Carcinoma Of Gastroesophageal Junction Research Articles

Fatal hemoptysis in patients with advanced esophageal cancer treated with apatinib.

Targeted therapy is commonly used for treating advanced malignant tumors. Compared with cytotoxic drugs, targeted drugs have the characteristics of good curative results, less adverse effects, and convenient oral administration. Hence, they are especially suitable for patients with cancer who are not able to tolerate chemotherapy. Anti-angiogenic therapy can achieve the objective by inhibiting the formation of new blood vessels in tumors. Apatinib is a novel tyrosine kinase inhibitor targeting the intracellular domain of vascular endothelial growth factor receptor-2. It has been proven to be effective and safe in treating patients with gastric carcinoma and gastroesophageal junction carcinoma. So far, no reports are available on the treatment of esophageal cancer with apatinib. Two patients with advanced esophageal cancer were treated with oral apatinib because of their poor physical condition. After treatment, the dyspnea symptoms disappeared and quality of life significantly improved. Chest computed tomography showed massive necrosis of tumor tissues in each patient. The tumors significantly reduced and a cavity was formed locally in each patient. However, both patients died of massive hemoptysis, probably due to the rupture of the bronchial artery eroded by tumors. The results indicated that apatinib was effective in treating some patients with advanced esophageal cancer, and adverse effects were controllable. However, doctors should choose appropriate candidates according to apatinib’s indications. In addition, the use of apatinib should be carefully controlled for patients with esophageal cancer, especially in those with large vessels and trachea or bronchus eroded by tumor, so as to avoid or reduce the occurrence of fatal hemorrhage.

Oesophago-gastric cancer: One disease or separate entities?: Translating molecular subtyping into clinical practice

The comprehensive molecular analysis of esophageal adenocarcinomas (EAC), gastroesophageal junction (GEJ) carcinomas and gastric adenocarcinomas showed several resemblances and a continuum of molecular profile can be described (1). EAC are molecularly closer to gastric cancer than to esophageal squamous cell carcinoma (ESCC), which are in turn close to head and neck cell carcinoma. Among the 4 four described molecular groups of gastric cancer (Epstein-Barr virus (EBV) infection, microsatellite instability (MSI), chromosomal instability (CIN) and genomic stability (GS), EAC and gastric cancer group with a CIN phenotype form a distinct group from the others 3 gastric cancer groups. For the GEJ clearly derived for esophagus the only phenotype was the CIN. On the contrary, the MSI phenotype and the phenotype linked to EBV was observed only in GEJ for which the origin is uncertain or gastric. These results suggest that there is no specific anatomic entity but rather molecular entities with a large predominance of gastric CIN phenotype in the GEJ carcinomas, the others phenotypes show be considered as gastric cancers. Nevertheless, among the EAC and GEJ with CIN phenotype there is an inverse gradient of methylation from the esophagus to the stomach. Four clusters (C1 to C4) can be identified based on the abundance of CpG methylation. Several genes are specifically methylated according to the cluster of methylation and could explain a difference of sensitivity regarding alkylating agents. Several other differences in the CIN subgroup can be reported in terms of frequency of somatic genetic alteration in APC, SMARC4 or CDKN2A accordingly to the tumor location.

Carcinoma of gastro-oesophageal junction in a pregnant woman.

Carcinoma of gastro-oesophageal junction in a pregnant woman.

Gastroesophageal Junction Adenocarcinoma in Iran; a Ret-rospective Study to Investigate Demographic Characteristics and Effect of Multimodality Therapy on Survival Rate

