Superficial Cancer Research Articles

Confocal laser endomicroscopy for gastric neoplasm.

Confocal laser endomicroscopy (CLE) is a novel endoscopic modality that provides real-time histological information via high-resolution magnified view of the mucosa. CLE has a higher sensitivity, specificity, and diagnostic accuracy in detecting atrophic gastritis as compared to chromoendoscopy and narrow-band imaging. It can even predict low-grade and high-grade intraepithelial neoplasia by analyzing gastric pit patterns. CLE may have some advantages over the standard biopsy protocol, such as higher diagnostic yield and fewer biopsy requirements. Its diagnostic accuracy in detecting superficial gastric cancer is higher than that of white-light endoscopy. Inherent limitations, such as a narrow field of vision, can be surpassed by technological advancements and integration with other detection methods. Artificial intelligence holds promise in automated analysis of histopathological images. Thus, CLE can be helpful in screening for early gastric cancer and may help reduce the risk of complications from repeated biopsies, such as mucosal damage, bleeding, and infection.

247. INVESTIGATION ON THE RECURRENCE AND PROGNOSIS WITH MM/SM1 OESOPHAGEAL SUPERFICIAL CANCER AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION

Abstract Background The therapeutic strategy for MM/SM1 oesophageal superficial cancer (OSC) after endoscopic submucosal dissection (ESD) still remains controversial, but there are some opinions that cut-end positive, vascular invasion positive, infiltrative growth pattern (INF) c, and poorly differentiated carcinoma are the risk factors for the recurrence of lymph-node (LN) or distal metastases. Methods This study aimed to investigate the recurrence and prognosis after ESD in patients with MM/SM1 OSC who do not have the risk factors. We performed ESD in 167 patients with OSC, and among these, we enrolled 15 patients with MM/SM1 OSC who did not have cut-end positive, vascular invasion positive, INF c, or poorly differentiated carcinoma in this study. The clinical background characteristics, endoscopic findings, additional therapy after ESD, recurrence, and prognosis of these patients were investigated. Results The median age of the patients, including 11 males and 4 females, was 69 years (range: 59–84). The mean follow-up duration was 75 months (range: 17-137). Of these, 3 patients had chronic obstructive pulmonary disease, 1 had cerebrovascular disease, and 1 had chronic heart failure. Regarding the lesion location, 2 patients had the lesion at Ut, 11 had at Mt, and 2 had at Lt. In 3 patients, the lesion occupied more than 3/4 of the lumen. We found 2 patients with elevated-type lesions, 10 with flat-type lesions, and 3 with depressed-type lesions. The mean long diameter of the lesions was 29 mm (range: 11-47). Regarding the lesion depth, there were 12 lesions in MM and 3 lesions in SM1. A total of 4 patients received additional radiation therapy, and the remaining 11 patients were followed up without additional therapy. The patients who received additional therapy did not have recurrences; however, 4 among the 11 patients without additional therapy manifested LN and lung metastases. Furthermore, 3 patients died because of the progression of oesophageal cancer, and another patient received chemotherapy. Conclusion In this study we showed that follow-up without additional therapy after ESD in patients with MM/SM1 OSC is unlikely to be acceptable despite not having risk factors. Therefore, we should urgently develop a treatment strategy for patients with MM/SM1 OSC after ESD.

Endoscopic submucosal dissection for superficial esophageal cancer in the remnant esophagus after esophagectomy.

