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Tippareddy C, Martinez OM, Benza AR, Bera K, Ramaiya N, Tirumani SH. From guidelines to radiology practice: navigating the 2023 ASCO guidelines for advanced gastroesophageal cancer and beyond. Abdom Radiol (NY) 2025; 50:78-93. [PMID: 39123051 PMCID: PMC11711647 DOI: 10.1007/s00261-024-04499-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 07/09/2024] [Accepted: 07/13/2024] [Indexed: 08/12/2024]
Abstract
The American Society of Clinical Oncology (ASCO) updated the guidelines for the treatment of advanced gastroesophageal (GE) cancer in 2023, signifying a major shift towards targeted therapeutics and precision medicine. This article serves as an imaging-based review of recent developments in the care of patients with GE cancer. We cover the epidemiology, the developing treatment paradigms, and the imaging assessment of GE malignancy. In addition, this review aims to familiarize radiologists with the unique adverse effects pertaining to therapeutics, surgeries, radiation therapies, and associated imaging corollaries. A case-based approach will be used to both explore the efficacy of modern treatments and demonstrate their adverse effects, such as chemotherapy-associated pneumonitis, radiation esophagitis, and anastomotic failure. With this comprehensive exploration of gastroesophageal cancer, radiologists will be equipped with the essential tools to inform the treatment decisions made by medical oncologists, radiation oncologists, and surgical oncologists in the new era of precision medicine.
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Affiliation(s)
- Charit Tippareddy
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 1110 Euclid Ave, Cleveland, OH, 44106, USA.
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | | | - Andrew R Benza
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 1110 Euclid Ave, Cleveland, OH, 44106, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kaustav Bera
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 1110 Euclid Ave, Cleveland, OH, 44106, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nikhil Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 1110 Euclid Ave, Cleveland, OH, 44106, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sree Harsha Tirumani
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 1110 Euclid Ave, Cleveland, OH, 44106, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Yun SM, Yeom JA, Lee JW, Kim GH, Nam KJ, Jeong YJ. Findings of Endoscopic US and CT of Esophageal Disease. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:883-901. [PMID: 39416323 PMCID: PMC11473974 DOI: 10.3348/jksr.2023.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/03/2024] [Accepted: 03/05/2024] [Indexed: 10/19/2024]
Abstract
Various diseases can affect the esophagus. Endoscopic ultrasound (EUS), which provides precise information about the layers of the esophageal wall, is the primary approach used to investigate esophageal diseases. However, CT is one of the most important imaging modalities for diagnosing esophageal diseases as it can elucidate mediastinal involvement, adjacent lymphadenopathy, and distant disease spread. These two modalities complement each other in the diagnosis of esophageal diseases. Although radiologists may be unfamiliar with EUS procedures and their interpretation, understanding them aids in the differential diagnosis of esophageal conditions. This pictorial essay illustrates the EUS and CT findings of various esophageal diseases originating in the esophageal wall.
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Nobel T, Sihag S. Advances in Diagnostic, Staging, and Restaging Evaluation of Esophageal and Gastric Cancer. Surg Oncol Clin N Am 2024; 33:467-485. [PMID: 38789190 DOI: 10.1016/j.soc.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
The initial endoscopic and staging evaluation of esophagogastric cancers must be accurate and comprehensive in order to select the optimal therapeutic plan for the patient. Esophageal and gastric cancers (and treatment paradigms) are delineated by their proximity to the cardia (within 2 cm). The most frequent and important symptom that informs the initial staging evaluation is dysphagia, which is associated with at least cT3 or locally advanced disease. Endoscopic ultrasound is often needed if earlier stage disease is suspected, preferably in combination with endoscopic mucosal or submucosal resection or fine-needle aspiration of suspicious lymph nodes to enhance staging accuracy.
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Affiliation(s)
- Tamar Nobel
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-881, New York, NY 10065, USA
| | - Smita Sihag
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-881, New York, NY 10065, USA.
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Ebert MP, Fischbach W, Hollerbach S, Höppner J, Lorenz D, Stahl M, Stuschke M, Pech O, Vanhoefer U, Porschen R. S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:535-642. [PMID: 38599580 DOI: 10.1055/a-2239-9802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Matthias P Ebert
- II. Medizinische Klinik, Medizinische Fakultät Mannheim, Universitätsmedizin, Universität Heidelberg, Mannheim
- DKFZ-Hector Krebsinstitut an der Universitätsmedizin Mannheim, Mannheim
- Molecular Medicine Partnership Unit, EMBL, Heidelberg
| | - Wolfgang Fischbach
- Deutsche Gesellschaft zur Bekämpfung der Krankheiten von Magen, Darm und Leber sowie von Störungen des Stoffwechsels und der Ernährung (Gastro-Liga) e. V., Giessen
| | | | - Jens Höppner
- Klinik für Allgemeine Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck
| | - Dietmar Lorenz
- Chirurgische Klinik I, Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Darmstadt, Darmstadt
| | - Michael Stahl
- Klinik für Internistische Onkologie und onkologische Palliativmedizin, Evang. Huyssensstiftung, Evang. Kliniken Essen-Mitte, Essen
| | - Martin Stuschke
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen
| | - Oliver Pech
- Klinik für Gastroenterologie und Interventionelle Endoskopie, Krankenhaus Barmherzige Brüder, Regensburg
| | - Udo Vanhoefer
- Klinik für Hämatologie und Onkologie, Katholisches Marienkrankenhaus, Hamburg
| | - Rainer Porschen
- Gastroenterologische Praxis am Kreiskrankenhaus Osterholz, Osterholz-Scharmbeck
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Ma J, Liu T, Xu L. Stack-Layer Dual-Frequency Ultrasound Array With Ground Shielding for Super-Harmonic Imaging. IEEE TRANSACTIONS ON INSTRUMENTATION AND MEASUREMENT 2024; 73:1-8. [DOI: 10.1109/tim.2023.3332397] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2024]
Affiliation(s)
- Jianguo Ma
- School of Instrumentation and Optoelectronics Engineering, Beihang University, Beijing, China
| | - Tieming Liu
- School of Instrumentation and Optoelectronics Engineering, Beihang University, Beijing, China
| | - Lijun Xu
- School of Instrumentation and Optoelectronics Engineering, Beihang University, Beijing, China
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Puranik AD, Choudhury S, Ghosh S, Dev ID, Ramchandani V, Uppal A, Bhosale V, Palsapure A, Rungta R, Pandey R, Khatri S, George G, Satamwar Y, Maske R, Agrawal A, Shah S, Purandare NC, Rangarajan V. Tata Memorial Centre Evidence Based Use of Nuclear medicine diagnostic and treatment modalities in cancer. Indian J Cancer 2024; 61:S1-S28. [PMID: 38424680 DOI: 10.4103/ijc.ijc_52_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Abstract
ABSTRACT PET/CT and radioisotope therapy are diagnostic and therapeutic arms of Nuclear Medicine, respectively. With the emergence of better technology, PET/CT has become an accessible modality. Diagnostic tracers exploring disease-specific targets has led the clinicians to look beyond FDG PET. Moreover, with the emergence of theranostic pairs of radiopharmaceuticals, radioisotope therapy is gradually making it's way into treatment algorithm of common cancers in India. We therefore would like to discuss in detail the updates in PET/CT imaging and radionuclide therapy and generate a consensus-driven evidence based document which would guide the practitioners of Oncology.
