Inoperable Cancer Patients Research Articles

ENDOSCOPIC BOUGIENAGE AS PALLIATIVE TREATMENT FOR INOPERABLE ESOPHAGEAL CANCER: A CASE SERIES

Relevance: Esophageal cancer is one of the most aggressive tumors of the digestive tract, with a 5-year survival rate of only 10%. Given the global aging of the population and consequently the increase in the number of patients who will not undergo surgery, chemotherapy, andradiation, or the fact that they do not want it, especially due to deficiencies and concomitant pathology, endoscopic methods for palliative treatment are an alternative. The article aimed to report the results using distal caps to treat esophageal stenosis in inoperable esophageal cancer. Methods: The article describes cases of endoscopic cap bougienage in patients with inoperable cancerous esophageal stenosis at the National Scientific Cancer Center (Astana, Kazakhstan). Results: All 5 patients had inoperable cancerous esophageal stenosis and endoscopically installed percutaneous gastrostomy. All patients refused to eat through gastrostomy and wanted to take food physiologically orally while preserving the perception of food taste. Sessions of distal esophageal bougienage with distal caps were performed outpatiently and without sedation; the intervals between sessions ranged from 7 to 20 days and the number of bougees ranged from 4 to 11. Conclusions In our clinic, distal cap bougienage has been successfully used in patients with benign strictures for a long time, and in this article we present cases of bougienage in 5 patients with malignant stenoses. Further investigation of the effectiveness of cap bougienage of malignant stenoses requires a more extensive sample of patients and longer follow-ups. However, we decided to publish our preliminary results since we were the first in Kazakhstan to use them in inoperable cancer patients. Bougie, as a palliative treatment for inoperable esophageal cancer, is a method to improve food passage and a more physiological meal, which, according to taste preferences, is more psychologically demanded by patients, compared to eating through gastrostomy. Bougie caps are a safe method since the Bougie Cap is transparent and the bougie is performed under the visual supervision of an endoscopist. This bougie technique can be recommended for widespread use in clinics as the safest bougie method not only for malignant stenoses but also for benign strictures of the esophagus.

Efficacy of Oesophageal self expandable metal stent placement for palliation of dysphagia in inoperable oesophageal cancer patients: A low-income country perspective

Efficacy of Oesophageal self expandable metal stent placement for palliation of dysphagia in inoperable oesophageal cancer patients: A low-income country perspective

Correlation between overall survival and quality of life in colon cancer patients with chemotherapy

BackgroundPatients presenting with inoperable colon cancer at first onset (ICF) or at time of relapse (ICR) are considered in unrecoverable. The therapeutic goal for unrecoverable cancer is to prolong overall survival (OS) and maintain a high quality of life (QOL). As data on objective indicators of QOL in cancer patients, such as length of hospitalisation (LOH), outpatient consultation times (OCT), and hospital-free survival (HFS), is limited, this study compared ICF and ICR with respect to OS and QOL over the entire clinical course.MethodsWe retrospectively evaluated 90 inoperable colon cancer patients with chemotherapy and compared ICF and ICR in terms of OS, LOH, OCT, and HFS.ResultsPatients with ICF had a worse OS than those with ICR. In patients with ICF and ICR, OS and LOH were not correlated but OS and OCT and OS and HFS were strongly correlated. In patients with ICF and ICR, OCT and HFS accounted for approximately 8% and 90% of their OS, respectively.ConclusionsThe LOH, OCT, and HFS are important factors for evaluating objective QOL of patients with inoperable colon cancer and should be considered when making treatment decisions.

