Squamous Cell Carcinoma Of The Esophagus Research Articles

Ethiopian Medicinal Plants Traditionally Used for the Treatment of Cancer; Part 3: Selective Cytotoxic Activity of 22 Plants against Human Cancer Cell Lines.

Medicinal plants have been traditionally used to treat cancer in Ethiopia. However, very few studies have reported the in vitro anticancer activities of medicinal plants that are collected from different agro-ecological zones of Ethiopia. Hence, the main aim of this study was to screen the cytotoxic activities of 80% methanol extracts of 22 plants against human peripheral blood mononuclear cells (PBMCs), as well as human breast (MCF-7), lung (A427), bladder (RT-4), and cervical (SiSo) cancer cell lines. Active extracts were further screened against human large cell lung carcinoma (LCLC-103H), pancreatic cancer (DAN-G), ovarian cancer (A2780), and squamous cell carcinoma of the esophagus (KYSE-70) by using the crystal violet cell proliferation assay, while the vitality of the acute myeloid leukemia (HL-60) and histiocytic lymphoma (U-937) cell lines was monitored in the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) microtiter assay. Euphorbia schimperiana, Acokanthera schimperi, Kniphofia foliosa, and Kalanchoe petitiana exhibited potent antiproliferative activity against A427, RT-4, MCF-7, and SiSo cell lines, with IC50 values ranging from 1.85 ± 0.44 to 17.8 ± 2.31 µg/mL. Furthermore, these four extracts also showed potent antiproliferative activities against LCLC-103H, DAN-G, A2780, KYSE-70, HL-60, and U-937 cell lines, with IC50 values ranging from 0.086 to 27.06 ± 10.8 µg/mL. Hence, further studies focusing on bio-assay-guided isolation and structural elucidation of active cytotoxic compounds from these plants are warranted.

Where to Start and What to Do Next: The Sequencing of Treatments in Metastatic Esophagogastric Cancer.

Esophagogastric cancer is associated with rising incidence and high mortality. Nearly 40% of patients have metastatic disease at the time of diagnosis with poor 5-year overall survival. The treatment of squamous cell carcinoma of the esophagus and gastroesophageal adenocarcinoma has started to bifurcate in recent years, owing to the evolving understanding of the biologic and genomic characteristics of these tumors. Incorporation of HER2-directed therapy in the form of monoclonal antibody and antibody-drug conjugate is now standard of care for patients with HER2-positive disease. The addition of immune checkpoint inhibitors to the therapeutic landscape of metastatic esophagogastric cancer is associated with modest improvement in overall survival, and definition of predictive biomarkers of response to checkpoint inhibition remains imprecise. A number of therapeutic targets including FGFR2b, Claudin 18.2, DKK-1, and DNA repair defects are being explored in clinical trials. Similarly, combination immunotherapy and novel HER2-targeting agents, such as bispecific antibody and small-molecule inhibitors, are at various stages of clinical development. Despite the progress made in the field of targeted therapies and checkpoint inhibition, chemotherapy remains an integral part of treatment of metastatic esophagogastric cancer but is associated with considerable toxicity. Clinical trials focusing on minimizing toxicity of currently available therapeutic agents, development of novel biomarker-driven treatment strategies, and overcoming resistance to immune checkpoint inhibition will define the future of this traditionally indelible disease.

Endoscopically detected multicentric squamous cell carcinoma of the esophagus; Case presentation and literature review

Endoscopically detected multicentric squamous cell carcinoma of the esophagus; Case presentation and literature review

TGF-β and PD-L1 inhibition combined with definitive chemoradiotherapy in esophageal squamous cell carcinoma: A phase II clinical trial (NCT04595149).