Gastroesophageal junction (GEJ) carcinoma is a rare but highly aggressive cancer. Adenocarcinomas of the GEJ (GEJAD) represent around 90% of all the GEJ cancers. In recent years, a significant increase in the prevalence of GEJAD has been recorded in many countries. In the current study, it was aimed to investigate the GEJAD in Iran and effect of multimodality therapy on survival rate. 246 patients with GEJAD have been investigated in terms of age, gender, Siewert types, tumor stage and history of cancer. To assess the impact of different types of treatments on survival outcomes, 124 patients that completed their treatment remained in the study. Analyses were performed using SPSS statistical software. Survival rates were estimated by use of the Kaplan-Meier method. All statistical tests were 2-sided, and p ≤ 0.05 indicated statistical significance. 198 males (80.5%) and 48 females (19.5 %) with mean ages of 67.52 and 64.23 years were studied respectively. The number of patients with Siewert type I (n= 107) was more than types II and III (n= 94 and 45 respectively). There was a significant correlation between Siewert types and tumor stage (p= 0.032). 15.1 % of patients had the family history of cancer in which 56.7% of them were related to the male first-degree relatives (father, brother). Overall mean and median survival time were 33.5 and 30 months respectively. There were significant differences between survival times based on different kinds of treatments (p=0.041). SUR→RT and CHT→SUR→RT, with two years' survival rates of 60% and 100% respectively; in addition, there were the most effective treatments for GEJAD patients. In order to obtain more significant results about the impact of SUR→RT and CHT→SUR→RT on survival time, more patients with long-term assessments need to be studied.

Clinicopathological Features and Increased Expression of Toll-Like Receptor 4 of Gastric Cardia Cancer in a High-Risk Chinese Population.

The incidence of gastric cardia cancer (GCC) is high in China. However, the clinicopathological characteristics and the carcinogenesis of GCC are unclear. Toll-like receptor 4 (TLR4) is an important innate immunity receptor and has a role in non-GCC (NGCC). We compared the clinicopathological characteristics of GCC patients from a high-risk area in China to esophageal cancer (EC) patients. Immunohistochemistry for TLR4 was performed in 201 histological samples of normal gastric cardia mucosa (n = 11), gastric cardia inflammation (n = 87), and GCC (n = 103). We included 84 patients with EC and 99 with GCC. GCC tissue was more poorly differentiated than EC tissue and more invasive, with more histomorphologic variation. Lymph node metastasis was more frequent in GCC than in EC. The Helicobacter pylori infection rate was higher but not significantly with GCC than EC. Survival was shorter with lymph node metastasis. We found a statistically significant trend for progressive increase of TLR4 expression from normal mucosa to inflammation in GCC. GCC in this high-risk area displays clinicopathologic characteristics different from those of EC and different from those of gastroesophageal junction carcinomas in other countries, although this was not analyzed statistically. Increased TLR4 expression in gastric cardia lesions may be associated with GCC tumorigenesis.

Management of Multiple Primary Cancers: What is the Priority?

Multiple primary cancers are known entity due to the propensity of cancer survivors to develop additional malignancies both from genetic predisposition and exogenous influences. However, the development of triple or quadruple primary cancers, especially presenting simultaneously, presents challenging diagnostic and treatment dilemmas. We report here a patient who presented initially with neurological symptoms. Extensive evaluation and pathologic workup revealed that the patient actually has an intra-medullary vascular neoplasm at the level of upper thoracic spine, mucinous adenocarcinoma of the right lower lobe, poorly differentiated adenocarcinoma of the stomach near the gastro-esophageal (GE) junction, and conventional type adenocarcinoma of the hepatic flexure of the colon. The patient underwent neoadjuvant chemo-radiation for the GE junction carcinoma followed by surgical resection of the three different adenocarcinomas simultaneously as definitive management. This case illustrates the utility of immuno-histochemistry in delineating the site of origin for primary tumors, and the challenges posed when dealing with multiple primary neoplasms concurrently.

