Role of Ct Imaging and Staging of Esophgus Carcinoma

Background and Aim: Esophageal carcinoma is the 8thmost common type of cancer worldwide and is considered a leading cause of cancer mortality. Cancer of the esophagus is one of the most lethal of all cancers. The esophagus is clearly visible on CT images. Over the last decade, computerized tomography (CT) tools have qualified the carcinoma early finding, thereby lowering mortality rates. The advent of multidetector computerized tomography (MDCT) scanners has been a boon to clinical imaging practice. The aim of the present study was to assess the role of computed tomography imaging in esophagus carcinoma staging and detection. Materials and Methods: This prospective study was conducted on 82 esophagus carcinoma patients in the department of Radiology, Sir Ganga Ram Hospital Lahore from July 2020 to June 2021. Individuals who presented with esophagus carcinoma signs and symptoms were enrolled in this study. Esophagus carcinoma was confirmed based on histopathological examination (HPE) reports and postoperative biopsy confirmed the CT findings. Data analysis was done with SPSS version 20. Results: Of the total 82 esophagus carcinoma patients, 44 (54%) were male and 38 (46%) were female. The overall mean age was 45.53±7.3 years with an age range from 18 years to 80 years. The incidence of esophagus carcinoma was more prevalent in the age group of 40 to 60 years. Male patients are more prone to esophagus carcinoma compared to females. The carcinoma in most cases affected the esophagus lower third and middle compared to the upper third. The prevalence of stage patients was as follows; T1 and T2 had 22 (26.8%) stage patients, T3 had 46 (56.1%) stage patients, and T4 had 14 (17.1%). About 52 (64%) patients had asymmetrical wall thickness while 30 (36%) had symmetrical wall thickness. Conclusion: Preoperative esophageal carcinoma staging is significantly aided by computed tomography. Imaging modality CT scans have improved esophageal carcinoma treatment and operative resection rate. As a result, CT is a non-invasive and quick imaging tool for detecting lymphadenopathies, distant metastases, and tumors. Keywords: Esophagus carcinoma; Staging; CT scan; Multidetector computerized tomography

A study on the cutaneous manifestations of an internal malignancy in a tertiary care center in North India

Introduction: Cutaneous metastases may precede a malignancy and, in other cases, herald the recurrence of a malignancy after surgery. Aim: To determine the significance of cutaneous manifestations in patients with an internal malignancy and to observe the various types of carcinomas in patients attending a dermatology OPD. Methods: This was a prospective hospital-based study undertaken to observe the cutaneous features in a dermatology OPD in patients coming from the oncology department of a medical college. Results: The commonest malignancy in males was a lung carcinoma, observed in 5.50% of the patients, followed by a prostate carcinoma, observed in 4.58% of the patients, an esophagus carcinoma, observed in 4.12% of the patients, and a penis carcinoma, observed in 2.29% of the patients. Specific cutaneous manifestations included cutaneous metastatic infiltrates, observed in 5.04% of the patients, and carcinoma erysipeloides, observed in 1.37% of the patients. Discussion: Skin metastases may herald the recurrence of a malignancy after treatment and usually indicate a poor prognosis.

An energy metabolism-based eight-gene signature correlates with the clinical outcome of esophagus carcinoma