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Affiliation(s)
- Ameya D Puranik
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital and Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Conca F, Rosso N, López Grove R, Savluk L, Santino JP, Ulla M. Esophageal tumors: The keys to diagnosis by pneumo-computed tomography. RADIOLOGIA 2023; 65:546-553. [PMID: 38049253 DOI: 10.1016/j.rxeng.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/28/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE To review and describe the most characteristic radiological findings of the most frequent esophageal tumor lesions, with emphasis on the esophago-gastric distention technique pneumo-computed tomography performed in our institution. To know the main advantage of this distension technique. CONCLUSION Malignant tumor lesions (predominantly squamous cell carcinoma in the mid esophagus and adenocarcinoma in the distal esophagus) present as asymmetric wall thickening, mucosal irregularity, or mass extending into adjacent organs with lymph node involvement. Benign tumors (mainly leiomyoma being the most frequent and others such as lipoma) present as endoluminal growth, with defined borders and homogeneous attenuation. Post-contrast enhancement is scarce or moderate. The technique of computed tomography pneumotomography technique achieves an additional distension of the esophageal lumen in all cases. It allows delimiting the superior and inferior borders of the lesions, helping the surgeon to define the therapeutic strategy.
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Affiliation(s)
- F Conca
- Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
| | - N Rosso
- Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - R López Grove
- Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - L Savluk
- Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - J P Santino
- Servicio de Anatomía Patológica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - M Ulla
- Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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Lei X, Cao Z, Wu Y, Lin J, Zhang Z, Jin J, Ai Y, Zhang J, Du D, Tian Z, Xie C, Yin W, Jin X. Preoperative prediction of clinical and pathological stages for patients with esophageal cancer using PET/CT radiomics. Insights Imaging 2023; 14:174. [PMID: 37840068 PMCID: PMC10577114 DOI: 10.1186/s13244-023-01528-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Preoperative stratification is critical for the management of patients with esophageal cancer (EC). To investigate the feasibility and accuracy of PET-CT-based radiomics in preoperative prediction of clinical and pathological stages for patients with EC. METHODS Histologically confirmed 100 EC patients with preoperative PET-CT images were enrolled retrospectively and randomly divided into training and validation cohorts at a ratio of 7:3. The maximum relevance minimum redundancy (mRMR) was applied to select optimal radiomics features from PET, CT, and fused PET-CT images, respectively. Logistic regression (LR) was applied to classify the T stage (T1,2 vs. T3,4), lymph node metastasis (LNM) (LNM(-) vs. LNM(+)), and pathological state (pstage) (I-II vs. III-IV) with features from CT (CT_LR_Score), PET (PET_LR_Score), fused PET/CT (Fused_LR_Score), and combined CT and PET features (CT + PET_LR_Score), respectively. RESULTS Seven, 10, and 7 CT features; 7, 8, and 7 PET features; and 3, 6, and 3 fused PET/CT features were selected using mRMR for the prediction of T stage, LNM, and pstage, respectively. The area under curves (AUCs) for T stage, LNM, and pstage prediction in the validation cohorts were 0.846, 0.756, 0.665, and 0.815; 0.769, 0.760, 0.665, and 0.824; and 0.727, 0.785, 0.689, and 0.837 for models of CT_LR_Score, PET_ LR_Score, Fused_ LR_Score, and CT + PET_ LR_Score, respectively. CONCLUSIONS Accurate prediction ability was observed with combined PET and CT radiomics in the prediction of T stage, LNM, and pstage for EC patients. CRITICAL RELEVANCE STATEMENT PET/CT radiomics is feasible and promising to stratify stages for esophageal cancer preoperatively. KEY POINTS • PET-CT radiomics achieved the best performance for Node and pathological stage prediction. • CT radiomics achieved the best AUC for T stage prediction. • PET-CT radiomics is feasible and promising to stratify stages for EC preoperatively.
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Affiliation(s)
- Xiyao Lei
- Department of Radiation Oncology, Lishui Municipal Central Hospital, Lishui, 323000, China
- Department of Radiotherapy Center, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Zhuo Cao
- Department of Respiratory, Lishui People's Hospital, Lishui, 323000, China
| | - Yibo Wu
- Department of Radiotherapy Center, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Jie Lin
- Department of Nuclear Medicine, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Zhenhua Zhang
- Department of Radiology, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Juebin Jin
- Department of Radiotherapy Center, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Yao Ai
- Department of Radiotherapy Center, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Ji Zhang
- Department of Radiotherapy Center, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Dexi Du
- Department of Radiation Oncology, Lishui Municipal Central Hospital, Lishui, 323000, China
| | - Zhifeng Tian
- Department of Radiation Oncology, Lishui Municipal Central Hospital, Lishui, 323000, China
| | - Congying Xie
- Department of Radiotherapy Center, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
- Department of Medical and Radiation Oncology, 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
| | - Weiwei Yin
- Department of Nuclear Medicine, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
| | - Xiance Jin
- Department of Radiation Oncology, Lishui Municipal Central Hospital, Lishui, 323000, China.
- Department of Radiotherapy Center, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
- School of Basic Medical Science, Wenzhou Medical University, Wenzhou, 325000, China.