Characteristics and treatment of patients with neuroendocrine carcinoma of the gastroesophageal junction: an analysis of 13 cases

Background: Digestive neuroendocrine carcinoma (NEC) as well as mixed adeno-NEC (MANEC) is rare and highly malignant neoplasm which is classified as classes 3 and 4 neuroendocrine neoplasm (NEN) respectively according to the 2010 WHO classification of digestive NEN. The digestive NENs are found more in the rectum or appendix rather than in the stomach. Most gastric NENs belong to well differentiated class 1 or 2 neuroendocrine tumors (NETs, grade 1 or 2 respectively), while gastric NEC or MANEC are even rarer. Carcinoma of proximal stomach, i.e., carcinoma of gastroesophageal junction (GEJ) is controversial in epidemiology, clinicopathology, mechanisms of tumorigenesis, histology, clinical presentations, and staging, mostly between Western populations and Chinese. This article is to investigate the clinical characteristics, pathological classification and treatment of GEJ NEC. Methods: Clinicopathological data of 13 GEJ-NEC/MANEC patients at Peking Union Medical College Hospital (PUMCH) from January 2006 to January 2017 were reviewed and analyzed retrospectively. Results: Of 13 patients with pathologically confirmed GEJ-NEC/MANEC who underwent surgical resection, there were 10 cases (76.9%) of male and 3 cases (23.1%) of female. Patient age varied from 46 to 80 (median 64) years. Only 1 case (7.7%) was pathologically diagnosed as GEJ-NEC by pre-operational gastroscopy biopsy and 5 cases (38.5) were diagnosed as poorly differentiated adenocarcinoma. Twelve patients (92.3%) received proximal subtotal gastrectomy and lower esophagectomy. Another 1 patient (7.7%) received total gastrectomy and lower esophagectomy. Post operational histopathology revealed NEC in 8 cases (61.5%) and MANEC in 5 cases (38.5%). Conclusions: GEJ-NEC/MANEC is difficult to diagnosis before operation and surgery is still the primary treatment for resectable GEJ-NEC/MANEC.

Palliative chemotherapy and targeted therapies for esophageal and gastroesophageal junction cancer.

Almost half of people with esophageal or gastroesophageal junction cancer have metastatic disease at the time of diagnosis. Chemotherapy and targeted therapies are increasingly used with a palliative intent to control tumor growth, improve quality of life, and prolong survival. To date, and with the exception of ramucirumab, evidence for the efficacy of palliative treatments for esophageal and gastroesophageal cancer is lacking. To assess the effects of cytostatic or targeted therapy for treating esophageal or gastroesophageal junction cancer with palliative intent. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Web of Science, PubMed Publisher, Google Scholar, and trial registries up to 13 May 2015, and we handsearched the reference lists of studies. We did not restrict the search to publications in English. Additional searches were run in September 2017 prior to publication, and they are listed in the 'Studies awaiting assessment' section. We included randomized controlled trials (RCTs) on palliative chemotherapy and/or targeted therapy versus best supportive care or control in people with esophageal or gastroesophageal junction cancer. Two authors independently extracted data. We assessed the quality and risk of bias of eligible studies according to the Cochrane Handbook for Systematic Reviews of Interventions. We calculated pooled estimates of effect using an inverse variance random-effects model for meta-analysis. We identified 41 RCTs with 11,853 participants for inclusion in the review as well as 49 ongoing studies. For the main comparison of adding a cytostatic and/or targeted agent to a control arm, we included 11 studies with 1347 participants. This analysis demonstrated an increase in overall survival in favor of the arm with an additional cytostatic or targeted therapeutic agent with a hazard ratio (HR) of 0.75 (95% confidence interval (CI) 0.68 to 0.84, high-quality evidence). The median increased survival time was one month. Five studies in 750 participants contributed data to the comparison of palliative therapy versus best supportive care. We found a benefit in overall survival in favor of the group receiving palliative chemotherapy and/or targeted therapy compared to best supportive care (HR 0.81, 95% CI 0.71 to 0.92, high-quality evidence). Subcomparisons including only people receiving second-line therapies, chemotherapies, targeted therapies, adenocarcinomas, and squamous cell carcinomas all showed a similar benefit. The only individual agent that more than one study found to improve both overall survival and progression-free survival was ramucirumab. Palliative chemotherapy and/or targeted therapy increased the frequency of grade 3 or higher treatment-related toxicity. However, treatment-related deaths did not occur more frequently. Quality of life often improved in the arm with an additional agent. People who receive more chemotherapeutic or targeted therapeutic agents have an increased overall survival compared to people who receive less. These agents, administered as both first-line or second-line treatments, also led to better overall survival than best supportive care. With the exception of ramucirumab, it remains unclear which other individual agents cause the survival benefit. Although treatment-associated toxicities of grade 3 or more occurred more frequently in arms with an additional chemotherapy or targeted therapy agent, there is no evidence that palliative chemotherapy and/or targeted therapy decrease quality of life. Based on this meta-analysis, palliative chemotherapy and/or targeted therapy can be considered standard care for esophageal and gastroesophageal junction carcinoma.