Real-Time Online Adaptive Magnetic Resonance Image Guided Stereotactic Body Radiation Therapy with or without Elective Nodal Irradiation for Inoperable Pancreas Cancer Patients

<h3>Purpose/Objective(s)</h3> Stereotactic body radiation therapy (SBRT) to patients with inoperable pancreas cancer has shown promising outcomes. Dose escalated SBRT is usually challenging given the associated risks to nearby organs. This study aims to report treatment outcomes and adverse events of Real-time Online Adaptive Magnetic Resonance-Guided SBRT (MRgSBRT). <h3>Materials/Methods</h3> This IRB approved retrospective study included inoperable pancreas cancer patients who were treated consecutively with MRgSBRT from 2020 to 2021. Most patients (89%) received 50Gy prescribed to gross tumor volume (GTV), two patients (11%) received 40 Gy to GTV. Ten patients (56%) received elective nodal irradiation (ENI) to celiac and super mesenteric lymph nodes, & 8 patients (44%) did not receive ENI. Planning Target Volume (PTV) received a median dose of 35 Gy (range 25-50 Gy) and 40 Gy (range 40-50 Gy), in patients with, and without ENI respectively. PTV was defined as 3 mm expansion of either GTV, or a clinical target volume encompassing GTV and ENI areas when treated. Real-time Online Adaptive MRgSBRT was utilized in 59% of the treated fractions (53 of 90 fractions), while gated MRgSBRT was utilized in all fractions (100%). Real-time Online Adaptive MRgSBRT was utilized whenever the predicted radiation plan did not meet the organs at risk (OARs) constraints based on daily anatomic variations. Reoptimized plans were generated after re-contouring OARs within a 3 cm ring, & verifying GTV & PTV, & always met OARs constraints. All patients were treated twice weekly. <h3>Results</h3> The study included 18 eligible patients with median age of 72.5 years (range 56-85). Patients had local-regional advanced (44%), borderline (33%) & metastatic (22%) diseases. At a median follow up of 10 months from MRgSBRT (range 2-17 months), in patients with & without ENI local-regional progression was 20% versus 67% (p 0.12 Fisher's Exact Test), distant progression was 30% versus 67% (p 0.3), & overall survival was 80% and 37.5% (p 0.14) respectively. Of those who developed disease progression, first site of progression was distant metastases (75%), versus regional nodal progression (75%) in patients with & without ENI respectively. In the non-ENI group, 50%, 12.5%, 12.5%, & 25% were dead of disease (DOD), dead without disease progression (DWODP), alive with disease (AWD), & alive without disease progression (AWODP) respectively. In the ENI group, 10%, 10%, 60%, & 20% were DOD, DWODP, AWD, & AWODP respectively. Median follow up from diagnosis was 19 months (range 6-103 months). Acute & chronic toxicities were uncommon, & included grade 1-2 nausea (22%), fatigue (17%), & abdominal discomfort (11%). No grades 3-5 toxicities were reported. <h3>Conclusion</h3> Real-time Online Adaptive MRgSBRT is a feasible, & safe approach with minimal treatment related toxicities & promising local-regional control in a cohort of advanced pancreas cancer patients. ENI is safe & shows a trend for improved local-regional control. Larger controlled prospective trials are recommended.

Long-term efficacy of percutaneous transhepatic cholangioscopy-guided photodynamic therapy for postoperative recurrent extrahepatic cholangiocarcinoma