Treatment of esophageal cancer in the remnant esophagus after esophagectomy is highly invasive, therefore, early detection and minimally invasive treatment are considered necessary. Consequently, we aimed to clarify the safety and efficacy of endoscopic submucosal dissection (ESD) for residual esophageal cancer compared to that for esophageal cancer in a normal cervical esophagus. This study involved 47 patients with 59 residual esophageal cancers and 92 patients with 107 cervical esophageal cancers in normal esophagus who underwent ESD between January 2008 and December 2023. Their clinicopathological findings and long-term outcomes were retrospectively collected and evaluated. The median tumor diameter was 13mm, and the median procedure time was 31minutes in remnant esophagus group, with no significant difference between the two groups. No serious complications such as perforation, massive intraoperative bleeding, and pneumonia were observed in the remnant group, except for one case of postoperative bleeding. The rates of complete resection and disease specific survival were not significantly different between two groups, with complete resection rate of 86.4% and 5-year disease-specific survival rate of 95.7% in the remnant esophagus group. No local recurrence was observed during the median observation period of 43months in the remnant esophagus group. ESD for superficial cancer of the remnant esophagus showed a high complete resection rate without serious complications and good local-regional control with no evidence of local recurrence. This indicates that ESD is a safe and useful treatment for superficial cancer of the remnant esophagus.

Nanosense: Nonsurgical treatment of superficial cancer by (PLAN)

Nanosense: Nonsurgical treatment of superficial cancer by (PLAN)

Defining the role of intensity modulation in electron conformal therapy for the treatment of head and neck cancer

Bolus electron conformal therapy (BECT) in the treatment of cancers of the head and neck is often limited by an inability to reduce dosimetric hot spots resulting from surface irregularity or tissue heterogeneity. We examined the potential benefits of using intensity modulation for electron therapy (IM-BECT) to reduce hotspots in patients undergoing electron beam therapy for superficial cancers of the head and neck (HN). Twenty patients with HN cancer previously treated with BECT were identified. Each case included the treatment targets and a primary organ at risk (OAR) that were defined by the radiation oncologist. A target +2 cm rind structure was created for analysis of the dose deposition in areas surrounding the target volume as a measure of conformality. Each patient plan was transferred into the novel IM-BECT planning software and each case was recomputed as per the original parameters. Next, each case was replanned with the inclusion of intensity modulation, as well as a new custom conformal bolus that was redesigned for optimized range compensation when paired with an intensity modulator. The plans were then normalized to prescription dose and compared for target coverage/dose and OAR dose. For patients who had a hotspot of 125% or greater, the hotspot was on average reduced by 13.1% with IM-BECT. For IM-BECT, the average primary OAR means dose and target+2cm rind mean dose increased slightly by 10.6% and 6.4%, respectively (primary OAR mean [p = 0.0001], and Target+2cm rind mean [p = 0.0001], paired t-test). IM-BECT is an effective method of reducing hotspots in patients with superficial HN cancer. Improvements came at the expense of slight increases in dose to the underlying tissues. This retrospective planning study represents the first example of IM-BECT to actual HN patient cases. Expanding the role of IM-BECT in other disease sites could potentially compared to conventional BECT.

F127/chlorin e6-nanomicelles to enhance Ce6 solubility and PDT-efficacy mitigating lung metastasis in melanoma.

Photodynamic Therapy (PDT) is a promising paradigm for treating cancer, especially superficial cancers, including skin and oral cancers. However, the effectiveness of PDT is hindered by the hydrophobicity of photosensitizers. Here, chlorin e6 (Ce6), a hydrophobic photosensitizer, was loaded into pluronic F127 micelles to enhance solubility and improve tumor-specific targeting efficiency. The resulting Ce6@F127 Ms demonstrated a significant increase in solubility and singlet oxygen generation (SOG) efficiency in aqueous media compared to free Ce6. The confocal imaging and fluorescence-activated cell sorting (FACS) analysis confirmed the enhanced internalization rate of Ce6@F127 Ms in murine melanoma cell lines (B16F10) and human oral carcinoma cell lines (FaDu). Upon laser irradiation (666nm), the cellular phototoxicity of Ce6@F127 Ms against B16F10 and FaDu was approximately three times higher than the free Ce6 treatment. The in vivo therapeutic investigations conducted on a murine model of skin cancer demonstrated the ability of Ce6@F127 Ms, when combined with laser treatment, to penetrate solid tumors effectively, which resulted in a significant reduction in tumor volume compared to free Ce6. Further, the Ce6@F127 Ms demonstrated upregulation of TUNEL-positive cells, downregulation of proliferation markers in tumor tissues, and prevention of lung metastasis with insignificant levels of proliferating cells and collagenase, as validated through immunohistochemistry. Subsequent analysis of serum and blood components affirmed the safety and efficacy of Ce6@F127 Ms in mice. Consequently, the developed Ce6@F127 Ms exhibits significant potential for concurrently treating solid tumors and preventing metastasis. The photodynamic formulation holds great clinical translation potential for treating superficial tumors.

