Standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) have been considered prognostic factors for survival in many cancers. However, their prognostic value for radiotherapy-treated squamous esophageal cancer has not been evaluated. In this study, SUV, MTV, and TLG were measured to predict their prognostic role in overall survival (OS) in 38 esophageal cancer patients who had undergone 18F-FDG PET/CT before radiotherapy. TLG demonstrated higher sensitivity and specificity for predicting OS than MTV and SUV; and a better OS was observed in patients with low TLG compared to those with high TLG in locally advanced disease (OS, 46.9 months; 95% confidence interval [CI], 33.50-60.26 vs. 25.3 months; 95% CI, 8.37-42.28; P=0.003). Multivariate analyses in these patients determined that TLG and the use of combination chemotherapy were the independent prognostic factors for OS (hazard ratio [HR], 7.12; 95% CI, 2.038-24.857; P=0.002 and HR, 6.76; 95% CI, 2.149-21.248; P=0.001, respectively). These results suggest that TLG is an independent prognostic factor for OS and a better predictor of survival than MTV and SUV in patients with locally advanced esophageal cancer treated with radiotherapy.
Adult ; Aged ; Aged, 80 and over ; Area Under Curve ; Esophageal Neoplasms/mortality/pathology/*radiography ; Female ; Fluorodeoxyglucose F18/chemistry ; Glycolysis/*physiology ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; *Positron-Emission Tomography ; Prognosis ; Proportional Hazards Models ; ROC Curve ; Radiopharmaceuticals/*chemistry ; Retrospective Studies ; Survival Rate ; *Tomography, X-Ray Computed

We present a case of a patient with rapid deterioration of esophageal varices caused by portal hypertension accompanied by a large arterioportal shunt that developed after radiofrequency ablation of hepatocellular carcinoma. We used n-butyl cyanoacrylate (NBCA) as an embolic material to achieve pinpoint embolization of the shunt, because the microcatheter tip was 2 cm away from the shunt site. Under hepatic arterial flow control using a balloon catheter, the arterioportal shunt was successfully embolized with NBCA, which caused an improvement in the esophageal varices.
Aged ; Arteriovenous Fistula/etiology/radiography/*therapy ; Carcinoma, Hepatocellular/*surgery ; Catheter Ablation/*adverse effects ; Embolization, Therapeutic/*methods ; Enbucrilate/*therapeutic use ; Esophageal and Gastric Varices/etiology/*therapy ; Hepatic Artery/*abnormalities/radiography ; Humans ; Liver Neoplasms/*surgery ; Male ; Portal Vein/*abnormalities/radiography

OBJECTIVETo study the cancer stem cell populations in esophageal cancer cell lines KYSE150 and TE1 and identify whether resulting stem-like cell spheres display radiation resistance characteristics.

METHODSSerum-free medium (SFM) suspension was used to culture the esophageal cancer stem cell lines and enrich the esophageal stem-like cell spheres. RT-PCR assay was used to detect the stem cell gene expression in the sphere cells. Radiosensitivity of the sphere cells and parental cells were evaluated by clone formation assay. Different cells after irradiation at different doses were tested to evaluate the changes of sphere formation, and cell cycle and CD44(+)CD271(+) expression of the sphere cells were also analyzed by flow cytometry before and after irradiation.