TPS4154 Background: Esophageal cancer is the 6th leading cause of mortality worldwide, with an overall 5-year survival rate of 10%. This is in part due to more than 50% of patients presenting with irresectable or metastatic disease. With the introduction of definitive chemoradiation, 3-year survival rates of patients with irresectable tumors have risen to up to 40% (Hulshof et al., ASCO GI Oral Presentation, 2020). However, treatment still fails in the majority of patients due to locoregional recurrences or development of metastatic disease. Recently, it has been shown that addition of TGF-β inhibition to chemoradiation may improve treatment efficacy (Steins et al., Int J Cancer, 2019). Additionally, PD-L1 inhibition has emerged as a relevant therapeutic strategy in specific patient subgroups, such as squamous cell carcinoma (Kato et al., The Lancet Oncology, 2019). In this phase II study, we will investigate the feasibility of addition of bintrafusp alfa, a bifunctional fusion protein blocking TGF-β and PD-L1, to definitive chemoradiation in patients with esophageal squamous cell carcinoma. Methods: To assess feasibility, 52 patients will receive definitive chemoradiation combined with three doses of bintrafusp alfa at week 1, 4 and 7 (Table). Feasibility is defined as ≥80% of patients completing 2 cycles of bintrafusp alfa and will be tested with a one-sample test for a binomial proportion, comparing the observed percentage to the fixed reference value of unfeasibility (62%). Secondary endpoints are toxicity, progression-free survival, overall survival and quality of life. Additionally, exploratory endpoints include development of biomarkers to predict treatment response. Eligible for inclusion are patients with surgically irresectable (T1-4a N+ M0) squamous cell carcinoma of the esophagus or gastro-esophageal junction, or patients with resectable tumors refraining from radical surgery. Patients with M1 disease solely on the basis of supraclavicular metastasis are eligible. Patients with locoregional recurrences are eligible, provided that full dose of radiation can be safely delivered. Currently, 2 of planned 52 patients have been enrolled. Clinical trial information: NCT04595149. [Table: see text]

Role of chemotherapy after curative esophagectomy in squamous cell carcinoma of the thoracic esophagus: A propensity score-matched analysis.

BackgroundThe efficacy of postoperative treatment of squamous cell carcinoma of the esophagus has not yet been determined. In this retrospective study, we investigated whether postoperative adjuvant chemotherapy (POCT) confers a survival benefit on patients who undergo curative esophagectomy.MethodsA total of 782 patients were enrolled in our study. The patients were divided into surgery alone (S) and surgery plus postoperative chemotherapy (S + POCT) groups. Propensity score matching (PSM) was used to eliminate the differences in baseline characteristics. The primary endpoint was overall survival (OS), which was calculated by the Kaplan–Meier method and compared with the log‐rank test. A Cox proportional hazards model was used to identify factors influencing the prognosis.ResultsOf 782 patients, 343 (43.9%) underwent S alone, and 439 (56.1%) underwent S + POCT before PSM. The five‐year OS rates were 42.3% and 47.8% in the S and S + POCT groups (p = 0.080), respectively. After PSM (296 patients per group), the five‐year OS rates were 48.7% and 56.2% in the S and S + POCT groups (p = 0.025), respectively. For different cycles of POCT, patients with more than three cycles had a better survival than those with less than three cycles. The significant predictive factors for OS were pN stage (HR = 1.861, 95% CI: 1.310–2.645, p = 0.001), number of dissected nodes (HR = 0.621, 95% CI: 0.494–0.781, p < 0.001) and POCT received (HR = 0.699, 95% CI: 0.559–0.875, p = 0.002), which were identified by multivariate Cox regression analyses in the matched samples.ConclusionsPOCT appears to improve the OS rate of patients with ESCC after resection, and at least four chemotherapy cycles are necessary. These conclusions warrant further confirmation in large‐scale multicenter randomized controlled trials.

Prevalence of HER2 overexpression and amplification in squamous cell carcinoma of the esophagus: A systematic review and meta-analysis.

Accurate data on HER2 positivity in esophageal squamous cell carcinoma patients (ESCC) is lacking. We conducted a systematic review and meta-analysis (Single Incidence Rates; metarate package, R) to examine the prevalence of HER2 in ESCC. Data on in situ hybridization (ISH) and immunohistochemistry (IHC) were extracted to derive pooled prevalence estimates, characteristics of the studies were extracted for subgroup analysis. Eighteen studies with 1505 patients were identified. HER2 gene amplification by ISH were prevalent in 10 % (95 % CI 6.9 %-15 %). Prevalence of HER2 overexpression (IHC3+) and borderline HER2 expression (IHC2+) were 6 % (95 % CI: 3.5 %-8.7 %) and 10 % (95 % CI: 6.0 %-17 %), respectively. An estimated 8.6 % (95 % CI: 5.5 %-13 %) of ESCC were HER2 positive using initial IHC followed by reflex ISH confirmation of borderline HER2 expression. In conclusion: Estimated prevalence of HER 2 positivity in ESCC were 10 % assessed by ISH and 8.6 % assessed by initial IHC followed by ISH.