Evaluating the performance of thermoplastic 3D bolus used in radiation therapy

A 3D-printed bolus is being developed to deliver accurate doses to superficial cancers. In this study, flexible thermoplastic filaments, specifically PLA, TPU, PETG, and HIPS, were fabricated into boluses and then compared to commercial bolus for the variation of the dose elevation region of photon beams. The experimental results indicate that the maximum dose depth is similar, and the consistent trend of the percentage depth dose confirms the potential usage as a build-up bolus.

The Potential of Narrow-Band Imaging as a Novel Light Source for Photodynamic Therapy for Superficial Cancers via Endoscopes.

Photodynamic therapy (PDT) has advanced through the utilization of photosensitizers and specific-wavelength light (≥ 600 nm). However, the widespread adoption of PDT is still impeded by high equipment costs and stringent laser safety requirements. Porphyrins, crucial in PDT, have another absorbance peak of blue light (λ = 380 - 500 nm). This peak corresponds to the wavelength of narrow-band imaging (NBI) (λ = 390 - 445 nm), an image-enhancement technology integrated into endoscopes by Olympus Medical Systems. The study aimed to investigate the potential of widely adopted NBI as a PDT light source for superficial cancers via endoscopes. Esophageal and biliary cancers were selected for investigation. Human esophageal cancer cell lines (KYSE30, KYSE70, KYSE170) and cholangiocarcinoma cell lines (HuCCT-1, KKU-213) were subjected to verteporfin-mediated PDT under NBI light (λ = 390 - 445 nm). Assessments included spectrometry, crystal violet staining, and fluorescein imaging of singlet oxygen generation and apoptosis. Verteporfin exhibited a peak (λ = 436 nm) consistent with the NBI spectrum, suggesting compatibility with NBI light. NBI light significantly inhibited the growth of esophageal and biliary cancer cells. The half-maximum effective concentration (EC50) values (5 J/cm2) for KYSE30, KYSE70, KYSE170, HuCCT-1, and KKU-213 were calculated as 2.78 ± 0.37µM, 1.76 ± 1.20 µM, 0.77 ± 0.16 µM, 0.65 ± 0.18 µM, and 0.32 ± 0.04 µM, respectively. Verteporfin accumulation in mitochondria, coupled with singlet oxygen generation and observed apoptotic changes, suggests effective PDT under NBI light. NBI is a promising PDT light source for superficial cancers via endoscopes.

Methylation analysis of DCC gene in saliva samples is an efficient method for non-invasive detection of superficial hypopharyngeal cancer

BackgroundAdvances in upper gastrointestinal endoscopic technology have enabled early detection and treatment of hypopharyngeal cancer. However, in-depth pharyngeal observations require sedation and are invasive. It is important to establish a minimally invasive and simple evaluation method to identify high-risk patients.MethodsEighty-seven patients with superficial hypopharyngeal cancer and 51 healthy controls were recruited. We assessed the methylation status of DCC, PTGDR1, EDNRB, and ECAD, in tissue and saliva samples and verified the diagnostic accuracy by methylation analyses of their promoter regions using quantitative methylation-specific PCR.ResultsSignificant differences between cancer and their surrounding non-cancerous tissues were observed in the methylation values of DCC (p = 0.003), EDNRB (p = 0.001), and ECAD (p = 0.043). Using receiver operating characteristic analyses of the methylation values in saliva samples, DCC showed the highest area under the curve values for the detection of superficial hypopharyngeal cancer (0.917, 95% confidence interval = 0.864–0.970), compared with those for EDNRB (0.680) and ECAD (0.639). When the cutoff for the methylation values of DCC was set at ≥0.163, the sensitivity to detect hypopharyngeal cancer was 82.8% and the specificity was 90.2%.ConclusionsDCC methylation in saliva samples could be a non-invasive and efficient tool for early detection of hypopharyngeal cancer in high-risk patients.