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Harino T, Yamasaki M, Murai S, Yamashita K, Tanaka K, Makino T, Saito T, Yamamoto K, Takahashi T, Kurokawa Y, Nakajima K, Tomiyama N, Eguchi H, Nakamura H, Doki Y. Impact of MRI on the post-therapeutic diagnosis of T4 esophageal cancer. Esophagus 2023; 20:740-748. [PMID: 37233847 DOI: 10.1007/s10388-023-01010-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/25/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Opportunities for T4b esophageal cancer patients to receive curative surgery are increasing with the development of multidisciplinary treatments. However, the best modality to accurately diagnose infiltration to the organs surrounding T4b esophageal cancer is still unknown. The aim of this study was to determine the performance of CT and MRI in diagnosing T stage in T4b esophageal cancer, with reference to the pathological diagnosis. METHODS A retrospective medical records review of patients with T4b esophageal cancer patients from January 2017 to December 2021 was conducted. Among 125 patients who were treated for cT4b esophageal cancer in Osaka University Hospital, 30 patients were diagnosed with cT4b esophageal cancer by CT, ycT staging with CT (contrast-enhanced images) and MRI (T2-FSE images), and curative R0 resection was performed. Preoperative MRI staging was independently performed by two experienced radiologists. The diagnostic performance of CT and MRI were examined using McNemar's test. RESULTS Nineteen and 12 patients were diagnosed with ycT4b by CT and MRI, respectively. Combined T4b organ resection was performed in 15 patients. A pathological diagnosis of ypT4b was made in 11 cases. In comparison to CT, MRI showed a higher diagnostic performance, specificity (47% vs. 89%, p = 0.013), and accuracy (60% vs. 90%, p = 0.015) for CT vs. MRI. CONCLUSIONS Our results-with reference to the pathological diagnosis-revealed that MRI had a superior diagnostic performance to CT for diagnosing T4b esophageal cancer invading the surrounding organs. An accurate diagnosis of T4b esophageal cancer may facilitate the implementation of appropriate treatment strategies.
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Affiliation(s)
- Takashi Harino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Makoto Yamasaki
- Department of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka, 573-1010, Japan.
| | - Sachiko Murai
- Department of Radiology, Saito Yukokai Hospital, Osaka, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takuro Saito
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kiyokazu Nakajima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | | | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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Li Z, Li Y, Liu X, Zheng Y, Sun H, Liang G, Wang Z, Xing W. Stratification of lymph node metastasis improves diagnostic efficiency in thoracic esophageal squamous cell carcinoma. Dis Esophagus 2023; 36:doad017. [PMID: 37013856 DOI: 10.1093/dote/doad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/11/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Difference of the short diameter of lymph nodes in the main regions of esophageal squamous cell carcinoma (ESCC) and its value in the diagnosis of lymph nodes need to explore. METHODS The clinical data of patients with thoracic ESCC who underwent surgical treatment in our hospital were collected. The short diameters of the largest lymph node in each region of the patient were measured by preoperative enhanced computed tomography (CT) and were compared with the postoperative pathology. RESULTS A total of 477 patients with thoracic ESCC who did not receive neoadjuvant therapy were enrolled in this study. The receiver operating characteristic curve suggested that the short diameters of the paracardial nodes, the left gastric nodes, the right recurrent laryngeal nerve nodes, and the left recurrent laryngeal nerve nodes could well predict the postoperative pathology of the lymph nodes, with area under curve (AUC) of 0.958, 0.937, 0.931, and 0.915, the corresponding cut-off values of 5.7 mm, 5.7 mm, 5.5 mm, and 4.8 mm, the corresponding sensitivities of 94.7%, 85.4%, 88.7%, and 79.4%, and the corresponding specificities of 93.7%, 96.3%, 86.2%, and 95.0%, respectively. The AUC of the thoracic paraesophageal lymph nodes, the subcarinal nodes and all regional lymph nodes were 0.845, 0.688, and 0.776, respectively. CONCLUSION Region-based criterion for lymph node metastasis of thoracic ESCC is beneficial to improve the diagnostic efficiency of preoperative CT.
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Affiliation(s)
- Zhenxuan Li
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianben Liu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Yan Zheng
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Haibo Sun
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Guanghui Liang
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Zongfei Wang
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Wenqun Xing
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
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Authors, und die Mitarbeiter der Leitlinienkommission, Collaborators:. S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:e209-e307. [PMID: 37285869 DOI: 10.1055/a-1771-6953] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Pollard JH, DiCamillo PA, Dundar A, Averill SL, Aswani Y. Gastrointestinal Malignancies. RADIOLOGY‐NUCLEAR MEDICINE DIAGNOSTIC IMAGING 2023:407-455. [DOI: 10.1002/9781119603627.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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13
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Buchanan ME, Fishman EK, Azadi JR. CT Evaluation of the Esophagus: The Role of CT Imaging and CT Imaging Findings in Diagnosing Esophageal Abnormalities. Curr Probl Diagn Radiol 2023; 52:289-299. [PMID: 37045693 DOI: 10.1067/j.cpradiol.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/16/2023] [Indexed: 04/14/2023]
Abstract
Esophageal disorders are commonly encountered by radiologists on computed tomography. Characteristic computed tomography findings of various esophageal pathologies have been extensively described and are important for the radiologist to know to facilitate accurate and timely diagnosis. Esophageal disorders can be broadly classified as infectious and inflammatory, congenital/structural, or neoplastic. This paper reviews the most common presentations of various esophageal pathologies within each classification.
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Affiliation(s)
- Mary E Buchanan
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Elliot K Fishman
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Javad R Azadi
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD.
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Chakrabarty N, Mahajan A, Prabhash K, Patil P, Chowhan M, Munmmudi N, Niyogi D, Dabkara D, Singh S, Singh A, Devarmani S, Dhull VS. Imaging Recommendations for Diagnosis, Staging, and Management of Esophageal Cancer. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1760324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
AbstractEarly staging and treatment initiation affect prognosis of patients with esophageal and esophagogastric junction cancer; hence, it is imperative to have knowledge of proper choice of imaging modality for staging of these patients, to effectively convey relevant imaging findings to the treating physician/surgeon. It is also essential to be aware of pertinent imaging findings that need to be conveyed to the treating physician/surgeon at staging, and after treatment, including post-therapy complications (if any), so as to provide timely management to such patients. In this article, we have provided imaging guidelines for diagnosis, staging, post-therapy response evaluation, follow-up, and assessment of post-therapy complications of esophageal and esophagogastric junction cancer in a systematic manner. Besides, risk factors and clinical workup have also been elucidated. We have also attached comprehensive staging and post-therapy contrast-enhanced computed tomography and fluorodeoxyglucose-positron emission tomography/computed tomography-based synoptic reporting formats “ECI-RADS” and “pECI-RADS,” respectively, for esophageal and esophagogastric junction cancer in the supplement, for effective communication of imaging findings between a radiologist and the treating physician/surgeon.