Update ESMO: gastric and esophageal cancer

During this year’s virtual congress of the European Society of Oncology (ESMO) some practice-changing abstracts were presented. Especially immunotherapy (IO) has found its way into the treatment of esophageal (EC) and gastric cancer (GC) in both the adjuvant and palliative setting. The CheckMate 577 trial, which was presented in EMSO Presidential Symposium III, showed a doubling in disease-free survival (DFS) for patients with resected esophageal (EC) or esophagogastric junction cancer (EGJC) following neoadjuvant chemoradiation therapy (CRT), who had not achieved a pathological complete response, treated with nivolumab versus placebo. For advanced disease, the KEYNOTE-590 trial revealed a benefit of adding pembrolizumab to chemotherapy for patients with locally advanced or metastatic adenocarcinoma (EAC) or squamous cell carcinoma of the esophagus (ESCC) or EGJC Siewert type 1. In the CheckMate 649 study, patients (predominantly Caucasians) with advanced gastric, EGJC or EAC benefitted from the addition of nivolumab to chemotherapy in terms of overall survival (OS) and progression-free survival (PFS). In contrast, in the ATTRACTION‑4 trial, the Asian population gained a prolongation of PFS but not of OS by adding IO to chemotherapy.

A rare cause of dysphagia in children: Squamous cell carcinoma of the esophagus: A case report and review of literature

A rare cause of dysphagia in children: Squamous cell carcinoma of the esophagus: A case report and review of literature

A rare cause of dysphagia in children: Squamous cell carcinoma of the esophagus: A case report and review of literature

A rare cause of dysphagia in children: Squamous cell carcinoma of the esophagus: A case report and review of literature

Esophageal Cancer: An Updated Review.

The incidence of esophageal cancer (EC) is on the rise. With the distinct subtypes of adenocarcinoma and squamous cell carcinoma comes specific risk factors, and as a result, people of certain regions of the world can be more prone to a subtype. For example, squamous cell carcinoma of the esophagus has the highest incidence in eastern Africa and eastern Asia, with smoking being a major risk factor, whereas adenocarcinoma is more prevalent in North America and western Europe, with gastroesophageal reflux disease being a leading risk factor. With that being said, adenocarcinoma and squamous cell carcinoma have similar and unfortunately poor survival rates, partly because EC is prone to early metastasis given that the esophagus does not have a serosa, as well as the superficial nature of its lymphatics compared with the rest of the gastrointestinal tract. This makes early detection of the utmost importance, and certain patients have been shown to have the benefit of screening/surveillance endoscopies, including those with Barrett's esophagus, lye-induced/caustic strictures, tylosis, and Peutz-Jeghers syndrome. Until treatments significantly improve, identifying EC at the earliest stage will have the best success for patient outcomes, and further elucidation of its pathogenesis and risk factors may lead to identifying other high-risk groups that should be screened.

Pentixafor PET/CT for imaging of chemokine receptor 4 expression in esophageal cancer \u2013 a first clinical approach