Efficacy and safety of the water pressure method for endoscopic submucosal dissection in superficial pharyngeal cancer

Background: Superficial pharyngeal cancers can be cured with transoral surgery (TOS), which preserves organ function and quality of life. Pharyngeal endoscopic submucosal dissection (ESD) is challenging to perform because of limited manoeuvrability and complex anatomical features. The water pressure method (WPM) is useful for natural traction techniques during ESD, and is potentially useful for pharyngeal ESD. This study aimed to investigate the short-term outcomes of WPM-ESD for pharyngeal lesions. Patients and Methods: Therapeutic outcomes of patients who underwent WPM-ESD for pharyngeal lesions at Keio University between May 2019 and February 2022 were retrospectively analysed. Results: Twenty-one pharyngeal lesions treated with WPM-ESD were analysed. Three lesions were located in the oropharynx and 18 in the hypopharynx. All ESD procedures were performed under general anaesthesia. The endoscopic en bloc resection rate was 100%. The median procedure time was 15 min (range 4–45 min). All patients were successfully extubated on the day of ESD. No serious adverse events related to WPM-ESDs were observed. None of the patients required nasogastric intubation, percutaneous endoscopic gastrostomy, or tracheotomy. The median fasting time and hospital stay were 2 d (range 2–5 d) and 6 d (range 6–10 d), respectively. All the histological results indicated squamous cell carcinoma. The complete histologic resection rate was 76.2%. Conclusions: WPM-ESD achieved a high en bloc resection rate and short procedure time without serious adverse events. Thus, WPM-ESD may be a useful treatment for pharyngeal lesions.

Evaluation of the risk of lymph node metastases in superficial T1 rectal cancer: the current role of endoscopic treatment and future perspective

Evaluation of the risk of lymph node metastases in superficial T1 rectal cancer: the current role of endoscopic treatment and future perspective

Targeting superficial cancers with gold nanoparticles: a review of current research.

Superficial cancers typically refer to cancers confined to the surface layers of tissue. Low-targeting therapies or side effects prompt exploration of novel therapeutic approaches. Gold nanoparticles (AuNPs), due to their unique optical properties, serve as effective photosensitizers, enabling tumor ablation through photothermal therapy (PTT). PTT induced by AuNPs can be achieved through light sources externally applied to the skin. Near-infrared radiation is the main light candidate due to its deep tissue penetration capability. This review explores recent advancements in AuNP-based PTT for superficial cancers, specifically breast, head and neck, thyroid, bladder and prostate cancers. Additionally, challenges and future directions in utilizing AuNPs for cancer treatment are discussed, emphasizing the importance of balancing efficacy with safety in clinical applications.

Numerical study of two microwave antennas dedicated to superficial cancer hyperthermia

Microwave hyperthermia is an effective non-ionizing heating method for tumor sensitization. Therapy planning is necessary to achieve optimal hyperthermia treatment. This study aims to simulate two microwave antennas with different geometrical aperture’s, used in hyperthermia, to choose the one giving better heating performances. The analysis of both the antennas provides a maximum temperature of 44.2°C and 41.9°C for the antenna with parallel plates and the trapezoidal antenna. Additionally, the Bland-Altman analysis shows an agreement between thermal simulations and measured temperatures with an average difference of 0.11°C and - 0.06 °C for parallel and trapezoidal antennas.

Three-stage endoscopic transoral resection for multiple, widespread, simultaneous superficial cancers in the hypopharynx and oropharynx/oral cavity: a case report

Three-stage endoscopic transoral resection for multiple, widespread, simultaneous superficial cancers in the hypopharynx and oropharynx/oral cavity: a case report

Antitumor activity of membranes associated with Acmella oleracea extract.

