 1 month. Traditionally, the ocular tilt reaction has been attributed to unilateral or asymmetric dysfunction of the graviceptive pathways extending from the utricle to the upper midbrain lesions. However, this case highlights the potential involvement of the prefrontal cortex in the ocular tilt reaction. Further research is warranted on the role of the prefrontal cortex within the vestibular system.

Nursing of a patient with pyopneumothorax and respiratory failure caused by pulmonary fungal infection after chemotherapy for esophageal cancer

Nursing of a patient with pyopneumothorax and respiratory failure caused by pulmonary fungal infection after chemotherapy for esophageal cancer

Docetaxel, cisplatin, and fluorouracil with pegfilgrastim on day 3 as neoadjuvant chemotherapy for esophageal cancer.

A high risk of febrile neutropenia (FN) from neoadjuvant chemotherapy with docetaxel, cisplatin, and fluorouracil (DCF) for esophageal cancer has been reported. The optimal timing of prophylactic use of pegfilgrastim remains to be elucidated. To evaluate the effect of pegfilgrastim administered on day 3, we conducted a feasibility study. Chemotherapy consisted of intravenous administration of docetaxel (70 mg/m2 per day) and cisplatin (70 mg/m2 per day) on day 1 and continuous infusion of 5-fluorouracil (750 mg/m2 per day) on days 1-5. Pegfilgrastim was given as a single subcutaneous injection at a dose of 3.6 mg on day 3 during each treatment course. This regimen was repeated every 3 weeks for up to a maximum of three courses. Prophylactic antibiotics were not needed but were allowed to be given at the discretion of the physician. The primary endpoint was the incidence of FN. Twenty-six patients were administered DCF in combination with pegfilgrastim on day 3. After the first course of DCF, 10 out of 26 patients (38.5%) experienced grade 4 neutropenia, and two patients (7.7%) experienced FN. Of the 14 patients who did not receive prophylactic antibiotics, four had grade 4 neutropenia, including two who developed FN. On the contrary, of the 12 patients who received prophylactic levofloxacin, six had grade 4 neutropenia, but no cases of FN were observed. Administration of pegfilgrastim on day 3 was not sufficient to prevent FN due to DCF treatment, and prophylactic administration of both pegfilgrastim and antibiotics could be a solution.

Esophageal Cancer: Etiology, Modern Treatment Methods and Future Directions

Esophageal cancer (EC) is globally recognized as the sixth most often diagnosed cancer and the eighth most frequent cancer in terms of total occurrence. At the time of diagnosis, it exhibits a notable fatality rate and poor healing outcomes. Esophageal squamous cell carcinoma (ESCC) is commonly brought on by carcinogens entering and exiting the esophageal mucosa directly, such as via mechanical stress, alcohol intake, smoking, and obesity. The main pathophysiologic pathway for esophageal adenocarcinoma (EAC) is chronic gastroesophageal reflux disease (GERD). The treatment of different types of EC varies. The primary strategy for treating locally advanced malignancies is surgery, with the inclusion of neoadjuvant chemotherapy or radiotherapy for combination management. The purpose of adding chemotherapy in EC is to lower the tumor stage, reduce the risk of the tumor, and facilitate subsequent targeted therapy. In this paper, we will discuss the etiology of EC, modern treatment methods and future directions.

Assessment of Prescription Pattern of Chemotherapy in Subjects with Esophageal Cancer

Esophageal cancer is a disease that arises when the tissues of the esophagus generate malignant cells. In terms of its prevalence, it ranks 13th among cancers in women and 7th among cancers in men. The goal of the study is to assess prescription pattern in subjects receiving chemotherapy for esophageal cancer and this research will provide guidance to healthcare professionals on ways to utilize medications effectively and improve subjects' quality of life and survival chances while reducing potentially dangerous side effects. This was a prospective observational study carried out in the Department of Oncology in ESI MC & PGIMSR, Rajajinagar, Bengaluru. A total of 35 samples were collected, of which 28 were selected for the study. Subjects for the study were identified by the investigator during ward rounds based on the inclusion and exclusion criteria. Relevant data collected were recorded on the Self-designed data collection form. All recorded data were entered using Microsoft excel software for determining the statistical significance. The results were expressed in descriptive statistics such as percentages were calculated for categorical variables. 71% (n=20) of the subjects involved in the study were prescribed with Carboplatin. Carboplatin with paclitaxel was the most preferred combination therapy. In the present study, we have concluded that the oncologists in this hospital prefer Cytotoxic drugs over Targeted drugs for the treatment of esophageal cancer. During the covid pandemic, subject previously diagnosed with EC discontinued their therapy and follow-ups due to restrictions imposed by the government and inability to travel during lockdowns. Hence, resulted in inadequate therapy which leads to spread of cancer among the subjects and there by the therapy is changed from dual therapy (carboplatin and paclitaxel) the triple therapy.