BackgroundCholangiocarcinoma recurs frequently following excision surgery and is usually inoperable, while radiotherapy, chemotherapy, and immunotherapy are of limited benefit. As palliative care, percutaneous transhepatic cholangial drainage (PTCD) can relieve biliary obstruction, prevent jaundice, and maintain quality of life (QOL), but does not improve overall survival. In contrast, photodynamic therapy (PDT) has been demonstrated to prolong the survival of inoperable cancer patients. ObjectiveThis study evaluated the clinical efficacy of percutaneous transhepatic cholangioscopy (PTCS)-guided PDT following PTCD versus PTCD alone for recurrent inoperable cholangiocarcinoma. MethodsThe case files of 39 patients with postoperative recurrence were retrospectively analyzed, including 18 receiving PTCS-guided PDT (PTCS-PDT group) and 21 receiving PTCD only as a control (PTCD group). Survival time was compared by Kaplan-Meier analysis and log-rank test, and QOL by the Functional Assessment of Cancer Therapy–Hepatobiliary (FACT-HEP) questionnaire. Clinicodemographic factors, including serum bilirubin and adverse reaction rates, were compared by Student's t-test or Fisher's exact test. The maximum follow-up period was 71 months. ResultsMedian survival time was significantly longer in the PTCS-PDT group than the PTCD group (23 months vs. 10 months, P = 0.00001). At 6 and 12 months post-treatment, total FACT-HEP score was lower in the PTCS-PDT group (P < 0.05), indicating improved QOL. There was no significant difference in total adverse events incidence between groups (19 [51.4%] vs. 15 [71.4%]; P = 0.131). ConclusionPTCS-guided PDT can prolong survival and improve the QOL of patients with postoperative cholangiocarcinoma recurrence without increasing complications. Significant and/or new findingsCompared to PTCD alone, PTCS-guided PDT significantly prolonged the survival time of patients with postoperative recurrent extrahepatic cholangiocarcinoma. Photodynamic therapy also improved patient quality of life by facilitating timely removal of the PTCD drainage tube. PTCS-guided PDT did not increase surgery-related complications except for skin phototoxicity, which can be easy avoided and treated.

American Radium Society (ARS) Appropriate Use Criteria (AUC) for Locoregional Gastric Adenocarcinoma: Systematic Review and Guidelines.

The objective of this study was to systematically evaluate the data regarding the use of neoadjuvant, perioperative, surgical, and adjuvant treatment options in localized gastric cancer patients and to develop Appropriate Use Criteria recommended by a panel of experts convened by the American Radium Society. Preferred reporting items for systematic reviews and meta-analyses methodology was used to develop an extensive analysis of peer-reviewed phase 2/2R/3 trials, as well as meta-analyses found within the Ovid Medline database between 2010 and 2020. The expert panel then rated the appropriateness of various treatments in 5 representative clinical scenarios through a well-established consensus methodology (modified Delphi). For patients with medically operable locally advanced gastric cancer, the strongest recommendation was for perioperative chemotherapy based on high-quality data. Acceptable alternatives included surgery followed by either chemotherapy or concurrent chemoradiotherapy (CRT). For patients with upfront resection of stages I to III gastric cancer (no neoadjuvant therapy), the group strongly recommended adjuvant therapy with either chemotherapy alone or CRT, based on high-quality data. For patients with locally advanced disease who received preoperative chemotherapy without tumor regression, the group strongly recommended postoperative chemotherapy or postoperative CRT. Finally, for medically inoperable gastric cancer patients, there was moderate consensus recommending definitive concurrent CRT. The addition of chemotherapy and/or radiation, either in the neoadjuvant, adjuvant, or perioperative setting, results in improved survival rates for patients compared with surgery alone. For inoperable patients, definitive CRT is a reasonable treatment option, though largely palliative.

RGS1 and related genes as potential targets for immunotherapy in cervical cancer: computational biology and experimental validation

BackgroundEffective treatment is needed for advanced, inoperable, or chemotherapy-resistant cervical cancer patients. Immunotherapy has become a new treatment modality for cervical cancer patients, and there is an urgent need to identify additional targets for cervical cancer immunotherapy.MethodsIn this study the core gene, RGS1, which affects immune status and the FIGO stage of cervical cancer patients was identified by WGCNA analysis and differential analysis using TCGA database. 10 related genes interacting with RGS1 were identified using PPI network, and the functional and immune correlations were analyzed. Based on the expression of RGS1 and related genes, the consensus clustering method was used to divide CESC patients into two groups (group 1, high expression of RGS1; group 2, low expression of RGS1). Then, the functional enrichment analysis was used to search for the functional differences in differentially expressed genes (DEGs) between group 1 and group 2. Immune infiltration analysis was performed using ESTIMATE, CIBERSORT, and ssGSEA, and the differences in expression of immune checkpoint inhibitors (ICIs) targets were assessed between the two groups. We investigated the effect of RGS1 on the clinical relevance of CESC patients, and experimentally verified the differences in RGS1 expression between cervical cancer patient tissues and normal cervical tissues, the role of RGS1 in cell function, and the effect on tumor growth in tumor-bearing mice.ResultsWe found that RGS1 was associated with CD4, GNAI3, RGS2, GNAO1, GNAI2, RGS20, GNAZ, GNAI1, HLA-DRA and HLA-DRB1, especially CD4 and RGS2. Functional enrichment of DEGs was associated with T cell activation. Compared with group 2, group 1 had stronger immune infiltration and higher ICI target expression. RGS1 had higher expression in cervical cancer tissues than normal tissues, especially in HPV-E6 positive cancer tissues. In cervical cancer cell lines, knockdown of RGS1 can inhibited cell proliferation, migration, invasion, and tumor growth in nude mice and promoted apoptosis.ConclusionsRGS1, as an oncogenic gene of cervical cancer, affects the immune microenvironment of patients with cervical cancer and may be a target of immunotherapy.