Epithelial cancers, such as epidermoid cancer and some adenocarcinomas, affect surface areas that are generally more accessible to various treatments. However, this group of tumor cells has an aggressive behavior, leading to a high annual mortality rate. The development of a biomaterial that is non-invasive, can kill tumor cells, and prevent opportunistic infections is the basis for the treatment for this type of cancer. Therefore, the objective of this study was to develop a biomaterial from chitosan and A. oleracea extracts that exhibits cytotoxic action against the HEp-2 tumor cell line. Dried crude 90% ethanol extracts were obtained through ultrasound-assisted maceration, followed by liquid-liquid extraction to yield the butanol fraction. From these extracts, chitosan membranes were developed and evaluated for their antitumor activity against HEp-2 using viability tests with crystal violet and MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay, in addition to a wound healing test. The cytotoxic assays indicated a significant reduction in cell density and mitochondrial activity, especially at the concentration of 1000 µg/mL of crude extract. The butanol fraction had minimal effects on mitochondrial activity. The wound healing test demonstrated that the biomaterial and extract prevented closure of the wound created in the cell monolayer within 48 h of incubation and caused changes in cell morphology. In view of this, we concluded that a chitosan membrane associated with a 90% ethanol extract of Acmella oleracea exhibited cytotoxic activity is a potential alternative treatment for superficial cancers.

A Bioorthogonal Antidote Against the Photosensitivity after Photodynamic Therapy.

As an effective and non-invasive treatment modality for cancer, photodynamic therapy (PDT) has attracted considerable interest. With the recent advances in the photosensitizing agents, the fiber-optic systems, and other aspects, its application is extended to a wide range of superficial and localized cancers. However, for the few clinically used photosensitizers, most of them suffer from the drawback of causing prolonged photosensitivity after the treatment. As a result, post-PDT management is also a crucial issue. Herein, a facile bioorthogonal approach is reported that can effectively suppress this common side effect of PDT in nude mice. It involves the use of an antidote that contains a black-hole quencher BHQ-3 conjugated with a bicyclo[6.1.0]non-4-yne (BCN) moiety and a tetrazine-substituted boron dipyrromethene-based photosensitizer. By using tumor-bearing nude mice as an animal model, it is demonstrated that after PDT with this photosensitizer, the administration of the antidote can effectively quench the photodynamic activity of the residual photosensitizer by bringing the BHQ-3 quencher close to the photosensitizing unit through a rapid click reaction. It results in substantial reduction in skin damage upon light irradiation. The overall results demonstrate that this simple and facile strategy can provide an effective means for minimizing the photosensitivity after PDT.

Legendre wavelet collocation method for investigating thermo-mechanical responses on biological tissue during laser irradiation

Objective of the present work is to propose a numerical approach based on the Legendre wavelet to address a problem of biological tissue in the presence of superficial cancer and analyze the thermo-mechanical behavior during laser irradiation. The model of thermoelasticity with variable thermal conductivity is considered to investigate transient thermoelastic coupling response in the framework of Moore–Gibson–Thompson (MGT) bioheat transfer. The Kirchhoff mapping is first performed to linearize the nonlinear governing equations due to variable thermal properties, then finite difference discretization is applied for the time domain and subsequently space domain is approximated using Legendre wavelets. The collocation points are taken to transform the system of partial differential equations into a set of algebraic equations, from which the solution can be determined. A thorough parametric analysis is carried out to examine the effects of some material and geometrical parameters on the behavior of various fields such as the displacement, temperature, stress and the tumor-normal tissue interface. The outcomes of the present work are graphically shown and compared to the predictions of other existing models. The advantages of the current numerical procedure include its simplicity, effectiveness and low computational cost even with the few collocation points.

Comparison of Partial Versus Superficial or Total Parotidectomy for Superficial T1-2 Primary Parotid Cancers.