RESULTSCancer stem-like cell spheres were generated from KYSE150 and TE1 cells and enriched by culture in serum-free medium, and the number of spheres was increasing alone with the increase of cell passages. The numbers of spheres formed from the 1st, 2nd and 3rd generations of KYSE150 cells were 25 ± 2, 37 ± 2 and 47 ± 3, respectively. The numbers of spheres formed from the 1st, 2nd and 3rd generations of TE1 cells were 15 ± 3, 24 ± 3 and 36 ± 4, respectively. Certain doses of radiation increased the sphere formation rate. The average survival fraction (SF2) of the suspension-cultured KYSE150 stem-like cell spheres after 2 Gy irradiation were 0.81 ± 0.03 and 0.69 ± 0.04, while that of TE1 parental cells were 0.87 ± 0.01 and 0.80 ± 0.03 (P < 0.05 for all). In the esophageal parental KYSE150 and TE1 cells, arrest at G2 phase was induced after irradiation. After the same dose of irradiation, the inhibition of proliferation of the cancer stem cells was lower than that of the parent cells (P < 0.05). After 0, 4 and 8 Gy irradiation, the CD44(+)CD271(+) cell percentage of KYSE150 parental cells were (1.08 ± 0.03)%, (1.29 ± 0.07)% and (1.11 ± 0.09)%; the CD44(+)CD271(+) cell percentage of TE1 parental cells were (1.16 ± 0.11)%, (0.97 ± 0.08)% and (1.45 ± 0.35)% (P > 0.05 for all). After 0, 4 and 8 Gy irradiation, the percentage of CD44(+)CD271(+) cells of KYSE150 stem cell-like spheres were (35.83 ± 1.23)%, (44.90 ± 1.67)% and (57.77 ± 1.88)%, and that of TE1 stem cell-like spheres were (16.07 ± 0.91)%, (22.67 ± 1.12)% and (33.27 ± 1.07)%. Compared the 4 Gy and 8 Gy irradiated KYSE150 and TE1 stem-like cell spheres with the 0 Gy irradiated spheres, the differences were statistically significant (P < 0.05 for all).

CONCLUSIONSThe cancer stem cells in KYSE150 and TE1 spheres are more radio-resistant than their parental cells. It may suggest that cancer stem cell populations in the esophageal cancer cells are related to the mechanism of occurrence of radioresistance.

Cell Cycle ; Cell Line, Tumor ; diagnostic imaging ; Clone Cells ; Esophageal Neoplasms ; diagnostic imaging ; Flow Cytometry ; Humans ; Neoplastic Stem Cells ; diagnostic imaging ; Radiation Tolerance ; Radiography

OBJECTIVETo compare the efficacy and toxicity of intensity- modulated radiation therapy plus chemotherapy (IMRT-TP) with simple intensity-modulated radiation therapy (IMRT) in the treatment of locally advanced esophageal carcinoma.

METHODSA total of 170 eligible patients with locally advanced esophageal carcinoma were recruited prospectively from September 2004 to April 2008 and randomly divided into IMRT-TP group and IMRT group. Two groups were treated with IMRT of 6MV-X. The radiation dose was 60 Gy in 30 fractions in IMRT-TP group and 66 Gy in 30 fractions in IMRT group. The regimen of chemotherapy consisted of docetaxel and cisplatin in IMRT-TP group for 2 cycles.

RESULTSOf 170 patients, 160 completed the trial, including 75 patients of IMRT-TP group and 85 of IMRT group. As compared to IMRT group, total recurrence rate [69.3% (52/75) vs. 84.7% (72/85), P=0.020] and local recurrence rate [50.7% (38/75) vs. 67.1% (57/85), P=0.035] decreased in IMRT-TP group, the 5-year overall survival (29.3% vs. 15.3%, P=0.031) and 5-year recurrence free survival (24.0% vs. 10.6%, P=0.015) increased in IMRT-TP group. While severe side effect ratio increased obviously in IMRT-TP group [54.7% (41/75) vs. 4.7% (4/85), P=0.000].