Contact x-ray brachytherapy for older or inoperable rectal cancer patients: short-term oncological and functional follow-up.

Background: Total mesorectal excision for rectal cancer is a major operation, associated with morbidity and mortality. For older or inoperable patients alternatives are necessary. This study evaluated the functional and oncological outcome, and quality of life of older or inoperable rectal cancer patients treated with a contact x-ray brachytherapy boost to avoid major surgery.

Contact X-ray Brachytherapy for Older or Inoperable Rectal Cancer Patients: Short-Term Oncological and Functional Follow-Up.

Simple SummaryThe cornerstone in rectal cancer treatment is total mesorectal excision, a major surgical procedure associated with morbidity and mortality, especially in older rectal cancer patients. To avoid major surgery, different radiotherapy techniques are being investigated. Studies on contact X-ray brachytherapy reveal promising oncological results. However, there are limited data on functional outcome and quality of life, which are highly important for older or inoperable patients. This study aims to report the oncological and functional outcome, quality of life, and patients’ experiences of older or inoperable rectal cancer patients treated with contact X-ray brachytherapy to avoid major surgery. This study shows that contact X-ray brachytherapy can provide a good tumor response and is well tolerated, with minimal impact on functional outcome and quality of life. These data suggest contact X-ray brachytherapy can be considered an option for older or inoperable rectal cancer patients to avoid major rectal surgery.Total mesorectal excision for rectal cancer is a major operation associated with morbidity and mortality. For older or inoperable patients, alternatives are necessary. This prospective study evaluated the oncological and functional outcome and quality of life of older or inoperable rectal cancer patients treated with a contact X-ray brachytherapy boost to avoid major surgery. During follow-up, tumor response and toxicity on endoscopy were scored. Functional outcome and quality of life were assessed with self-administered questionnaires. Additionally, in-depth interviews regarding patients’ experiences were conducted. Nineteen patients were included with a median age of 80 years (range 72–91); nine patients achieved a clinical complete response and in another four local control of the tumor was established. The 12 month organ-preservation rate, progression-free survival, and overall survival were 88%, 78%, and 100%, respectively. A transient decrease in quality of life and bowel function was observed at 3 months, which was generally restored at 6 months. In-depth interviews revealed that patients’ experience was positive despite the side-effects shortly after treatment. In older or inoperable rectal cancer patients, contact X-ray brachytherapy can be considered an option to avoid total mesorectal excision. Contact X-ray brachytherapy is well-tolerated and can provide good tumor control.

Pretreatment neutrophil-to-lymphocyte ratio predicts the benefit of gastric cancer patients with systemic therapy.