This study aimed to compare the oncological outcomes of partial versus superficial or total parotidectomy for superficial T1 or T2 primary parotid cancers and investigate their prognostic factors and recurrence patterns. The medical records of 77 patients with T1-2 primary parotid malignancies between May 2003 and March 2022 were retrospectively reviewed. Univariate and multivariate analyses were performed to evaluate the prognostic factors associated with overall survival, disease-free survival, and local and distant recurrence. The average follow-up duration was 70.2 months (range, 12-202 months). The 5-year overall and disease-free survival rates were 88.7% and 77.1%, respectively. Twenty-two patients underwent partial parotidectomy, and 55 underwent superficial or total parotidectomy. There were no significant differences in the disease recurrence (P=0.320) and mortality rates (P=0.884) of the partial and superficial or total parotidectomy groups. The mean duration of surgery was shorter and the overall complication rates were significantly lower in the partial group than in the superficial or total parotidectomy group (P=0.049). Sixteen cases of recurrence occurred during the study period (20.8%). Univariate analyses showed that high-grade tumors (P=0.006), lymphovascular invasion (P=0.046), and regional lymph node metastasis (P=0.010) were significant risk factors for disease recurrence. Multivariate analysis identified regional lymph node metastasis as an independent prognostic factor for disease recurrence (P=0.027), and lymphovascular invasion as an independent prognostic factor for overall survival (P=0.033). The conservative surgical approach of partial parotidectomy can yield oncological outcomes comparable to those of superficial or total parotidectomy with careful patient selection in T1-2 parotid cancers.

Using SRIM code for calculating Bragg curve, projected range, straggling of 12C ion in biological materials

‘The Stopping and Range of Ions in Matter’ SRIM program, utilizing the built-in compound directory has been used to compute Bragg curve, projected range, longitudinal, lateral straggle of 12C ion with energies of 1 − 150 MeV in biological matter: liquid water (benchmark) human blood, skin, thyroid, and spleen are assessed. Results show that in the studied biological media for higher energy beam i): noticeable modification are seen in Bragg peak, shift in peak-position; ii) maximum projected range: 595.2 μm suggests effective use of 12C ions for cancer tumor therapy, especially for superficial cancer tumors, without much damage to healthier cells; iii) longitudinal straggling ~ 22.6 μm, low lateral straggling ~ 4.7 μm suggests potential application of 12C ions in treating cancer tumor nearby critical organs, causing minimal damage in nearby normal tissues.

Endoscopic‐pathological characteristics of early‐onset gastric carcinoma in Vietnamese in the period 2014–2019: A single‐center experience

AbstractTo investigate the time‐trend and endoscopic‐pathological characteristics of early‐onset gastric carcinoma (EOGC) in Vietnamese patients. All patients who underwent upper gastrointestinal endoscopy at a tertiary hospital during the 2014–2019 period and had pathologically confirmed gastric carcinoma were retrospectively recruited. The demographic data and endoscopic and pathological findings from all patients were recorded and analyzed to compare the EOGC group (i.e., ≤40 years of age) with the older group (>40 years of age). Out of 1668 patients with gastric carcinoma, 151 (9.1%) patients were with EOGC. The time‐trend change in the EOGC rate was insignificant during the investigated period (p = .972). The median age of patients with EOGC was 35 (IQR, 32–38). Compared with the older group, EOGC was more likely to present with a female predominance (52.3% vs. 30.7%, p < .001), endoscopically located at the gastric body (34.4% vs. 19.2%, p < .001), presented with a diffuse infiltrative appearance (18.9% vs. 11.7%, p = .011) but were less likely to have superficial gastric cancer morphology (0.0% vs. 4.5%, p = .009). Pathologically, it was more likely to have diffuse type (36.4% vs. 23.9%, p = .001) and poor differentiation (90.6% vs. 62.7%, p < .001). EOGC in Vietnamese individuals is not rare, and its incidence has not significantly changed during the studying period. The majority of EOGC was poorly differentiated carcinoma. This study reported the different endoscopic distribution and appearance of EOGC from gastric carcinoma in older patients requiring attention during endoscopic examination.