ASO Author Reflections: Delivery of Perioperative Chemotherapy for Esophageal Cancer in Routine Clinical Practice.

ASO Author Reflections: Delivery of Perioperative Chemotherapy for Esophageal Cancer in Routine Clinical Practice.

A Case of Unilateral Recurrent Nerve Palsy Improved by Chemotherapy for Esophageal Cancer

A Case of Unilateral Recurrent Nerve Palsy Improved by Chemotherapy for Esophageal Cancer

MO40-5 Early administration of pegfilgrastim contributes to the safety of DCF therapy as neoadjuvant chemotherapy for esophageal cancer

MO40-5 Early administration of pegfilgrastim contributes to the safety of DCF therapy as neoadjuvant chemotherapy for esophageal cancer

MO40-4 DCF regimen might be useful as neo-adjuvant chemotherapy for esophageal cancer from our institutional experience

MO40-4 DCF regimen might be useful as neo-adjuvant chemotherapy for esophageal cancer from our institutional experience

Genetic polymorphisms as predictive biomarkers of adverse events during preoperative chemotherapy in esophageal cancer.

This study aimed to explore associations between genetic polymorphisms and adverse effects due to preoperative chemotherapy with docetaxel, cisplatin, and fluorouracil (DCF) for esophageal cancer. Preoperative DCF (docetaxel, 70mg/m2/day, day 1; cisplatin, 70mg/m2/day, day 1; fluorouracil, 750mg/m2/day, days 1-5) was repeated every 3weeks for up to three cycles. Genotyping of nine candidate genetic polymorphisms was conducted using blood samples from the enrolled patients. According to a multivariable analysis evaluating 50 patients, grade 3 or worse neutropenia was more likely to occur in those with the ABCC2-24C/T or T/T genotype (rs717620) (OR, 5.30, P = 0.013). Additionally, patients with the TYMS 3'-UTR 0bp/0bp genotype (rs151264360) showed a trend toward grade 3 or worse hyponatremia (OR, 0.16, P = 0.005). Grade 2 or worse thrombocytopenia was more likely to occur in patients with the TNF-α-1031C/T or T/T genotype (rs1799964) (OR, 6.30, P = 0.016) and IL-6-634C/C genotype (rs1800796) (OR, 0.18, P = 0.034), and grade 2 or worse anemia was more likely to occur in patients with the MCP-1-2518G/G genotype (rs1024611) (OR, 0.19, P = 0.027). ABCC2-24C > T (rs717620), TYMS 3'-UTR 6-bp indel (rs151264360), TNF-α-1031T > C (rs1799964) as well as IL-6-634G > C (rs1800796), and MCP-1-2518A > G (rs1024611) polymorphisms might serve as independent and predictive biomarkers for neutropenia, hyponatremia, thrombocytopenia, and anemia, respectively, during preoperative chemotherapy with docetaxel, cisplatin, and fluorouracil for patients with esophageal cancer.

Development and Validation of a Nomogram Model for the Risk of Cardiac Death in Patients Treated with Chemotherapy for Esophageal Cancer.

The primary cause of mortality in esophageal cancer survivors is cardiac death. Early identification of cardiac mortality risk during chemotherapy for esophageal cancer is crucial for improving the prognosis. We developed and validated a nomogram model to identify patients with high cardiac mortality risk after chemotherapy for esophageal cancer for early screening and clinical decision-making. We randomly allocated37,994 patients with chemotherapy-treated esophageal cancer into two groups using a 7:3 split ratio: model training (n = 26,598) and validation (n = 11,396). 5- and 10-year survival rates were used as endpoints for model training and validation. Decision curve analysis and the consistency index (C-index) were used to evaluate the model's net clinical advantage. Model performance was evaluated using receiver operating characteristic curves and computing the area under the curve (AUC). Kaplan-Meier survival analysis based on the prognostic index was performed. Patient risk was stratified according to the death probability. Age, surgery, sex, and year were most closely related to cardiac death and used to plot the nomograms. The C-index for the training and validation datasets were 0.669 and 0.698, respectively, indicating the nomogram's net clinical advantage in predicting cardiac death risk at 5 and 10years. The 5- and 10-year AUCs were 0.753 and 0.772 for the training dataset and 0.778 and 0.789 for the validation dataset, respectively. The accuracy of the model in predicting cardiac death risk was moderate. This nomogram can identify patients at risk of cardiac death after chemotherapy for esophageal cancer at an early stage.