Initial Results of the Oesophageal and Gastric Cancer Registry From the Comunidad Valenciana

AimsTo evaluate the initial results of the oesophagogastric cancer registry developed for the Sociedad Valenciana de Cirugía and the Health Department of the Comunidad Valenciana (Spain). MethodsFourteen of the 24 public hospitals belonging to the Comunidad Valenciana participated. All patients with diagnosis of oesophageal or gastric carcinomas operated from January 2013 to December 2014 were evaluated. Demographic, clinical and pathological data were analysed. ResultsFour hundred and thirty-four patients (120 oesophageal carcinomas and 314 gastric carcinomas) were included. Only two hospitals operated more than 10 patients with oesophageal cancer per year. Transthoracic oesophagectomy was the most frequent approach (84.2%) in tumours localised within the oesophagus. A total gastrectomy was performed in 50.9% patients with gastroesophageal junction (GOJ) carcinomas. Postoperative 30-day and 90-day mortality were 8% and 11.6% in oesophageal carcinoma and 5.9% and 8.6% in gastric carcinoma.Before surgery, middle oesophagus carcinomas were treated mostly (76.5%) with chemoradiotherapy. On the contrary, lower oesophagus and GOJ carcinomas were treated preferably with chemotherapy alone (45.5% and 53.4%). Any neoadjuvant treatment was administered to 73.6% of gastric cancer patients. Half patients with oesophageal carcinoma or gastric carcinoma received no adjuvant treatment. ConclusionsThis registry revealed that half patients with oesophageal cancer were operated in hospitals with less than 10 cases per year at the Comunidad Valenciana. Also, it detected capacity improvement for some clinical outcomes of oesophageal and gastric carcinomas.

Safety and Efficacy of Preoperative Chemoradiotherapy in Patients with Locally Advanced Gastroesophageal Junction Carcinoma: Primary Results of the Multicenter Randomized PAPER Trial in Beijing, Tianjin, and Hebei Province

Safety and Efficacy of Preoperative Chemoradiotherapy in Patients with Locally Advanced Gastroesophageal Junction Carcinoma: Primary Results of the Multicenter Randomized PAPER Trial in Beijing, Tianjin, and Hebei Province

Advanced esophagogastric cancers: the making or breaking of a backbone

Esophageal cancer is the sixth leading causes of cancer mortality worldwide (1). In North America, adenocarcinoma has become the most common histology whereas squamous remains the most common histology worldwide. While the risk factors, tumor location, biology and prognosis of these two histologies differ, the treatment of these two types in the metastatic setting is the same. Unfortunately, most patients with either histology present with advanced disease at the time of diagnosis. Consensus is lacking as to the optimal first line chemotherapy regimen in the advanced or metastatic setting. Much of the data guiding the treatment of advanced esophageal cancer are extrapolated from trials in advanced gastric cancer and trials combining esophageal and gastric cancers. The National Comprehensive Cancer Network (NCCN) guidelines give a category 1 recommendation for doublet therapy combining fluorouracil or capecitabine and cisplatin for first line treatment for advanced esophageal and gastroesophageal junction (GEJ) carcinomas (2). However, several other chemotherapy combinations are also considered acceptable and are well tolerated.

Clonality analysis of synchronous gastro-oesophageal junction carcinoma and distal gastric cancer by whole-exome sequencing.