CONCLUSIONAs compare to simple IMRT, IMRT plus docetaxel and cisplatin can decrease the local recurrence rate, prolong the overall survival and regression-free survival, but bring more side effects.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Cisplatin ; administration & dosage ; Esophageal Neoplasms ; diagnostic imaging ; drug therapy ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Radiography ; Radiotherapy, Intensity-Modulated ; Taxoids ; administration & dosage

OBJECTIVE: To retrospectively evaluate the feasibility and effectiveness of three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage (GEAL). MATERIALS AND METHODS: From January 2007 to January 2011, 28 cases of postoperative GEAL after an esophagectomy with intrathoracic esophagogastric anastomotic procedures for esophageal and cardiac carcinoma were treated by the insertion of three tubes under fluoroscopic guidance. The three tubes consisted of a drainage tube through the leak, a nasogastric decompression tube, and a nasojejunum feeding tube. The study population consisted of 28 patients (18 males, 10 females) ranging in their ages from 36 to 72 years (mean: 59 years). We evaluated the feasibility of three-tube insertion to facilitate leakage site closure, and the patients' nutritional benefit by checking their serum albumin levels between pre- and post-enteral feeding via the feeding tube. RESULTS: The three tubes were successfully placed under fluoroscopic guidance in all twenty-eight patients (100%). The procedure times for the three tube insertion ranged from 30 to 70 minutes (mean time: 45 minutes). In 27 of 28 patients (96%), leakage site closure after three-tube insertion was achieved, while it was not attained in one patient who received stent implantation as a substitute. All patients showed good tolerance of the three-tube insertion in the nasal cavity. The mean time needed for leakage treatment was 21 +/- 3.5 days. The serum albumin level change was significant, increasing from pre-enteral feeding (2.5 +/- 0.40 g/dL) to post-enteral feeding (3.7 +/- 0.51 g/dL) via the feeding tube (p < 0.001). The duration of follow-up ranged from 7 to 60 months (mean: 28 months). CONCLUSION: Based on the results of this study, the insertion of three tubes under fluoroscopic guidance is safe, and also provides effective relief from postesophagectomy GEAL. Moreover, our findings suggest that three-tube insertion may be used as the primary procedure to treat postoperative GEAL.
Adult ; Aged ; Anastomosis, Surgical ; Anastomotic Leak/radiography/*therapy ; Decompression, Surgical/instrumentation ; Drainage/instrumentation ; Enteral Nutrition/instrumentation ; Esophageal Neoplasms/*surgery ; Esophagectomy ; Female ; Fluoroscopy ; Humans ; Intubation, Gastrointestinal/*methods ; Male ; Middle Aged ; Postoperative Complications/*radiography/*therapy ; Radiography, Interventional/*methods ; Retrospective Studies ; Stomach Neoplasms/*surgery

OBJECTIVE: We wanted to report on our experience with modified radiology-guided percutaneous gastrostomy (MRPG) without endoscopic or nasogastric access for treating patients with complete obstruction of the upper digestive tract. MATERIALS AND METHODS: Fourteen oncology patients (13 had hypopharyngeal cancer and 1 had upper esophageal cancer) with complete obstruction of the upper digestive tract were recruited. Conventional percutaneous endoscopic gastrostomy (PEG) and radiologic (fluoroscopy-guided) percutaneous gastrostomy (RPG) were not feasible in all the patients. An MRPG technique (with a combination of ultrasound, an air enema and fluoroscopic guidance) was performed in these patients. RESULTS: We achieved successfully percutaneous gastrostomy using the modified technique in all patients without any major or minor complications after the procedure. CONCLUSION: A modified radiology-guided percutaneous gastrostomy technique can be safely performed in patients who failed to receive conventional PEG or RPG due to the absence of nasogastric access in the completely obstructed upper digestive tract.
Adult ; Aged ; Conscious Sedation ; Contrast Media/diagnostic use ; Esophageal Neoplasms/radiography/*surgery ; Female ; Gastrostomy/*methods ; Humans ; Intestinal Obstruction/radiography/*surgery ; Iothalamate Meglumine/diagnostic use ; Laryngeal Neoplasms/radiography/*surgery ; Male ; Middle Aged ; Radiography, Interventional ; Retrospective Studies ; Upper Gastrointestinal Tract/radiography/*surgery