Fragmented care, Commission on Cancer accreditation, and overall survival in patients receiving surgery and chemotherapy for esophageal cancer

BackgroundIncreasing regionalization for esophagectomy for cancer may lead patients to travel for surgery at one institution and receive chemotherapy at another closer to home. We explore the effects on survival for care fragmentation, the Commission on Cancer status of secondary institutions providing chemotherapy, and the type of institution performing surgery. MethodsWe queried the National Cancer Database to identify all patients who underwent esophagectomy for esophageal cancer and received perioperative chemotherapy between 2006 and 2019. Patients were divided into single-center care, fragmented–to–Commission on Cancer care, or fragmented–to–non–Commission on Cancer care. We identified associations using multivariable logistic regression, Kaplan-Meier survival analyses, and Cox proportional hazards models. ResultsA total of 18,502 patients met the criteria for inclusion: 8,290 (44.8%) received single-center care; 3,414 (18.5%) fragmented–to–Commission on Cancer care; and 6,798 (36.4%) fragmented–to–non–Commission on Cancer care. Fragmented care was more likely in White patients (adjusted odds ratio = 1.25; P < .001) and in patients nonadjacent to a metropolitan area (adjusted odds ratio = 1.36; P < .001). Overall survival was equivalent between single-center and fragmented care, but undergoing an esophagectomy at an academic center was associated with improved survival (adjusted hazard ratio = 0.82; P = .016). In patients with an esophagectomy at a nonacademic center, overall survival was best if perioperative chemotherapy was administered at Commission on Cancer–accredited facilities compared with chemotherapy at fragmented–to–non–Commission on Cancer centers (P = .022). ConclusionMost of the esophageal cancer care in the US is fragmented at multiple institutions. When care is fragmented, it is most commonly at non–Commission on Cancer centers for perioperative chemotherapy. Overall survival is best when esophagectomy is performed at an academic center, and perioperative therapy is administered at Commission on Cancer–accredited facilities.

18. ASSOCIATION OF TUMOR PATHOLOGICAL COMPLETE RESPONSE WITH THE USE OF METFORMIN DURING NEOADJUVANT CHEMORADIOTHERAPY IN ESOPHAGEAL CANCER PATIENTS: RETROSPECTIVE STUDY

Abstract Background Metformin is a standard treatment for type 2 diabetes mellitus (DM). Previous in vitro and in vivo studies have reported the association of metformin’s additive anticancer response with chemotherapy in esophageal cancer. However, no clinical studies have been reported. Therefore, this study is to aim the administration of metformin use can improve clinical outcomes of esophageal cancer patient with neoadjuvant combined chemotherapy and radiation (CCRT). Methods A total of 209 patients with esophageal cancer and underlying DM who underwent neoadjuvant CCRT before surgical resection were included from 1998 to 2022. There were 22 patients with metformin medication (10.5%) and 186 patients without metformin (89%). Univariable and multivariable regression analysis were done for complete response effect of metformin medication. Moreover, early clinical outcomes such as, overall survival and disease free survival were compared between the two groups. Results The complete response rate was higher for the metformin group (45.5% vs 22.6%; p = 0.019) and the recurrence rate was significantly lower (21.1% vs 45.7%, p = 0.040). The metformin group was associated with complete response rate in univariate logistic regression analysis (odds ratio [OR] = 2.86 [1.15–7.08], p = 0.023) and multivariable analysis (odds ratio [OR] = 2.84 [1.12–7.23], p = 0.028). Median follow-up duration was 19.8 months for metformin group, 17.3 months for non-metformin group. Overall 2-year survival rate and disease free survival was higher for metformin group than non-metformin group, (40% vs 26.5%, p = 0.380, 31.6% vs 24.3%, p = 0.095), however, not significant. Conclusion An association of metformin use with complete response rate in neoadjuvant CCRT esophageal cancer patients has been shown. The potential of metformin’s tumor response after neoadjuvant CCRT for esophageal cancer has been demonstrated in our study. Further prospective study should be needed for clinical evidence.

Effect of sequential vs. non-sequential early enteral nutrition therapy on nutritional status, recovery, and quality of life of patients with esophageal cancer.

To study the effects of early sequential enteral nutrition (ESEN) therapy and early non-sequential enteral nutrition (EN) therapy on the nutritional status, recovery, and quality of life of patients who undergo postoperative chemotherapy for esophageal cancer. The data of 90 patients who underwent postoperative chemotherapy for esophageal cancer in Gansu Provincial Cancer Hospital from January 2018 to June 2020 were analyzed retrospectively. Patients were divided the Test group and the Control group (n=45 each) based on the method of nutritional support. Patients in the Control group were treated with non-sequential early enteral nutrition and the Test group treated with sequential early enteral nutrition until the discharge. Nutritional status, recovery, and quality of life of the chemotherapy patients in the two groups were compared. After the intervention, the pre-protein, albumin and hemoglobin levels were higher in the Test group than in the control group (p<0.05). Postoperative exhaustion, incision healing and length of hospital stay were significantly lower in the Test group than in the Control group (p<0.05), while the scores on all dimensions of the short-form 36 health survey scale (SF-36) and the total score were higher than in the Control group (p<0.05). Sequential early enteral nutrition may be used for patients who undergo chemotherapy after esophageal cancer surgery to promote their early recovery and improve their quality of life and nutritional status.