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Affiliation(s)
- Nivedita Chakrabarty
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Abhishek Mahajan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Prachi Patil
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Manoranjan Chowhan
- Department of Nuclear Medicine and PET/CT, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
| | - Naveen Munmmudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Devayani Niyogi
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Deepak Dabkara
- Department of Oncology, CHL Hospitals, Indore, Madhya Pradesh, India
| | - Suryaveer Singh
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ajaykumar Singh
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sanjana Devarmani
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Varun Singh Dhull
- Department of Nuclear Medicine and PET/CT, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
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Karande M, Kang M, Lazarow F. Bronchoesophageal fistula diagnosed on modified barium swallow, a unique presentation. Radiol Case Rep 2022; 17:4855-4858. [PMID: 36247698 PMCID: PMC9556915 DOI: 10.1016/j.radcr.2022.09.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/11/2022] [Accepted: 09/15/2022] [Indexed: 11/05/2022] Open
Abstract
Modified barium swallow (MBS) studies, performed in conjunction with speech pathologists, are routinely performed to assess for aspiration. The narrow field of view over the area of interest limits assessment of pathology in the thoracic esophagus and airways. We report a case of a 79-year-old female with bronchoesophageal fistula diagnosed incidentally after abnormal findings on an MBS initially performed to assess for aspiration.
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16
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Zhu L, Zhao Z, Liu A, Wang X, Geng X, Nie Y, Zhao F, Li M. Lymph node metastasis is not associated with survival in patients with clinical stage T4 esophageal squamous cell carcinoma undergoing definitive radiotherapy or chemoradiotherapy. Front Oncol 2022; 12:774816. [PMID: 36185192 PMCID: PMC9516552 DOI: 10.3389/fonc.2022.774816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundClinical T4 stage (cT4) esophageal tumors are difficult to be surgically resected, and definitive radiotherapy (RT) or chemoradiotherapy (dCRT) remains the main treatment. The study aims to analyze the association between the status of lymph node (LN) metastasis and survival outcomes in the cT4 stage esophageal squamous cell carcinoma (ESCC) patients that underwent treatment with dCRT or RT.MethodsThis retrospective study analyzed the clinical data of 555 ESCC patients treated with dCRT or RT at the Shandong Cancer Hospital and the Liaocheng People’s Hospital from 2010 to 2017. Kaplan–Meier and Cox regression analyses was performed to determine the relationship between LN metastasis and survival outcomes of cT4 and non-cT4 ESCC patients. The chi-square test was used to evaluate the differences in the local and distal recurrence patterns in the ESCC patients belonging to various clinical T stages.ResultsThe 3-year survival rates for patients with non-cT4 ESCC and cT4 ESCC were 47.9% and 30.8%, respectively. The overall survival (OS) and progression-free survival (PFS) rates were strongly associated with the status of LN metastasis in the entire cohort (all P < 0.001) and the non-cT4 group (all P < 0.001) but not in the cT4 group. The local recurrence rates were 60.7% for the cT4 ESCC patients and 45.1% for the non-cT4 ESCC patients (P < 0.001). Multivariate analysis showed that clinical N stage (P = 0.002), LN size (P = 0.007), and abdominal LN involvement (P = 0.011) were independent predictors of favorable OS in the non-cT4 group. However, clinical N stage (P = 0.824), LN size (P = 0.383), and abdominal LN involvement (P = 0.337) did not show any significant correlation with OS in the cT4 ESCC patients.ConclusionsOur data demonstrated that the status of LN metastasis did not correlate with OS in the cT4 ESCC patients that received dCRT or RT. Furthermore, the prevalence of local recurrence was higher in the cT4 ESCC patients.
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Affiliation(s)
- Liqiong Zhu
- Department of Clinical Medicine, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Department of Radiation Oncology, Liaocheng People’s Hospital, Liaocheng, China
| | - Zongxing Zhao
- Department of Radiation Oncology, Liaocheng People’s Hospital, Liaocheng, China
| | - Ao Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- School of Medicine, Shandong University, Jinan, China
| | - Xin Wang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Xiaotao Geng
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
| | - Yu Nie
- Department of Clinical Medicine, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Fen Zhao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- *Correspondence: Fen Zhao ; Minghuan Li,
| | - Minghuan Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- *Correspondence: Fen Zhao ; Minghuan Li,
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17
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Selection of dilution material for non-iodinated iodine as an oral contrast agent for esophageal cancer: a preliminary clinical trial. Jpn J Radiol 2022; 40:1167-1174. [PMID: 35857211 PMCID: PMC9616773 DOI: 10.1007/s11604-022-01299-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/30/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate the filling state of the esophagus using different oral contrast agents for the diagnosis of esophageal cancer by computed tomography (CT). MATERIALS AND METHODS This preliminary clinical trial enrolled patients with suspected esophageal carcinoma and admitted from January 2015 to January 2018. The patients were randomized into the yogurt (mixed with ioversol), lotus root powder (mixed with ioversol), gas-producing powder, and control (pure iodine water) groups. Chest CT examinations were performed. The degree of esophageal filling and the detection of esophageal lesions were compared. RESULTS Finally, 136 participants were enrolled (n = 34/group). There were no significant differences in esophageal filling degree among the yogurt, lotus root powder, and gas-producing powder groups (P = 0.093). There were 30/3/1 and 30/3/1 confirmed/false-negative/false-positive diagnoses in the yogurt and lotus powder groups, respectively, compared with 28/5/1 and 25/8/1 in the gas-producing powder and control groups, respectively. The concordance rates were the highest for the yogurt (88.2%, with 91.7% specificity and 86.4% sensitivity) and lotus root powder groups (88.2%, with 92.3% specificity and 85.7% sensitivity) and the lowest for the control group (73.5%, with 90.0% specificity and 66.7% sensitivity). CONCLUSION Yogurt mixed with ioversol could fill and expand the esophagus with minimal preparation, displaying the structure of the esophageal lumen and wall thickness. This mixture might be used as a positive contrast agent for esophageal CT. Similar results were observed for the lotus root powder mixed with ioversol, but its preparation was more arduous.
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18
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Chela HK, Gangu K, Ertugrul H, Juboori AA, Daglilar E, Tahan V. The 8th Wonder of the Cancer World: Esophageal Cancer and Inflammation. Diseases 2022; 10:44. [PMID: 35892738 PMCID: PMC9326664 DOI: 10.3390/diseases10030044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/22/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
Esophageal cancer is a devastating malignancy which can be detected at an early stage but is more often diagnosed as an advanced process. It affects both men and women and inflicts the young and the elderly. There are multiple underlying factors involved in the pathogenesis of this cancer including inflammation. The interplay of these factors promotes inflammation through various mechanisms including the recruitment of pro-inflammatory cells, mediators such as cytokines, reactive oxygen species, and interleukins, among others. The presentation can vary widely with one of the most notable symptoms being dysphagia. Diagnosis is based on clinical symptomatology, imaging and endoscopy with biopsy. Once the diagnosis has been established, treatment and prognosis are based on the stage of the disease. This review outlines esophageal cancer and its link to inflammation in relation to pathogenesis, along with clinical features, diagnosis and treatment.