Esophageal Neoplasms ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Radiography ; Subclavian Artery ; abnormalities ; diagnostic imaging ; surgery

Diffuse esophageal leiomyomatosis is a rare benign tumor, which can be associated with leiomyoma in female genital tracts involving the uterus, vagina, and vulva. Alport syndrome, an inherited disorder that includes the kidneys, eyes, and sensorineural hearing loss, is also rarely associated with these multiple leiomyomatosis. In our case, 18F-fluoroseoxyglucose positron emission tomography/computed tomography was used to distinguish esophageal and genital leiomyomatosis from malignant masses.
Diagnosis, Differential ; Esophageal Neoplasms/*radiography/*radionuclide imaging ; Female ; Fluorodeoxyglucose F18/diagnostic use ; Genital Neoplasms, Female/*radiography/*radionuclide imaging ; Humans ; Leiomyomatosis/*radiography/*radionuclide imaging ; Middle Aged ; Positron-Emission Tomography/*methods ; Radiographic Image Interpretation, Computer-Assisted ; Radiopharmaceuticals/diagnostic use ; Tomography, X-Ray Computed/*methods

OBJECTIVETo evaluate the accuracy of radiographic examination, endoscopic examination and clinical response evaluation criteria in staging for esophageal carcinoma after preoperative chemoradiation therapy(pre-CRT).

METHODSTwenty-seven patients of locally advanced esophageal squamous cell carcinoma were involved. CT scan for cervical part, chest and abdomen, and endoscopic ultrasound(EUS), electronic fibrobroncoscopic examination were used to assess the tumor for staging before pre-CRT. The tumors were re-assessed using the same methods after the completion of CRT. Response evaluation criteria in solid tumors(RECIST) was used to assess the tumor response. Surgery was carried out 3 to 6 weeks after CRT. The clinical tumor response before surgery was compared with pathological tumor response after surgery. Micrometastasis detection was carried out for paraffin embedded lymph nodes using anti-keratin monoclonal marker AE1 and AE3 by immunohistochemical(IHC) method.

RESULTSThe accuracy of CT scan in staging after pre-CRT was 40.9%(9/22) for primary tumors and 68.2%(15/22)for lymph nodes, with overall accuracy of 40.9%(9/22) for TNM staging. The accuracy of EUS in staging was 38.5%(5/13) for primary tumors and 69.2%(9/13) for lymph nodes, with overall accuracy of 38.5%(5/13)for TNM staging. While CT scan combined with EUS, the accuracy for TNM staging was 46.2%(6/13). Five cases achieved CR, 14 cases achieved PR and 8 cases achieved SD according to RECIST. Among 5 clinical CR cases, 3 cases were confirmed by pathologic examination, 1 case was diagnosed as pT(3)N(1) disease by HE stain. One case with pT(0)N(0) disease by HE stain was detected with lymph node micrometastasis by IHC. Among 5 pathological CR cases, 3 cases were diagnosed as clinical CR, 2 cases were diagnosed as clinical PR before surgery. Among 15 cases of N(0) disease by HE stain, 3 lymph nodes from 2 cases were detected with micrometastasis by IHC.

CONCLUSIONSThe current examinations(barium swallow, CT scan,EUS, endoscopy guided biopsy) and RECIST are not accurate enough to assess the tumor response for esophageal squamous cell carcinoma after pre-CRT. Surgery should be recommended for patients with clinical CR after pre-CRT.

Aged ; Carcinoma, Squamous Cell ; diagnostic imaging ; pathology ; therapy ; Chemotherapy, Adjuvant ; Esophageal Neoplasms ; diagnostic imaging ; pathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Preoperative Care ; Radiography ; Radiotherapy, Adjuvant ; Treatment Outcome

No abstract availble.
Esophageal Neoplasms/complications/pathology/*radiography ; Esophageal Perforation/etiology/*radiography/therapy ; Humans ; Male ; Middle Aged ; Stents ; Tomography, X-Ray Computed