BackgroundExpression of CXCR4, a chemokine (C-X-C motif) receptor that plays a central role in tumor growth and metastasis of circulating tumor cells, has been described in a variety of solid tumors. A high expression of CXCR4 has a prognostic significance with regard to overall and progression-free survival and offers a starting point for targeted therapies. In this context, [68]Ga-Pentixafor-Positron Emission Tomography/Computer Tomography (PET/CT) offers promising possibility of imaging the CXCR4 expression profile. We set out to compare a [18F] fluorodeoxyglucose (FDG)-PET/CT and a [68Ga]Pentixafor-PET/CT in (re-)staging and radiation planning of patients with localized esophageal cancer.Materials and methodsIn this retrospective analysis, ten patients, with adeno- or squamous cell carcinoma of the esophagus (n = 3 and n = 7, respectively), which were scheduled for radio (chemo) therapy, were imaged using both Pentixafor and FDG PET/CT examinations. All lesions were visually rated as Pentixafor and FDG positive or negative. For both tracers, SUVmax was measured all lesions and compared to background. Additionally, immunohistochemistry of CXCR4 was obtained in patients undergoing surgery.ResultsFDG-positive tumor-suspicious lesions were detected in all patients and a total of 26 lesions were counted. The lesion-based analysis brought equal status in 14 lesions which were positive for both tracers while five lesions were FDG positive and Pentixafor negative and seven lesions were FDG negative, but Pentixafor positive. Histopathologic correlation was available in seven patients. The CXCR4 expression of four non-pretreated tumour lesion samples was confirmed immunohistochemically.ConclusionOur data shows that additional PET/CT imaging with Pentixafor for imaging the CXCR4 chemokine receptor is feasible but heterogeneous in both newly diagnosed and pretreated recurrent esophageal cancer. In addition, the Pentixafor PET/CT may serve as complementary tool for radiation field expansion in radiooncology.

Epidemiology, Risk Factors, Clinical-Imaging Features And Priorities For The Prevention Of Esophageal Cancer In The Fergana Valley Of Uzbekistan

Cancer of the digestive system is the most common cause of death among malignant neoplasms (Table 1). According to the International Agency for Research on Cancer (IARC) for 2008, the incidence of cancer of the digestive system was 49.2 people per 100 thousand people per year, the mortality rate was 34.3 people per 100 thousand. At a relatively low incidence rate, esophageal cancer is the seventh most common cause of death from malignant tumors, giving way to lung, breast, stomach, liver, prostate, and colon cancers. This is due to the extremely malignant nature of the course, early metastasis, and late diagnosis of esophageal cancer. The aggressiveness index, calculated as the ratio of deaths to new cases, is extremely high in esophageal cancer and is about 95%. The absolute number of deaths from esophageal cancer in 2008 in the world was 406 thousand people. In developing countries, morbidity and mortality from esophageal cancer are significantly higher than in developed countries (Table 2). The most common two histological types of esophageal cancer are squamous cell carcinoma and esophageal adenocarcinoma. Despite the similarity of the clinical picture, diagnostic and therapeutic tactics, an extremely unfavorable prognosis for both forms of esophageal cancer, these malignant neoplasms have different risk factors, socio-geographic and ethnic characteristics, knowledge of which is necessary for the timely establishment of the diagnosis and preventive measures. Squamous cell carcinoma of the esophagus (Fig. 1) is an extremely aggressive epithelial malignant tumor of stratified squamous epithelium, in most cases localized between the middle and lower third of the esophagus, the tumor is rare in the cervical esophagus

A randomized clinical trial evaluating the efficacy and safety of the addition of oral metronomic chemotherapy after completion of standard chemoradiation versus observation in patients with locally advanced esophageal and gastroesophageal junction squamous cell carcinoma.