Gastro-oesophageal junction (GEJ) carcinoma and distal gastric cancer (GC) have distinct epidemiology and clinical features and their relationship is uncertain. Synchronous multiple gastric cancers located mostly at proximal and distal sites provide rare specimens for investigating the comprehensive genomic relationships among these cancers in the context of identical genetic circumstances. Formalin-fixed, paraffin-embedded (FFPE) samples from 12 patients with synchronous GEJ carcinoma and distal GC were collected in this study. Whole-exome sequencing (WES) was performed using normal tissues as a control. Mutational profiling, clonality analysis, a detailed clinico-pathological review, determination of MSI status, EBER in situ hybridization (ISH), and programmed cell death 1 (PD-1)/programmed death-ligand 1 (PD-L1) immunohistochemical staining were performed. Twenty-three of the 24 samples were microsatellite-stable (MSS). Subclonal analysis revealed that nine pairs of GEJ and distal GC tumours in neoadjuvant chemotherapy naïve patients developed independently from different origins. Two patients who received neoadjuvant chemotherapy shared clonal origins with highly similar somatic alterations. The remaining one patient who shared a rare mutation died within 6.2 months at the N3 stage. However, the enriched pathway identified from the overall mutation spectra in distal GC and GEJ carcinoma showed the close relationship of these cancers. Thus, although these cancers may have similar characteristics, histopathological and genetic profiling from single tumour specimens may still underestimate the mutational burden and somatic heterogeneity of multiple GCs. In addition, this series of cases also showed a PD-L1 expression rate of 58.3% and 66.7% in distal GC and GEJ carcinoma, respectively, with all the cases expressing PD-1. This result suggests the potential benefit of immunotherapeutic treatments. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Resultados iniciales del registro de carcinomas esófago-gástricos de la Comunidad Valenciana

AimsTo evaluate the initial results of the oesophagogastric cancer registry developed for the Sociedad Valenciana de Cirugía and the Health Department of the Comunidad Valenciana (Spain). MethodsFourteen of the 24 public hospitals belonging to the Comunidad Valenciana participated. All patients with diagnosis of oesophageal or gastric carcinomas operated from January 2013 to December 2014 were evaluated. Demographic, clinical and pathological data were analysed. ResultsFour hundred and thirty-four patients (120 oesophageal carcinomas and 314 gastric carcinomas) were included. Only two hospitals operated more than 10 patients with oesophageal cancer per year. Transthoracic oesophaguectomy was the most frequent approach (84.2%) in tumours localized within the oesophagus. A total gastrectomy was performed in 50.9% patients with gastroesophageal junction (GOJ) carcinomas. Postoperative 30-day and 90-day mortality were 8% and 11.6% in oesophageal carcinoma and 5.9 and 8.6% in gastric carcinoma.Before surgery, middle oesophagus carcinomas were treated mostly (76,5%) with chemoradiotherapy. On the contrary, lower oesophagus and GOJ carcinomas were treated preferably with chemotherapy alone (45.5 and 53.4%). Any neoadjuvant treatment was administered to 73.6% of gastric cancer patients. Half patients with oesophageal carcinoma or gastric carcinoma received no adjuvant treatment. ConclusionsThis registry revealed that half patients with oesophageal cancer were operated in hospitals with less than 10 cases per year at the Comunidad Valenciana. Also, it detected capacity improvement for some clinical outcomes of oesophageal and gastric carcinomas.

Molecular profiling-guided therapy in gastroesophageal carcinoma: A single-institution experience.