Pretreatment neutrophil-to-lymphocyte ratio (NLR) has been reported to be associated with the prognosis of inoperable gastric cancer patients with systemic therapy. However, no consensus on the association has been reached. In this study, we mainly evaluated whether pretreatment NLR predicted the benefit of inoperable gastric cancer patients with systemic therapy, including chemotherapy, targeted therapy and immunotherapy. PubMed, Embase and Cochrane Library databases were systematically searched from inception up to September 16th, 2020. A total of 36 studies including 8614 patients were involved in the meta-analysis. Pooled data revealed that high pretreatment NLR was significantly associated with poor outcomes of OS (HR = 1.78, 95% CI = [1.59, 1.99]) and PFS (HR = 1.63, 95% CI = [1.39, 1.91]) in gastric cancer. Subgroup analyses stratified by country, study type, case load, analysis of HR, cutoff of pretreatment NLR, or treatment types arrived at the same conclusion. Pooled data based on different effect models and sensitivity analyses did not change the conclusion. Overall, high pretreatment NLR predicts the poor prognosis of inoperable gastric cancer patients with systemic therapy. Measurement of pretreatment NLR will assist clinicians with patient counseling and clinical treatment guiding accordingly.

The potential adjunctive benefit of adding metformin to standard treatment in inoperable cancer patients: a meta-analysis of randomized controlled trials.

BackgroundRecently, there have been several randomized clinical trials (RCTs) conducted to evaluate the efficacy and safety of metformin plus standard treatment in inoperable cancer patients. Our meta-analysis aimed to assess the efficacy of metformin in combination with standard treatment in inoperable cancer patients.MethodsPubMed and Embase databases were systematically searched for relevant RCTs investigating the efficacy of adding metformin to standard treatment for cancer patients. The pooled relative risk (RR) for tumor response and safety was calculated to assess the efficacy of combining metformin with standard treatment. Meta-analysis was subsequently performed to pool the hazard ratio (HR) for overall survival (OS) and progression-free survival (PFS).ResultsTen RCTs comprising 1033 patients were included in our current meta-analysis. In patients with breast cancer, results of meta-analysis showed that the addition of metformin to standard treatment was beneficial to objective response rate (ORR) with 30.3% (33/109) in the metformin plus standard treatment group and 16.1% (18/112) in the placebo group (RR 1.92, 95% CI: 1.19–3.10, P=0.008). OS and PFS were not significantly improved in patients who received metformin plus standard treatment compared with those who received placebo plus standard treatment (OS: HR 1.02, 95% CI: 0.71–1.46, P=0.916; PFS: HR 1.14, 95% CI: 0.86–1.50, P=0.366). For lung cancer patients, meta-analysis results showed adding metformin to standard treatment could benefit ORR (metformin 65.3% vs. placebo 54.6%, RR 1.22, 95% CI: 1.03–1.43, P=0.018) with no significant survival benefit in the metformin group. For patients with pancreatic cancer, the pooled ORR was 17.6% (16/91) in metformin plus standard treatment group and 20% (18/90) in the placebo group, indicating metformin did not benefit ORR (RR 0.85, 95% CI: 0.49–1.49, P=0.576). Besides, the addition of metformin to standard treatment did not increase the incidence rate of adverse effects.ConclusionsOur results indicated that addition of metformin to standard treatment was beneficial to ORR in inoperable breast or lung cancer patients without increasing the incidence of adverse effects. However, adding metformin to standard treatment could not benefit OS and PFS.

Toxicity outcome of endorectal brachytherapy boost in medically inoperable patients.

This communication reviews results and toxicity of image-guided high-dose-rate endorectal brachytherapy (HDREBT) boost after external beam radiotherapy (ERT) in medically inoperable patients with rectal cancer. A total of 18patients with rectal cancer and clinical stage T2-4N0‑2 treated with HDREBT boost after ERT were retrospectively reviewed. Following treatment with amedian total dose (EQD2, α/β = 10) of 66 Gy (range 48-92 Gy), the incidence of early and late rectal grade3 toxicity was 11% and 19%, respectively. There was no correlation between the occurrence of acute and late toxicity. With proper technique, acombined approach using EBRT and HDREBT was associated with acceptable toxicity in medically inoperable rectal cancer patients.