163 Background: In RTOG 85-01, patients with locally advanced esophageal and gastroesophageal junction (GEJ) cancer treated with concurrent chemoradiotherapy (CRT) had a median overall survival (OS) of 14 months and 5-year OS of 27%. Improving outcomes in these patients is an unmet need. We investigated the addition of oral metronomic chemotherapy (OMC) following definitive CRT. Methods: A randomized integrated phase II/III clinical trial (CTRI/2015/09/006204) in patients with squamous cell carcinoma of the esophagus or the GEJ who had completed definitive radical CRT within the past 12 weeks, had an ECOG PS 0-2 and no clinical or radiologic evidence of progressive disease. Patients were stratified based on whether or not they had received induction chemotherapy followed by CRT, and then randomized 1:1 to receive OMC (celecoxib 200 mg twice daily and methotrexate 15 mg/m2 weekly) for 12 months or observation. The primary efficacy endpoint for the phase II portion was progression free survival (PFS). The secondary endpoints were OS and toxicity. With a power of 70% and an alpha of 10%, we hypothesized a hazard ratio of 1.5, with a median follow-up of 6 months. The planned sample size for the phase II portion was 151 patients. The p-value for stopping the trial after the phase II part of the study was set at 0.2 for the PFS. Results: Between Jan 2016 and Dec 2019, we enrolled 151 patients, 75 to the OMC arm and 76 to observation. The median age was 57 years, 59% were male. The tumor originated in the upper thoracic esophagus in 79% patients, with median tumor length 6 cm. Induction chemotherapy was received by 14% of the patients. Concurrent CRT consisted of median 63 Gy in median 35 fractions; 91% patients received concurrent weekly paclitaxel and carboplatin with radiation. OMC was started at a median of 11 weeks (IQR, 9 to 12) from the start of CRT. Grade 3 or higher toxicities (regardless of relatedness to study intervention) were noted in 27 patients (17.9%), 18 in the OMC arm and 9 in the observation arm; P=0.071. The median time to disease progression or death was 23 months (95% CI, 7.9-38.1) in the OMC arm and not reached in the observation arm; HR, 1.33, 95% CI, 0.83-2.14; P=0.23. The 1-year PFS was 67% in both the arms; the 2-year PFS were 48% and 61% in the OMC and observation arms respectively. The median OS was 36 months (95% CI, 17.9-54) in the OMC arm and not reached in the observation arm; HR, 1.75; 95% CI, 1.02-2.99; P, 0.037. The 1-year OS was 74.7% in the OMC arm and 88% in the observation arm; the 2-year OS was 53.9% in the OMC arm and 75% in the observation arm. Conclusion: Adjuvant oral metronomic chemotherapy after radical CRT does not improve outcomes in patients with locally advanced esophageal or GEJ squamous cell carcinoma. Clinical trial information: CTRI/2015/09/006204.

Kissing tumors; the concurrent diagnosis of leiomyosarcoma and squamous cell carcinoma of the esophagus

BackgroundEsophageal leiomyosarcoma (LMS) is a rare tumor that constitutes less than 1% of all malignant esophageal tumors. Concurrent occurrence of esophageal leiomyosarcoma with squamous cell carcinoma (SCC) is even rarer than isolated leiomyosarcoma.Case presentationIn this report, we present a case of concurrent leiomyosarcoma and SCC in a 64-year-old woman presenting with vomiting and solid dysphagia, which has not been properly diagnosed following several referrals and diagnostic modalities. At last Exploratory laparotomy with gastric pull-up was performed in addition to radical laryngectomy with partial resection of the esophagus and subtotal thyroidectomy. Pathologic evaluation of the surgical specimen showed concurrent LMS (5.2 × 4.5 × 3 cm) and SCC (1.5 × 0.6 × 0.6 cm) at the same anatomical level in the proximal esophagus.ConclusionsThis study proposes the importance of using ancillary diagnostic tests such as immunohistochemistry (IHC) to diagnose less common cases such as concurrent LMS and SCC.

NEOADJUVANT CHEMORADIOTHERAPY FOLLOWED BY TRANSHITAL ESOPHAGECTOMY IN LOCALLY ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA: IMPACT OF PATHOLOGICAL COMPLETE RESPONSE.

ABSTRACT Background Multimodal therapy with neoadjuvant chemoradiotherapy, followed by esophagectomy has offered better survival results, compared to isolated esophagectomy, in advanced esophageal cancer. In addition, patients who have a complete pathological response to neoadjuvant treatment presented greater overall survival and longer disease-free survival compared to those with incomplete response. Aim: To compare the results of overall survival and disease-free survival among patients with complete and incomplete response, submitted to neoadjuvant chemoradiotherapy, with two therapeutic regimens, followed by transhiatal esophagectomy. Methods: Retrospective study, approved by the Research Ethics Committee, analyzing the medical records of 56 patients with squamous cell carcinoma of the esophagus, divided into two groups, submitted to radiotherapy (5040 cGY) and chemotherapy (5-Fluorouracil + Cisplatin versus Paclitaxel + Carboplatin) neoadjuvants and subsequently to surgical treatment, in the period from 2005 to 2012, patients. Results The groups did not differ significantly in terms of gender, race, age, postoperative complications, disease-free survival and overall survival. The 5-year survival rate of patients with incomplete and complete response was 18.92% and 42.10%, respectively (p> 0.05). However, patients who received Paclitaxel + Carboplatin, had better complete pathological responses to neoadjuvant, compared to 5-Fluorouracil + Cisplatin (47.37% versus 21.62% - p = 0.0473, p <0.05). Conclusions There was no statistical difference in overall survival and disease-free survival for patients who had a complete pathological response to neoadjuvant. Patients submitted to the therapeutic regimen with Paclitaxel and Carboplastin, showed a significant difference with better complete pathological response and disease progression. New parameters are indicated to clarify the real value in survival, from the complete pathological response to neoadjuvant, in esophageal cancer.