e15582 Background: Gastroesophageal carcinoma (GEC) including carcinoma of stomach (GC), gastroesophageal junction (GEJ), and esophagus (EC) is the 2nd leading cause of cancer death worldwide. Chemotherapy and HER2-targeted therapy (trastuzumab) have shown limited efficacy. We aim to assess the impact of molecular profile (MP)-guided therapy (MPgt) by correlating expression of select biomarkers in GEC patients (pts) with survival. Methods: 27 GEC (11 GC, 9 GEJ, 7 EC) submitted to Caris Life Sciences for molecular profiling between 2011 and 2016 were analyzed and correlated with pt survival. The impact of MPgt was assessed by calculating the ratio of progression-free survival (PFS) on MPgt to PFS on the preceding empiric therapy. MPgt was deemed beneficial if PFS ratio ≥1.3. Results: In-situ hybridization indicated amplification of HER2 (15.4%) and c-MET (7.4%). Immunohistochemistry revealed increased expression of TOPO1 (57.7%), TOP2A (38.5%), HER2 (15.4%) and c-MET (6.9%), as well as decreased expression of TS (69.2%), ERCC1 (42.3%), and PGP (15.4%). These data suggest sensitivity to topoisomerase inhibitors, anthracyclines, trastuzumab, MET-targeted therapy, fluoropyrimidine, platinums, and taxanes, respectively. Expression of these markers was heterogeneous among pts, and a trend toward improved PFS was noted in pts with low/absent ERCC1 expression on platinum-based therapy ( P= 0.06). Of the 13 pts who had sufficient data to assess the benefit of MPgt, 5 (38%) achieved a PFS ratio ≥1.3. One pt with metastatic HER2-amplified EC who had initially demonstrated clinical benefit from trastuzumab-containing chemotherapy, developed a new HER2 and c-MET co-amplified lung metastasis. Conclusions: While MPgt was beneficial in 38% of pts, tumor-associated plasticity, clonal evolution, and adaptive resistance may have limited efficacy. The emergence of HER2 and c-MET co-amplified clones is a potential resistance mechanism in HER2-amplified GEC, and highlights combined inhibition of receptor tyrosine kinases as a therapeutic strategy. Further studies with expanded data sets will be needed to test the hypothesis that actionable targets can be used independently to predict treatment response in GEC pts.

Survival benefit of neoadjuvant radiation therapy in patients with carcinoma of gastroesophageal junction and distal esophagus? A population-based study

Background: The incidence of carcinoma of gastroesophageal junction (GEJ) and distal esophagus (DE) is growing globally and the standard treatment remained controversial. GEJ cancer is different from esophageal cancer (EC) and gastric cancer (GC) not only anatomically but also biologically. We aim to investigate the value of (neo)adjuvant radiotherapy (RT) in multidisciplinary treatment procedure of this disease. Methods: Data for carcinoma of GEJ and DE were obtained from January 1973 to December 2012 from the US National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program. Univariate and multivariate analyses were performed to examine the impact of race, gender, age, grade, histology, surgery, RT and other potential prognostic factors on overall survival (OS) and cancer-specific survival (CSS). Results: Five hundred and sixteen patients with carcinoma of GEJ and DE in the SEER database were identified in this study. Of them 135 received either surgery or RT, 139 underwent surgery and 164 underwent RT alone, 41 had neoadjuvant RT with surgery and 37 had adjuvant RT with surgery. Gender, histological type, and treatment modalities are independent prognostic factors (P Conclusions: Surgery is the primary choice for carcinoma of GEJ and DE while neoadjuvant RT is considerable in multidisciplinary treatment, especially in SCC. Special attention should be paid when thinking about conducting postoperative RT in SCC.

Survival benefit of neoadjuvant radiation therapy in patients with carcinoma of gastroesophageal junction and distal esophagus? A population-based study

Background: The incidence of carcinoma of gastroesophageal junction (GEJ) and distal esophagus (DE) is growing globally and the standard treatment remained controversial. GEJ cancer is different from esophageal cancer (EC) and gastric cancer (GC) not only anatomically but also biologically. We aim to investigate the value of (neo)adjuvant radiotherapy (RT) in multidisciplinary treatment procedure of this disease.

Adjuvant therapy for locally advanced gastric cancer.