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Affiliation(s)
- Harleen Kaur Chela
- Department of Gastroenterology, University of Missouri, Columbia, MO 65201, USA; (H.E.); (A.A.J.); (E.D.); (V.T.)
| | - Karthik Gangu
- Department of Medicine, Division of Hospital Medicine, University of Missouri, Columbia, MO 65201, USA;
| | - Hamza Ertugrul
- Department of Gastroenterology, University of Missouri, Columbia, MO 65201, USA; (H.E.); (A.A.J.); (E.D.); (V.T.)
| | - Alhareth Al Juboori
- Department of Gastroenterology, University of Missouri, Columbia, MO 65201, USA; (H.E.); (A.A.J.); (E.D.); (V.T.)
| | - Ebubekir Daglilar
- Department of Gastroenterology, University of Missouri, Columbia, MO 65201, USA; (H.E.); (A.A.J.); (E.D.); (V.T.)
| | - Veysel Tahan
- Department of Gastroenterology, University of Missouri, Columbia, MO 65201, USA; (H.E.); (A.A.J.); (E.D.); (V.T.)
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Shah E, Azhar W, Saleem S. A Trail to Diagnosis—Finding the Primary Lesions of Bone Metastasis. Cureus 2022; 14:e23814. [PMID: 35402113 PMCID: PMC8982521 DOI: 10.7759/cureus.23814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2022] [Indexed: 12/05/2022] Open
Abstract
This case reports an interesting case of hip pain. A 70-year-old male came to the hospital with lethargy and right hip pain. X-ray of the right hip was concerning for impending pathological fracture of right femur. Blood work was significant for hypercalcemia. He was managed with fluids, bisphosphates, and right hip arthroplasty. A bone biopsy was taken. His initial workup included an X-ray skeletal survey and computer tomography (CT) of the chest and abdomen to diagnose etiology of the right hip lesion. An X-ray skeletal survey showed multiple osteolytic bone lesions very suspicious for multiple myeloma. CT chest and abdomen did not show any concerning relevant findings. However, bone biopsy resulted as poorly differentiated adenocarcinoma of pancreatic or gastrointestinal origin. Magnetic resonance imaging (MRI) of the abdomen/pancreatic protocol was done, which showed normal pancreas and associated ducts. Later he underwent endoscopy showing stricture at the lower esophagus, whose biopsy confirmed the diagnosis of poorly differentiated adenocarcinoma with esophagus as primary site. Further staging workup was completed by positron emission tomography (PET) scan. It was stage four at the time of diagnosis. Right hip pain was secondary to bone metastasis from esophageal cancer (EC). The primary lesion was not noticeable on CT imaging despite the evident extensive metastasis, challenging the diagnosis. He was offered palliative radiation therapy for bone metastasis and associated pain. Unfortunately, he continued to have recurrent hospital admissions with other medical conditions, and his physical health declined rapidly. He died within a few months after diagnosis.
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20
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Gao LR, Li C, Han W, Ni W, Deng W, Tan L, Zhou Z, Chen D, Feng Q, Liang J, Lv J, Wang W, Liu W, Deng L, Wang X, Zhang T, Wang J, Zhai Y, Bi N, Wang L, Hui Z, Li YX, Xiao Z. Survival benefit of surgery in patients with clinical T4 esophageal cancer who achieved complete or partial response after neoadjuvant chemoradiotherapy or radiotherapy. Ther Adv Med Oncol 2022; 14:17588359221108693. [PMID: 35923925 PMCID: PMC9340417 DOI: 10.1177/17588359221108693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/06/2022] [Indexed: 11/26/2022] Open
Abstract
Objective: This study aimed to determine the long-term survival of patients with cT4
esophageal cancer (EC) and whether neoadjuvant
chemoradiotherapy/radiotherapy plus surgery (nCRT/RT + S) is superior to
definitive CRT(dCRT)/RT in terms of survival in cT4 EC downstaged after
nCRT/RT. Summary background data: Treatment options for cT4 EC include dCRT/RT and nCRT/RT + S, but it is not
clear whether the latter provides survival benefit in patients downstaged
after nCRT/RT. Methods: From 2002 to 2017, 726 patients with cT4 esophageal squamous cell carcinoma
(ESCC) were retrospectively analyzed. Patients achieving clinical complete
response (cCR) or partial response (PR) after 4-week RT (median dose,
40.7 Gy) and considered fit for surgery were offered esophagectomy. Of the
726 patients, 308 (42.4%) achieved cCR/PR, while 74 patients received
subsequent surgery (nCRT/RT + S group), 234 patients received dCRT/RT. Results: Median follow-up was 58 months. The 3-year overall survival (OS) and
progression-free survival (PFS) rates for all patients were 33.3% and 35.6%,
respectively. The corresponding OS and PFS rates were 54.8% and 48.5% in the
nCRT/RT + S group versus 30.0% and 22.1% in the dCRT/RT
group (both p < 0.0001). After adjusting the confounding
variables with inverse probability of treatment weighting, the adjusted
3-year OS rates were 50.4% in the nCRT/RT + S group versus
50.8% in the dCRT/RT group (p = 0.15). However, the
adjusted 3-year PFS rates were significantly different between the two
groups (49.0% and versus 38.3%,
p = 0.004). Postoperative complications occurred in 18
(24.3%) patients. Conclusion: The long-term survival of cT4 ESCC was improved after the use of
three-dimensional CRT. In cT4, EC responded to nCRT/RT, surgery improves PFS
but not OS.