Background The essence of energy metabolism has spread to the field of esophageal cancer (ESC) cells. Herein, we tried to develop a prognostic prediction model for patients with ESC based on the expression profiles of energy metabolism associated genes. Materials and methods The overall survival (OS) predictive gene signature was developed, internally and externally validated based on ESC datasets including The Cancer Genome Atlas (TCGA), GSE54993 and GSE19417 datasets. Hub genes were identified in each energy metabolism related molecular subtypes by weighted gene correlation network analysis, and then enrolled for determination of prognostic genes. Univariate, LASSO and multivariate Cox regression analysis were applied to assess prognostic genes and build the prognostic gene signature. Kaplan-Meier curve, time-dependent receiver operating characteristic (ROC) curve, nomogram, decision curve analysis (DCA), and restricted mean survival time (EMST) were used to assess the performance of the gene signature. Results A novel energy metabolism based eight-gene signature (including UBE2Z, AMTN, AK1, CDCA4, TLE1, FXN, ZBTB6 and APLN) was established, which could dichotomize patients with significantly different OS in ESC. The eight-gene signature demonstrated independent prognostication potential in patient with ESC. The prognostic nomogram constructed based on the gene signature showed excellent predictive performance, whose robustness and clinical usability were higher than three previous reported prognostic gene signatures. Conclusions Our study established a novel energy metabolism based eight-gene signature and nomogram to predict the OS of ESC, which may help in precise clinical management.

Lead to elevate the temperature and speed of emergency rescue and nursing care of common carotid artery rupture and massive hemorrhage after operation of typical esophageal cancer

Objective: Objective To explore the first aid and nursing of patients with anastomotic fistula after radical resection of esophagus carcinoma complicated with major carotid hemorrhage.Methods: The clinical data of anastomotic fistula complicated with carotid artery rupture and massive hemorrhage after radical resection of typical esophageal carcinoma were analyzed and summarized.Results:Through the close cooperation of medical care, the rescue was successful.Conclusion:Earlier prevention observation, raising first aid consciousness and actively cooperating with doctors can improve the success rate of rescue.

Neoadjuvant Radio(chemo)therapy for Breast Cancer: An Old Concept Revisited

Background: The international standard of care for the treatment of high-risk breast cancer (BC) consists of neoadjuvant chemotherapy (NACT) and surgery followed by adjuvant whole breast/chest wall irradiation. In this setting, the time interval from the start of NACT to the end of radiotherapy (RT) is usually postponed to 6 months or longer. In addition to this, a high percentage of capsular fibrosis may occur when breast implants are irradiated. Most of these disadvantages could be avoided by using preoperative RT (PRT). PRT is already the standard of care in several other tumor entities (rectal cancer, esophagus carcinoma, lung cancer, and soft tissue sarcoma). Nevertheless, PRT in BC has been tested in several trials, but randomized prospective trials using modern radiation technology and systemic therapies are lacking. The available evidence summarized in this review indicates that PRT may improve survival and reduce long-term toxicity in patients with a higher risk of recurrence and should be consequently tested in a randomized trial. Summary: Prospective, randomized trials concerning PRT in high-risk BC are needed. We plan to conduct a NeoRad trial (NACT followed by PRT in high-risk BC). Key Messages: Prospective, randomized studies concerning PRT in high-risk BC are needed.

A socio-demographic study of esophagus carcinoma at a tertiary care hospital of Maharashtra, India

Background: Esophageal cancer incidence rates vary internationally from region to region. Esophageal cancer is usually 3 to 4 times more common among men than women. The present study was carried out to find out the socio-demographic determinants of esophageal cancer in a tertiary care teaching hospital of central part of India. A retrospective study was carried at tertiary care center in rural part of central India for a period of 6years (2007-2013).Methods: A total of 703 patients suffering with different kind of carcinoma were reported at the hospital of which 255 were retrieved as patients having esophageal carcinoma and reviewed. Patient history and profile like habits and socio-demographic records were collected and assessed. Majority of patients was on mixed diet. Out of 703 patients suffering with carcinoma in a specified period of six years, 255 patients had esophageal cancer.Results: Data reveals predominance of males (51.76) over females (48.24). Majority of peoples belongs to remote areas with a history of chewing tobacco, smoking and consumption of alcohols. The present study shows that esophageal cancer constitutes 32.27% of GIT cancer cases reported in research hospital. Dysphagia and loss of weight were very commonly observed symptoms. Ulceration, lumen narrowing, and wall thickening were also assessed in some patients. Mostly lower and middle esophagus was found to have cell growth.Conclusions: It was concluded from the data, that government must take efforts to improve socio-economic status of peoples standing in remote areas so as to potentially reduce the risk factors causing the disease and increase a public awareness among the peoples.