Upfront radiotherapy with brachytherapy for medically inoperable and unresectable patients with high-risk endometrial cancer

ObjectivesComprehensive surgery with adjuvant therapy is standard of care for high-risk endometrial cancers, whereas upfront radiotherapy with brachytherapy is indicated for inoperable/unresectable patients, irrespective of risk. We evaluated outcomes for inoperable/unresectable patients with high-risk endometrial cancer (HREC: stage III and/or grade 3) and low-risk endometrial cancer (LREC: stage I/II and grade 1/2) treated with upfront radiotherapy. MethodsTwenty-nine patients with inoperable/unresectable endometrial cancer were treated with upfront radiotherapy at an academic medical center from 2012 to 2019. Cancer-specific survival (CSS), overall survival (OS), and recurrence rates between patients with HREC and LREC were compared. ResultsMedian follow-up was 17.0 months (range 3.7–54.0). Twenty cancers were stage I + II and nine were stage III. Twenty-one cancers were grade 1 + 2 and eight were grade 3. Thirteen patients (45%) had HREC. Twenty-five patients received radiotherapy/chemoradiotherapy for primary treatment, while 4 patients received chemoradiotherapy before surgery. All patients underwent high dose rate brachytherapy (HDR) with 7 receiving HDR alone and 22 receiving external beam radiation and HDR. Two-year CSS was 100% for both HREC and LREC patients (log-rank p = 0.32). There was no OS difference between HREC and LREC patients (2-year: 73% vs. 77%; log-rank p = 0.33). Four HREC and 1 LREC patients recurred with one local recurrence in each group. There were no acute grade ≥3 and two late grade ≥3 gastrointestinal/genitourinary toxicities. ConclusionsUpfront radiotherapy for inoperable/unresectable HREC patients was well tolerated with high local control and CSS rates. Upfront radiotherapy with brachytherapy remains important even for high-risk inoperable and unresectable endometrial cancer patients.

EBRT Modality-Specific Treatment Outcome of Cervical Cancer Patients for Real-World Practice

Purpose: To compare the clinical outcome while treating cervical cancer patients with intensity modulated radiation therapy (IMRT) versus 3-dimensional conformal radiation therapy (3DCRT). Methods: Analyzed a very large dataset from real-world practice using the National Cancer Database (NCDB) for FIGO IB-IIIB inoperable cervical cancer patients treated with chemoradiation from 2004 to 2014. Patients who received initial treatment with external beam radiation therapy (EBRT), either IMRT or 3DCRT, of 40-60Gy dose were included. Patients who received EBRT boost were stratified based on treatment modality (IMRT or 3DCRT for initial and boost). Also considered another group where EBRT is followed by brachytherapy, i.e. the standard of care. IBM-SPSS was used for statistical analysis; p-value &lt;0.05 was considered statistically significant. Results: Median age of the eligible patient population was 53 years and the median follow-up was 24.4 months. Analysis revealed that the median OS was 36.1 months for IMRT versus 51.2 months for 3DCRT (p &lt;0.05); 2- and 5-year OS were 7% and 9%, higher for 3DCRT (p &lt;0.007). Conclusion: This study demonstrates 3DCRT was better than IMRT for OS when no brachytherapy boost was considered. However, 3DCRT and IMRT did not make any difference in OS when brachytherapy boost was used. Therefore, it is important to use brachytherapy boost whenever possible for treatment of inoperable cervical cancer patients with curative intent.

Efficacy of chronomodulated chemotherapy for palliation of hematemesis in inoperable gastric cancer: A single-institutional retrospective study