D2 gastrectomy is now the globally accepted surgical standard for locally advanced gastric cancer. However, since 2000, different evidence has emerged regarding the efficacy of adjuvant chemoradiation, perioperative adjuvant chemotherapy, and postoperative chemotherapy for locally advanced gastric cancer. This review summarizes the background, current status, and future perspectives of adjuvant therapy for locally advanced gastric cancer. The Intergroup 0116 study was the first to show the significant overall survival benefits of adjuvant (chemoradiation) therapy for gastric cancer. The second study was the MAGIC trial, which showed the efficacy of perioperative adjuvant chemotherapy. Although the findings from the Intergroup 0116 study and the MAGIC trial were positive, recent studies, such as the ARTIST and EORTC 40954 studies, found no survival benefit for patients who had undergone D2 gastrectomy for gastric cancer. Regarding the adjuvant chemotherapy strategy, two pivotal phase III trials: the ACTS-GC and the CLASSIC, demonstrated the efficacy of postoperative adjuvant chemotherapy following D2 gastrectomy. However, more intensive chemotherapy is necessary to improve the survival rate. Several studies have analyzed the effectiveness of molecular-targeted therapy against metastatic gastric or gastroesophageal junction carcinoma. Further studies should focus on the survival benefit of more-intensive adjuvant therapy with D2 resection, or with concurrent molecular-targeted therapy.

Nab-paclitaxel as second-line treatment in advanced gastric cancer: a multicenter phase II study of the Hellenic Oncology Research Group.

Background:This study evaluated the safety and efficacy of nab-paclitaxel as second-line treatment in patients with advanced gastric adenocarcinoma.Methods:Thirty-nine pretreated patients [33 with taxane-based regimens (docetaxel, cisplatin, and fluorouracil)] and 6 with combination of fluoropyrimidines plus cisplatin with locally advanced inoperable and metastatic gastric and gastroesophageal junction adenocarcinoma were treated with weekly nab-paclitaxel (150 mg/m2 d1, d8, d15 in cycles of 28 days).Results:Partial response (PR) was documented in nine patients (23.1%; 95% confidence interval 10.1-37.2%), stable disease (SD) in 11 (28.2%) and disease progression in 18 (46.2%). The disease control rate (SD + PR + complete response) was 51.3%. Grade 3 and 4 neutropenia occurred in 10.2% and 5.1% of patients, respectively; grade 3 anemia in 5.1%; grade 3 neurotoxicity in 5.1%; and grade 2 pain in 5.1%. The median progression-free survival was 3.0 months (range 0.3-13.6) and the median overall survival 6.8 months (range 0.3-22).Conclusion:Nab-paclitaxel as second-line treatment in locally advanced inoperable or metastatic gastric and gastroesophageal junction carcinoma is an active chemotherapy regimen with a manageable toxicity profile and merits further evaluation.

Cervical esophago-gastric anastomosis using linear cutter stapler in esophageal cancer.

Anastomosis in gastrointestinal (GI) surgery is a commonly performed procedure. Irrelevant various methods of intestinal anastomosis were followed - recent advance is the use of a stapler as a device for GI anastomosis. Due to the use of staplers, technical failures are a rarity, anastomosis is more consistent and can be used at difficult locations. : Between 2008 and August 2016, 75 patients with esophagus or gastroesophageal junction carcinoma underwent curative intent resection either via a right posterolateral thoracotomy (TTE) or transhiatal esophagectomy or video-assisted thoracoscopic surgery with linear stapler anastomosis. The average follow-up was approximately 9 months. Anastomotic leakage was observed in three patients. On follow-up, two patients presented with difficulty in swallowing, and on upper GI endoscopy, they were found to have anastomotic site stricture. There was no perioperative mortality. The linear-stapled esophagogastric anastomosis is a safe and effective anastomotic technique, which can decrease the rate of leak, postoperative dysphagia, and anastomotic stricture. As in this technique only two linear staplers are used in comparison to other techniques where three or more staplers are used, it is also cost-effective. The procedure deserves more attention and further application.

Gastroesophageal junction carcinoma and brachial plexopathy: An anatomic explanation via perineural spread

Gastroesophageal junction carcinoma and brachial plexopathy: An anatomic explanation via perineural spread