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Affiliation(s)
- Lin-Rui Gao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weiming Han
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjie Ni
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Deng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lijun Tan
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zongmei Zhou
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dongfu Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qinfu Feng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Liang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jima Lv
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenqing Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenyang Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Deng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianyang Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yirui Zhai
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nan Bi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lvhua Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhouguang Hui
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Road, Chaoyang District, Beijing 100021, China
| | - Zefen Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Road, Chaoyang District, Beijing 100021, China
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21
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Chen J, Nguyen VP, Jaiswal S, Kang X, Lee M, Paulus YM, Wang TD. Thin Layer-Protected Gold Nanoparticles for Targeted Multimodal Imaging with Photoacoustic and CT. Pharmaceuticals (Basel) 2021; 14:ph14111075. [PMID: 34832857 PMCID: PMC8624483 DOI: 10.3390/ph14111075] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/13/2021] [Accepted: 10/20/2021] [Indexed: 01/19/2023] Open
Abstract
The large size of nanoparticles prevents rapid extravasation from blood vessels and diffusion into tumors. Multimodal imaging uses the physical properties of one modality to validate the results of another. We aim to demonstrate the use of a targeted thin layer-protected ultra-small gold nanoparticles (Au-NPs) to detect cancer in vivo using multimodal imaging with photoacoustic and computed tomography (CT). The thin layer was produced using a mixed thiol-containing short ligands, including MUA, CVVVT-ol, and HS-(CH2)11-PEG4-OH. The gold nanoparticle was labeled with a heterobivalent (HB) peptide ligand that targets overexpression of epidermal growth factor receptors (EGFR) and ErbB2, hereafter HB-Au-NPs. A human xenograft model of esophageal cancer was used for imaging. HB-Au-NPs show spherical morphology, a core diameter of 4.47 ± 0.8 nm on transmission electron microscopy, and a hydrodynamic diameter of 6.41 ± 0.73 nm on dynamic light scattering. Uptake of HB-Au-NPs was observed only in cancer cells that overexpressed EGFR and ErbB2 using photoacoustic microscopy. Photoacoustic images of tumors in vivo showed peak HB-Au-NPs uptake at 8 h post-injection with systemic clearance by ~48 h. Whole-body images using CT validated specific tumor uptake of HB-Au-NPs in vivo. HB-Au-NPs showed good stability and biocompatibility with fast clearance and contrast-enhancing capability for both photoacoustic and CT imaging. A targeted thin layer-protected gold nanoprobe represents a new platform for molecular imaging and shows promise for early detection and staging of cancer.
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Affiliation(s)
- Jing Chen
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (J.C.); (S.J.); (X.K.); (M.L.)
| | - Van Phuc Nguyen
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI 48109, USA; (V.P.N.); (Y.M.P.)
| | - Sangeeta Jaiswal
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (J.C.); (S.J.); (X.K.); (M.L.)
| | - Xiaoyu Kang
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (J.C.); (S.J.); (X.K.); (M.L.)
| | - Miki Lee
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (J.C.); (S.J.); (X.K.); (M.L.)
| | - Yannis M. Paulus
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI 48109, USA; (V.P.N.); (Y.M.P.)
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Thomas D. Wang
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (J.C.); (S.J.); (X.K.); (M.L.)
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- Correspondence:
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22
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An updated review of the TNM classification system for cancer of the oesophagus and its complications. RADIOLOGIA 2021; 63:445-455. [PMID: 34625200 DOI: 10.1016/j.rxeng.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/07/2020] [Indexed: 11/21/2022]
Abstract
Cancer of the esophagus is an aggressive cancer with high mortality. Because of the esophagus's lack of serosa and its peculiar lymphatic drainage, esophageal cancer is diagnosed in advanced stages. The eighth edition of the TNM (2017) aims to standardize care for esophageal cancer throughout the world; it includes not only patients treated with esophagectomy alone, but also those receiving neoadjuvant chemotherapy and/or radiotherapy. One new development in the eighth edition is that it establishes separate classifications for different time periods, with pathologic stage groups for prior to treatment (cTNM), after esophagectomy (pTNM), and after neoadjuvant therapy (ypTNM). The combined use of endoscopic ultrasound, CT, PET-CT, and MRI provides the greatest accuracy in determining the clinical stage, and these techniques are essential for planning treatment and for evaluating the response to neoadjuvant treatment. Esophagectomy continues to be the main treatment; it is also the elective gastrointestinal surgery that has the highest mortality, and it carries the risk of multiple complications, including anastomotic leaks, pulmonary complications, technical complications, and functional complications.
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Bona D, Lombardo F, Matsushima K, Cavalli M, Lastraioli C, Bonitta G, Cirri S, Danelli P, Aiolfi A. Three-field versus two-field lymphadenectomy for esophageal squamous cell carcinoma: A long-term survival meta-analysis. Surgery 2021; 171:940-947. [PMID: 34544603 DOI: 10.1016/j.surg.2021.08.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/01/2021] [Accepted: 08/18/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND In the setting of esophageal squamous cell carcinoma, controversy exists regarding the optimal extent of lymphadenectomy, while conclusive evidence regarding the advantages of 3-field versus 2-field lymphadenectomy remains controversial. The purpose of the present meta-analysis was to investigate the effect of 3-field lymphadenectomy versus 2-field lymphadenectomy on overall survival. METHODS Systematic review and meta-analyses were computed to compare 3-field lymphadenectomy versus 2-field lymphadenectomy in the setting of esophageal squamous cell carcinoma. Risk ratio, weighted mean difference, hazard ratio, and restricted mean survival time difference were used as pooled effect size measures. RESULTS Fourteen studies (3,431 patients) were included. Overall, 1,664 (48.8%) patients underwent 3-field lymphadenectomy, and 1,767 (51.5%) underwent 2-field lymphadenectomy. Three-field lymphadenectomy was associated with a significantly improved 5-year overall survival (hazard ratio: 0.80; 95% confidence interval 0.71-0.90; P < .001). The restricted mean survival time difference showed a statistically significant difference between 3-field lymphadenectomy versus 2-field lymphadenectomy up to 48 months (1.6 months; P = .04), however, no significant differences were found at 60-month follow-up (1.2 months; P = .14). No significant differences were found in term of postoperative mortality, anastomotic leak, pulmonary complications, chylothorax, and recurrent nerve palsy. CONCLUSION For resectable esophageal squamous cell carcinoma, 3-field lymphadenectomy seems associated with a slight trend toward improved 5-year overall survival; however, its clinical benefit remains limited.
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Affiliation(s)
- Davide Bona
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Italy
| | - Francesca Lombardo
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Italy
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA
| | - Marta Cavalli
- Department of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Caterina Lastraioli
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Italy
| | - Gianluca Bonitta
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Italy
| | - Silvia Cirri
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Italy
| | - Piergiorgio Danelli
- Department of Biomedical and Clinical Sciences, "Luigi Sacco" Hospital, University of Milan, Italy
| | - Alberto Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Italy.
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Abstract
Gastrointestinal malignancies encompass a variety of primary tumor sites, each with different staging criteria and treatment approaches. In this review we discuss technical aspects of 18F-FDG-PET/CT scanning to optimize information from both the PET and computed tomography components. Specific applications for 18F-FDG-PET/CT are summarized for initial staging and follow-up of the major disease sites, including esophagus, stomach, hepatobiliary system, pancreas, colon, rectum, and anus.