Context:Aside abdominal discomfort and pain, upper gastrointestinal bleeding (UGIB) significantly disgraces the quality of life (QoL), especially in inoperable gastric cancer patients. Although, in early stages, it is infrequent and often ignored, but in advanced stages, its aggressiveness often deteriorates patient's hemoglobin (Hb) level and performing status.Aim:The aim of this study is to correlate the change in (1) the frequency of episodes of UGIB, (2) its severity in terms of Common Terminology Criteria for Adverse Events (CTCAE) grade for UGIB, and (3) Hb level with the successful completion of successive cycles of palliative chemotherapy where it becomes invariably the only modality to palliate the cancer disease.Setting and Design:This single-institutional retrospective observational study included seventy gastric carcinoma patients with a chief complaint of frequent hematemesis. They were divided according to the cause behind inoperability or irresectability: (1) Metastatic disease, (2) locally advanced irresectable disease, (3) uncontrolled comorbidities, (4) poor GC (PGC), and (5) refused to give surgical consent.Subjects and Methods:Following baseline evaluation and prechemotherapy workups, patients were subjected to three-weekly chronomodulated modified EOX regimen. Relevant parameters, i.e., (1) average episodes per-week (AEP) score, (2) Hb, and (3) average CTCAE grade value for UGIB were recorded after every cycle.Results:At 12-week follow-up, there was a significant decrease in mean AEP score from baseline (from 2.6691 ± 0.7047 to 1.5033 ± 0.6272) for the entire cohort (P < 0.001). Maximum benefit in terms of mean Hb (increase by 1.0737% above baseline) took place for PGC group (P < 0.001). Mean CTCAE grade value for the entire cohort decreased from baseline by 0.6428, which was statistically significant with a P < 0.001.Conclusions:PGC group was maximally benefited considering all three parameters. Though surgery defines the mainstay of treatment for gastric carcinoma, yet in inoperable cases, only chronomodulated chemotherapy significantly affects the severity of UGIB and thus may improve QoL.

Methods of stent placement in patients with upper-third and middle-third esophageal cancer

Relevance. At that moment of diagnosis patients with esophageal cancer (EC) are often inoperable due to locally advanced disease. Life expectancy in such cases augmented with dysphagia comprises 90 days in average. Curative treatment can be performed only in 20-30 % of patients with a 5-year survival rate varying from 10,3 to 35%.Objective. Assessing short-term and long-term outcomes of patients with stents with EC depending on the localization of the primary tumor.Materials and methods. We analyzed our experience of using intraesophageal self-expanding stents in ЕС patients. 49 of patients them had tumor in upper-third of esophagus and 73 patients had middle-third esophageal tumor location as compared to those who underwent stoma formation (53 patients) in EC patients.Results. All patients who were stented had significantly lower grade of dysphagia and could eat in the ordinary way. It also improved quality of life, and many of such patients had an opportunity to continue treatment. It has been revealed that stenting of inoperable cancer patients with upper and middle-third esophageal cancer gives benefit to patients as it allows to continue to eat naturally and thereby significantly improves the quality of life in contrast to stoma placement. Patients with upper-third esophageal cancer who were not stented because of fistula formation had significantly better long-term survival than EC patients with stoma and similar cancer patients with middle-third esophageal tumors. Survival rate of patients with cancer of upper-third of esophagus after stenting not because of fistula was significantly better. Patients with cancer of the middle esophagus, who experienced stent placement because of fistulae, had the same long-term survival rate as cancer patients with middle esophageal tumors and with fistula who were not stented. It shows high efficacy of stenting in cancer of the middle-third esophagus with presence of fistula.Conclusion. Stent placement in case of inoperable cancer of upper and middle-third of esophagus shows significant benefit. It allows patients to eat in an ordinary was, and thereby significantly improves the quality of life in comparison with stoma formation.

Pathfinders in oncology from the end of the 19th century to the first description of Ewing sarcoma.

During the period 1884 to 1922, the only option in cases of operable cancers was radical surgery, and only a minority of patients were cured. Sporadic attempts were made to treat inoperable cancer patients with bacterial toxins; however, with the discovery of x-ray and radium, the era of radiation treatment as an alternative to surgery began. The discovery of transmissible cancers and experimental growth of cancer cells offered new information and not only led to a better understanding of the cellular composition of cancers but also yielded important information that ultimately paved the way to chemotherapy. These efforts also advanced the understanding of the pathogenesis of tumors and induced new clinical and pathologic classifications and subspecializations. It is important to emphasize that many of the initiatives and discoveries made in Europe in the second half of the 19th century were first put into clinical practice in the United States during the first 2 decades of the 20th century, including the use of x-ray and radium for irradiation and as diagnostic tools. All things considered, the progress made between 1884 and 1922 came about through the hard work of many eminent individuals; however, there were 7 foresighted pathfinders (3 surgeons, 2 pathologists, 1 internist, and 1 physicist) who-despite their widely diverse backgrounds, personalities, and expertise-made remarkable contributions to oncology to an extent that is still felt today.