Cardiac tamponade as an unusual initial presentation of squamous cell carcinoma of the esophagus

Pericardial effusions leading to cardiac tamponade have previously been described with esophageal cancer. However, up to eighty percent of these cases have been reported in association with chemotherapy and radiation. Patients with esophageal cancer seldom initially present with pericardial effusion resulting from esophageal pericardial fistula (EPF). Herein, we present the case of a 62-year-old man who presented with pericardial effusion with an unknown etiology at presentation. Subsequently, the patient developed cardiac tamponade and was referred to the tertiary hospital for further evaluation. Computed tomography of the chest revealed a circumferential irregular enhancing lesion at the mid-thoracic esophagus suspecting esophageal cancer with EPF and a moderate amount of pericardial effusion. The patient underwent esophagoscopy and squamous cell carcinoma was found from the esophageal biopsy. An esophageal stent was successfully placed to conceal the perforation. Eventually, the patient died 13 days after admission complicated by refractory septic shock. This case highlights an atypical presentation of esophageal cancer and an unusual cause of cardiac tamponade.

Salvage Robot-Assisted Minimally Invasive Esophagectomy (RAMIE) for T4b Esophageal Cancer After Definitive Chemoradiotherapy

BackgroundPatients with esophageal cancer that invades adjacent structures (cT4b) are precluded from surgery and usually treated with definitive chemoradiotherapy (dCRT). dCRT might result in sufficient downstaging to enable a radical resection, possibly improving survival. This study aimed to assess the perioperative and oncologic outcomes of a salvage robot-assisted minimally invasive esophagectomy (RAMIE) in patients with cT4b esophageal cancer after dCRT.MethodsBetween June 2012 and November 2019, patients who underwent a RAMIE with a gastric conduit reconstruction after completion of dCRT for cT4b esophageal carcinoma were identified from a prospectively maintained surgical database at the University Medical Center Utrecht.ResultsIn total, 24 patients with a histopathologically confirmed T4b adenocarcinoma or squamous cell carcinoma of the esophagus were included. The adjacent organs involved were the tracheobronchial tree (67%), aorta (21%) or both (13%). No conversions or major intraoperative complications were observed. A radical resection was achieved in 22 patients (92%), and a pathologic complete response was observed in 13 (54%) patients. Postoperative grade 2 or higher complications occurred in 20 patients (83%). The disease-free survival at 24 months was 68% for the patients in whom a radical resection was achieved.ConclusionIn patients with cT4b esophageal cancer treated with dCRT followed by a salvage RAMIE, a radical resection rate of 92% was achieved, with acceptable complications and promising survival rates. These results demonstrate the feasibility of a curative surgical treatment for patients with initially irresectable esophageal cancer but underscore the importance of a proper preoperative patient selection.

Intratumoral Metabolic Heterogeneity and Other Quantitative 18F-FDG PET/CT Parameters for Prognosis Prediction in Esophageal Cancer.