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Affiliation(s)
- Brandon A Howard
- Division of Nuclear Medicine and Radiotheranostics, Department of Radiology, Duke University Medical Center, DUMC Box 3949, 2301 Erwin Road, Durham, NC 27710, USA.
| | - Terence Z Wong
- Division of Nuclear Medicine and Radiotheranostics, Department of Radiology, Duke University Medical Center, DUMC Box 3949, 2301 Erwin Road, Durham, NC 27710, USA
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Keshav N, Khalid S, Parasher G, Cassidy F, Thompson W, Shiehmorteza M. Dots, lines, contours, and ends: An image-based review of esophageal pathology. Eur J Radiol Open 2021; 8:100361. [PMID: 34141830 PMCID: PMC8187835 DOI: 10.1016/j.ejro.2021.100361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 05/29/2021] [Indexed: 11/25/2022] Open
Abstract
Learning Point #1: Small ulcers on esophagography are usually attributable to herpes esophagitis and drug-induced esophagitis. Although rare, Crohn’s disease may produce small apthoid ulcers. Large ulcers are usually attributable to CMV or HIV esophagitis. Learning Point #2: The early findings of candida are plaques that mimic glycogenic acanthosis. When plaques are seen, consider early candida or glycogenic acanthosis. When shaggy esophagus is identified, consider candidiasis. Learning Point #3: Varices and varicoid esophageal carcinoma may appear similar on imaging. The presence of obstruction and lack of change with time and position should sway the Radiologist to diagnosing varicoid esophageal carcinoma. Learning Point #4: Transverse esophageal lines should suggest the entities of feline esophagus and idiopathic eosinophilic esophagitis. Learning Point #5: Esophageal contour abnormalities may suggest extrinsic or intrinsic lesions. Extrinsic lesions include aberrant vessels. Intrinsic lesions include intramural pseudodiverticulosis, gastroesophageal reflux, Barrett’s esophagus, and esophageal cancer.
Esophageal pathologies encountered on fluoroscopic examination may pose a diagnostic challenge to the interpreting Radiologist. Understanding the varied imaging appearances of esophageal pathology requires a thorough understanding of barium esophagography. This article reviews the various fluoroscopic imaging findings of different esophageal pathologies by describing an approach to image interpretation centered on dots, lines, contours, and ends. By utilizing this approach, the Radiologist will be better positioned to reconcile seemingly disparate pathologies into a cogent and succinct differential diagnosis.
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Affiliation(s)
- Nandan Keshav
- University of New Mexico Health Sciences Center, Department of Diagnostic Radiology, MSC10 5530, 1 University of New Mexico, Albuquerque, NM, 87131, United States
| | - Sameen Khalid
- University of New Mexico Health Sciences Center, Division of Gastroenterology, Department of Internal Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, United States
| | - Gulshan Parasher
- University of New Mexico Health Sciences Center, Division of Gastroenterology, Department of Internal Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, United States
| | - Fiona Cassidy
- University of California San Diego School of Medicine, Department of Radiology, 8929 University Center Ln #101, San Diego, CA, 92122, United States
| | - William Thompson
- University of New Mexico Health Sciences Center, Department of Diagnostic Radiology, MSC10 5530, 1 University of New Mexico, Albuquerque, NM, 87131, United States
| | - Masoud Shiehmorteza
- University of New Mexico Health Sciences Center, Department of Diagnostic Radiology, MSC10 5530, 1 University of New Mexico, Albuquerque, NM, 87131, United States
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Bonde A, Daly S, Kirsten J, Kondapaneni S, Mellnick V, Menias CO, Katabathina VS. Human Gut Microbiota-associated Gastrointestinal Malignancies: A Comprehensive Review. Radiographics 2021; 41:1103-1122. [PMID: 33989072 DOI: 10.1148/rg.2021200168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The human gastrointestinal tract houses trillions of microbes. The gut and various types of microorganisms, including bacteria, viruses, fungi, and archaea, form a complex ecosystem known as the gut microbiota, and the whole genome of the gut microbiota is referred to as the gut microbiome. The gut microbiota is essential for homeostasis and the overall well-being of a person and is increasingly considered an adjunct "virtual organ," with a complexity level comparable to that of the other organ systems. The gut microbiota plays an essential role in nutrition, local mucosal homeostasis, inflammation, and the mucosal immune system. An imbalanced state of the gut microbiota, known as dysbiosis, can predispose to development of various gastrointestinal malignancies through three speculated pathogenic mechanisms: (a) direct cytotoxic effects with damage to the host DNA, (b) disproportionate proinflammatory signaling inducing inflammation, and (c) activation of tumorigenic pathways or suppression of tumor-suppressing pathways. Several microorganisms, including Helicobacter pylori, Epstein-Barr virus, human papillomavirus, Mycoplasma species, Escherichia coli, and Streptococcus bovis, are associated with gastrointestinal malignancies such as esophageal adenocarcinoma, gastric adenocarcinoma, gastric mucosa-associated lymphoid tissue lymphoma, colorectal adenocarcinoma, and anal squamous cell carcinoma. Imaging plays a pivotal role in diagnosis and management of microbiota-associated gastrointestinal malignancies. Appropriate use of probiotics, fecal microbiota transplantation, and overall promotion of the healthy gut are ongoing areas of research for prevention and treatment of malignancies. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Apurva Bonde
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., S.D., J.K., V.S.K.); University of Texas at Austin, Austin, Tex (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Sean Daly
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., S.D., J.K., V.S.K.); University of Texas at Austin, Austin, Tex (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Julia Kirsten
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., S.D., J.K., V.S.K.); University of Texas at Austin, Austin, Tex (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Sainath Kondapaneni
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., S.D., J.K., V.S.K.); University of Texas at Austin, Austin, Tex (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Vincent Mellnick
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., S.D., J.K., V.S.K.); University of Texas at Austin, Austin, Tex (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Christine O Menias
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., S.D., J.K., V.S.K.); University of Texas at Austin, Austin, Tex (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Venkata S Katabathina
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., S.D., J.K., V.S.K.); University of Texas at Austin, Austin, Tex (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
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Rocha-Filho DR, Peixoto RD, Weschenfelder RF, Rego JFM, Riechelmann R, Coutinho AK, Fernandes GS, Jacome AA, Andrade AC, Murad AM, Mello CAL, Miguel DSCG, Gomes DBD, Racy DJ, Moraes ED, Akaishi EH, Carvalho ES, Mello ES, Filho FM, Coimbra FJF, Capareli FC, Arruda FF, Vieira FMAC, Takeda FR, Cotti GCC, Pereira GLS, Paulo GA, Ribeiro HSC, Lourenco LG, Crosara M, Toneto MG, Oliveira MB, de Lourdes Oliveira M, Begnami MD, Forones NM, Yagi O, Ashton-Prolla P, Aguillar PB, Amaral PCG, Hoff PM, Araujo RLC, Di Paula Filho RP, Gansl RC, Gil RA, Pfiffer TEF, Souza T, Ribeiro U, Jesus VHF, Costa WL, Prolla G. Brazilian Group of Gastrointestinal Tumours' consensus guidelines for the management of oesophageal cancer. Ecancermedicalscience 2021; 15:1195. [PMID: 33889204 PMCID: PMC8043684 DOI: 10.3332/ecancer.2021.1195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Indexed: 11/28/2022] Open
Abstract
Oesophageal cancer is among the ten most common types of cancer worldwide. More than 80% of the cases and deaths related to the disease occur in developing countries. Local socio-economic, epidemiologic and healthcare particularities led us to create a Brazilian guideline for the management of oesophageal and oesophagogastric junction (OGJ) carcinomas. The Brazilian Group of Gastrointestinal Tumours invited 50 physicians with different backgrounds, including radiology, pathology, endoscopy, nuclear medicine, genetics, oncological surgery, radiotherapy and clinical oncology, to collaborate. This document was prepared based on an extensive review of topics related to heredity, diagnosis, staging, pathology, endoscopy, surgery, radiation, systemic therapy (including checkpoint inhibitors) and follow-up, which was followed by presentation, discussion and voting by the panel members. It provides updated evidence-based recommendations to guide clinical management of oesophageal and OGJ carcinomas in several scenarios and clinical settings.