Winged Partially Covered Self-Expandable Metal Stent to Prevent Distal Migration in Malignant Gastric Outlet Obstruction.

Through-the-scope implantation of self-expandable metal stents can be used for the palliation of malignant gastric outlet obstruction. Although covered stents were developed to prevent tumor ingrowth, often seen with uncovered stents, migration is still a major problem. Especially, surgical treatment is required for some patients if distal migration occurs. To evaluate the usefulness of the newly designed winged stent that was developed to prevent distal stent migration. This was a single-center, single-arm, retrospective study. A total of 63 inoperable cancer patients with symptomatic gastric outlet obstruction were reviewed to evaluate the safety and efficacy of a newly designed partially covered self-expandable metal stent with star-shaped wing flaps at the proximal end to reduce distal stent migration. Technical and clinical successes were achieved in 100% and 87.3% of patients, respectively. The gastric outlet obstruction scoring system score significantly improved after stent placement (from median 1 to 2, P < 0.001). The median duration of stent patency was 147days (interquartile range 76-201), and median duration of overall survival was 176days (interquartile range 79-325). Stent migration was observed in seven patients (11.1%), and restenosis was developed in 12 patients (19.0%). All cases of migration were proximal, and no distal migration was observed. Endoscopic removal of migrated stents was performed successfully in all cases. The newly designed winged stent showed feasible efficacy and safety for malignant gastric outlet obstruction. Furthermore, it effectively prevented distal stent migration.

Abstract No. 272 - Palliative prostatic arterial embolization (PAE) in inoperable prostate cancer patients

Abstract No. 272 - Palliative prostatic arterial embolization (PAE) in inoperable prostate cancer patients

SU‐F‐T‐420: Dosimetry Comparison of Advanced External Beam Radiation Treatment Modalities to Brachytherapy Treatments in Patients with Cervical Cancer

Purpose:A retrospective comparison of dose distributions achievable by High dose rate brachytherapy (HDRBT), Helical TomoTherapy (TOMO), CyberKnife (CK) and RapidArc (RA) in locally advanced inoperable cervical cancer patients is presented.Methods:Five patients with advanced stage cervical carcinoma were selected for this study after a full course of external beam radiotherapy (EBRT), chemotherapy and HDR Brachytherapy. To highlight any significant similarities/differences in dose distributions, high‐risk clinical target volume (HRCTV) coverage, organs at risk (OAR) sparing, and machine specific delivery limitations, we used D90 (dose received by 90% of the volume) as the parameter for HRCTV coverage as recommended by the GEC‐ESTRO Working Group. We also compared both integral and differential dose volume histograms (DVH) between different dose distributions treatment modalities for HRCTV and OAR.Results:TOMO and RA provided the most conformal dose distributions to HRCTV. Median doses (in Gy) to organs at risk were; for rectal wall: 1.7±0.6, 2.5±0.6,1.2±0.3, and 1.5±0.6, and for bladder wall: 1.6±0.1, 2.4±0.4, 0.8±0.6, and 1.5±0.5, for HDRBT, TOMO, CK, and RA, respectively.Conclusion:Contemporary EBRT modalities might be able to replace brachytherapy treatments for cervix cancer. While brachytherapy dose distributions feature high dose gradients, EBRT modalities provide highly conformal dose distributions to the target. However, it is still not clear whether a highly conformal dose or high gradient dose is more clinically relevant for the HRCTV in cervix cancer patients.