To evaluate the impact of intratumoral metabolic heterogeneity (IMH) and other quantitative fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT parameters for predicting progression-free survival (PFS) and overall survival (OS) in patients with esophageal cancer. In this retrospective study, an automated gradient-based segmentation method was used to assess the maximum standardized uptake value, mean standardized uptake value, metabolic tumor volume (MTV), and IMH index of the primary tumor in patients with biopsy-proven adenocarcinoma or squamous cell carcinoma of the esophagus with an initial staging 18F-FDG PET/CT. Data were collected between July 2006 and February 2016. OS and PFS were calculated using multivariable Cox proportional hazards regression with the adjustment (as covariates) of age, sex, weight, stage, tumor type, tumor grade, and treatment. All PET parameters were standardized before analysis. Log-rank tests were performed, and corresponding Kaplan-Meier survival plots were generated. A total of 71 patients (mean age, 64 years ± 10 [standard deviation], 62:9 men:women) were included. Median follow-up time was 28.2 months (range, 4-38 months), and median survival was 16.1 months (range, 0.1-60.3 months). Higher MTV was associated with reduced PFS for every standard deviation increase (hazard ratio [HR], 0.193; 95% CI: 0.052, 0.711; P = .01). Higher IMH was associated with reduced PFS for every standard deviation decrease in the area under the curve (HR, 10.78; 95% CI: 1.31, 88.96; P = .03). PFS for patients with esophageal cancer was associated with MTV and with IMH.Keywords: Esophagus, Neoplasms-Primary, PET/CT, Tumor Response © RSNA, 2020.

Clinical Effectiveness of Combination Immunotherapy DPX-Survivac, Low Dose Cyclophosphamide, and Pembrolizumab in Recurrent/Refractory DLBCL: The Spirel Study

Clinical Effectiveness of Combination Immunotherapy DPX-Survivac, Low Dose Cyclophosphamide, and Pembrolizumab in Recurrent/Refractory DLBCL: The Spirel Study

S1894 Atypical Presentation of Esophageal Squamous Cell Carcinoma Mimicking Severe Diffuse Esophagitis

INTRODUCTION: Esophagitis is a well-known condition described as an inflammation of the esophagus. There are various etiologies, including infectious, noninfectious, GERD (gastroesophageal reflux disease) being the most common. It is a fairly common condition, 14% of the patients undergoing esophagogastroduodenoscopy (EGD) are found to have esophagitis. Typical GERD symptoms and heartburn being the most common features, dysphagia and odynophagia being less common. It has a male predominance and usually occurs in older individuals. Hiatal hernia is a commonly associated finding in about 79-88% of patients. The most common complications are stenosis, ulcers, and Barrett esophagitis, which can progress to adenocarcinoma. However the squamous cell carcinoma (SCC) presenting as diffuse esophagitis in the absence of a mass or lesion is rare.We present a case of diffuse severe esophagitis in a patient with known grade 4 esophagitis and which was later found to be SCC of the esophagus on pathology of the routine biopsies. CASE DESCRIPTION/METHODS: A 61-year-old man presented to the gastroenterology clinic for dysphagia of 3 months duration to both solids and liquids. He had heartburn and weight loss of 15 pounds unintentionally. He had a prior history of hypertension. He also had a screening colonoscopy in the past which was unremarkable except right sided diverticulosis and internal hemorrhoids. He was a current smoker but denied using alcohol except on social occasions or illicit drugs. He did not have a family history of gastrointestinal cancers. His physical examination and laboratory tests were unremarkable. He underwent EGD which revealed Grade D esophagitis in the entire esophagus and random biopsies were done of the 3 segments of esophagus. Histopathology revealed high grade dysplasia and carcinoma in situ. Patient underwent endoscopic ultrasound (EUS) of esophagus which revealed a focal lesion. EUS guided fine needle aspiration (FNA) showed SCC of the esophagus. Patient underwent chemotherapy and radiotherapy and continues to follow up. DISCUSSION: Squamous cell carcinoma usually presents as a mass or a lesion seen endoscopically. However, it rarely presents as severe diffuse esophagitis seen on routine endoscopy. According to our observation, it would be reasonable for physicians to bear this unusual endoscopic presentation in mind and perform multiple random biopsies if encountered with such a case to rule out the possibility of any underlying malignancy.Figure 1.: Diffuse severe esophagitis in the lower third of esophagus on endoscopy.Figure 2.: Diffuse esophagitis in the upper third of the esophagus on endoscopy.