Thoracoscopic esophageal drainage for tracheal compression due to mucocele after esophagogastric bypass: a case report

BackgroundEsophagogastric bypass is performed for esophageal strictures. Mucus retention, known as mucocele, sometimes occurs at the stricture oral side of the remnant esophagus. It is often asymptomatic and is expected to be naturally decompressed, but it may cause respiratory failure depending on the case. Herein, we report a case in which we successfully performed thoracoscopic esophageal drainage as emergency airway management due to tracheal compression by a mucocele after esophagogastric bypass for unresectable esophageal cancer with esophagobronchial fistula.Case presentationA 56-year-old man underwent esophageal bypass surgery for an unresectable esophageal carcinoma with an esophagobronchial fistula following chemotherapy and radiation therapy. Nine months after bypass surgery, he experienced severe dyspnea due to tracheal compression caused by mucus retention on the oral side of the esophageal tumor. We planned thoracoscopic surgery for mucus retention drainage through the right thoracic cavity to secure the airway as an emergency procedure under general anesthesia. Intubation can be performed safely by guiding bronchoscopy in the semi-supine position. Upper esophageal dilation was observed on the cranial side of the azygos arch. We dissected the mediastinal pleura of the upper thoracic esophagus and exposed its wall. A 12-Fr silicone drain was placed in the esophagus through the right chest wall and 120 ml of white fluid was aspirated. He was discharged 9 days after surgery without complications and resumed treatment with an immune checkpoint inhibitor 23 days after surgery. Thereafter, he continued chemotherapy for esophageal cancer, but died of tumor progression and lung metastasis 35 months after bypass surgery and 25 months after thoracoscopic surgery.ConclusionsThoracoscopic esophageal drainage could be performed safely as emergency airway management, shorten the period of discontinuance, and allow cancer treatment to be resumed promptly. We believe that this thoracoscopic procedure is an effective and less invasive method if the percutaneous approach is difficult.

Skeletal muscle mass recovery after oesophagectomy and neoadjuvant chemotherapy in oesophageal cancer: retrospective cohort study

ObjectiveSkeletal muscle mass (SMM) is an important biomarker for prognosis and health in older patients with cancer. Limited information is available on the recovery course of SMM after oesophagectomy following...

CLINICAL OUTCOME OF HIGH DOSE RADIOTHERAPY WITH OR WITHOUT CONCURRENT CHEMOTHERAPY IN ESOPHAGEAL CANCER (EC): A STUDY FROM NORTH – EAST INDIA

OBJECTIVE: The objective of this study is to evaluate the clinical outcomes of high dose radiotherapy 63 Gray (Gy) with or without concurrent chemotherapy in Esophageal Cancer (EC) patients of North-East, India.&#x0D; MATERIAL AND METHODS: All reported EC patients belonging to different states of North-East and treated with radical intent with high dose radiotherapy with or without concurrent chemotherapy during the period 2017-2018 (2 years) at State Cancer Institute (SCI),Gauhati Medical College (GMC), Assam, India were included in the study. This study was retrospective in nature and two years retrospective data were analyzed for clinical outcome. Statistical analysis of data was done using Statistical Packages for Social Sciences (SPSS) and Disease Free Survival (DFS) was calculated using Kaplan-Meier method.&#x0D; RESULTS: Total 105 patients were treated during the period. All patients received a total dose of 63 Gy radiation. Out of 105 patients, 76 patients (72.4%) received concurrent chemotherapy and 29 patients (27.6%) not received chemotherapy only due to co-morbidities. Here, at first follow up, 89 (84.8%) patients showed complete response, 10 (9.5%) showed partial response and 6 (5.7%) showed progressive disease. Treatment related toxicities were assessed. None of the patient developed &gt; Grade 2 toxicity.&#x0D; Further, Median Disease Free Survival (DFS) was 13 months with estimated mean was 16.98 months. Also, Standard Error (SE) =1.683, Confidence Interval (CI) =13.682-20.279.&#x0D; CONCLUSION: The high dose radiation (63 Gy) with concurrent chemotherapy as weekly regimen of Cisplatin or Paclitaxel plus Carboplatin is an effective definitive treatment of Stage I – IVA EC with acceptable toxicity. Median DFS is minimal in EC irrespective of the treatment. The rate of survival is decreasing rapidly before the median DFS and the rate of survival is constant after the Median DFS.