RA05.02: PRELIMINARY STUDY ON SCOPE OF CERVICAL LYMPHADENECTOMY OF PATIENTS WITH ESOPHAGUS CARCINOMA UNDER THORACOSCOPE

Background Objective: To explore scope of cervical lymphadenectomy of patients with esophagus carcinoma under thoracoscope. Methods Select patients underwent routine bilateral cervical lymph node dissection under thoracoscope.The highest location of cervical lymphadenectomy was marked by titanium clip and recorded anatomic landmark around it.After surgery, CT scan of neck was contributed to estimate the location. Results The results: The upper boundary of lymph node dissection on right neck located on the upward side of the crosspoint of right inferior thyroid artery and right recurret laryngeal nerve, which was adjacent to the midpoint position between the upper pole and lower pole of right thyroid, the lower side of musculi omohyoideus and the plane of transverse cervical artery. The upper boundary of left scope of cervical lymphadenectomy was adjacent to the upper position of lower pole of left thyroid, which was about the same level as that of right titanium clip. Postoperative CT scan on neck and chest suggested that bilateral titanium clip was located on midpoint between the upper pole and lower pole of thyroid on the same side. Conclusion Bilateral cervical paraesophageal lymph nodes (101 group)under inferior thyroid artery could be finished by thracoscope for radical resection of esophageal carcinoma.But we still need more evidence to discover the difference between the 2.5 field lymph node dissection and the 3 field lymph node dissection. Disclosure All authors have declared no conflicts of interest.

Severe toxicity risk factor analysis of salvage radiotherapy for oligo-recurrence in the lymph nodes (LN) of esophagus carcinoma: From multi-institutional retrospective study.

186 Background: This multi-institutional retrospective study suggested that salvage radiotherapy (RT) or chemoradiation therapy (CRT) for oligo-recurrence in the lymph nodes (LN) of esophagus carcinoma was one of therapeutic options. However risk factors of severe toxicities of these therapies are unclear. Methods: Between January 2000 and April 2015, a total of 237 cases that met the study criteria of oligo-recurrence were treated by RT or CRT in five hospitals. We investigated risk factors of severe toxicities in these patients. We used the fisher’s exact test and Cox proportional hazard model. Toxicities were evaluated by CTCAE v4.0. Results: The median follow-up time for 93 living cases was 29.6 months (range; 1.9-154.0 months). Systemic chemotherapy was administrated to 210 cases (88.6%). Median biological effective dose(BED) was 72 Gy(range: 48-84Gy).The 3-year overall survival (OS) was 37%, local control was 45%, progression-free survival was 24%. Radiation induced Grade 3 or worse adverse events were observed in 11 patients (4.6%), which were fistula (4patients,1.7%), pneumonia (2patients,0.8%), pleural effusion (2patients,0.8%), esophageal bleeding (1 patient, 0.4%), esophageal stenosis (1patient,0.4%), cardiac tamponade (1patient,0.4%), and hyperglycemia (1patient,0.4%) ) Treatment related death occurred in 4 patients, these deaths were attributed to drug-induced or radiation-induced interstitial pneumoniae, pleural effusion, esophageal bleeding, and esophago-bronchial fistula. Severe toxicity was only observed in patients with oligo-recurrence in regional lymph nodes or BED ³a60 Gy. In univariate analysis by Fisher’s exact test, Karnofsky performance status (KPS) <80 (p=0.0006) and oligo-recurrence in regional lymph nodes (p=0.0078) were the risk factor of severe toxicity. In multivariate analysis, KPS<80 (HR:11.81,95% CI: 2.67-51.29, p=0.0017) was the risk factor of severe toxicity. Conclusions: This study suggested that KPS<80 and oligo-recurrence in regional lymph nodes is the risk factor for severe toxicity in patients who received RT or CRT for oligo-recurrence in the LNs of esophagus.