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Affiliation(s)
- Duilio R Rocha-Filho
- Hospital Universitário Walter Cantídio, 60430-372 Fortaleza, Brazil
- Grupo Oncologia D’Or, 04535-110 São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | - Diogo B D Gomes
- Hospital Israelita Albert Einstein, 05652-900, São Paulo, Brazil
| | - Douglas J Racy
- Hospital Beneficência Portuguesa de São Paulo, 01323-001 São Paulo, Brazil
| | | | - Eduardo H Akaishi
- Faculdade de Medicina da Universidade de São Paulo, 01246903 São Paulo, Brazil
| | | | - Evandro S Mello
- Faculdade de Medicina da Universidade de São Paulo, 01246903 São Paulo, Brazil
| | - Fauze Maluf Filho
- Faculdade de Medicina da Universidade de São Paulo, 01246903 São Paulo, Brazil
| | | | | | | | | | - Flavio R Takeda
- Faculdade de Medicina da Universidade de São Paulo, 01246903 São Paulo, Brazil
| | | | | | - Gustavo A Paulo
- Universidade Federal de São Paulo, 04040-003 São Paulo, Brazil
| | | | | | | | | | - Marcos B Oliveira
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, 01238-010 São Paulo, Brazil
| | | | | | - Nora M Forones
- Universidade Federal de São Paulo, 04040-003 São Paulo, Brazil
| | - Osmar Yagi
- Faculdade de Medicina da Universidade de São Paulo, 01246903 São Paulo, Brazil
| | | | | | | | - Paulo M Hoff
- Grupo Oncologia D’Or, 04535-110 São Paulo, Brazil
| | | | | | | | | | | | - Tulio Souza
- Hospital Aliança de Salvador, 41920-900 Salvador, Brazil
| | - Ulysses Ribeiro
- Faculdade de Medicina da Universidade de São Paulo, 01246903 São Paulo, Brazil
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Lichtenberger JP, Zeman MN, Dulberger AR, Alqutub S, Carter BW, Manning MA. Esophageal Neoplasms: Radiologic-Pathologic Correlation. Radiol Clin North Am 2021; 59:205-217. [PMID: 33551082 DOI: 10.1016/j.rcl.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The epidemiology and clinical management of esophageal carcinomas are changing, and clinical imagers are required to understand both the imaging appearances of common cancers and the pathologic diagnoses that drive management. Rare esophageal malignancies and benign esophageal neoplasms have distinct imaging features that may suggest a diagnosis and guide the next steps clinically. Furthermore, these imaging features have a basis in pathology, and this article focuses on the relationship between pathologic features and imaging manifestations that will help an informed imager maintain clinical relevance.
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Affiliation(s)
- John P Lichtenberger
- The George Washington University Medical Faculty Associates, 900 23rd Street Northwest, Suite G 2092, Washington, DC 20037, USA.
| | - Merissa N Zeman
- Department of Radiology, The George Washington University Hospital, 900 23rd Street Northwest, Suite G 2092, Washington, DC 20037, USA
| | - Adam R Dulberger
- Department of Radiology, David Grant Medical Center, Travis Air Force Base, 101 Bodin Cir, Fairfield, CA 94533, USA
| | - Sadiq Alqutub
- Department of Pathology, The George Washington University Hospital, 900 23rd Street Northwest, Suite G 2092, Washington, DC 20037, USA
| | - Brett W Carter
- Department of Thoracic Imaging, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
| | - Maria A Manning
- American Institute for Radiologic Pathology, American College of Radiology, 1100 Wayne Avenue, Suite 1020, Silver Spring, MD 20910, USA; MedStar Georgetown University Hospital, Washington, DC, USA
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Betancourt-Cuellar SL, Benveniste MFK, Palacio DP, Hofstetter WL. Esophageal Cancer: Tumor-Node-Metastasis Staging. Radiol Clin North Am 2021; 59:219-229. [PMID: 33551083 DOI: 10.1016/j.rcl.2020.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Esophageal cancer is an uncommon malignancy that ranks sixth in terms of mortality worldwide. Squamous cell carcinoma is the predominant histologic subtype worldwide whereas adenocarcinoma represents the majority of cases in North America, Australia, and Europe. Esophageal cancer is staged using the American Joint Committee on Cancer and the International Union for Cancer Control TNM system and has separate classifications for the clinical, pathologic, and postneoadjuvant pathologic stage groups. The determination of clinical TNM is based on complementary imaging modalities, including esophagogastroduodenoscopy/endoscopic ultrasound; endoscopic ultrasound-fine-needle aspiration; computed tomography of the chest, abdomen, and pelvis; and fluorodeoxyglucose PET/computed tomography.
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Affiliation(s)
- Sonia L Betancourt-Cuellar
- Thoracic Imaging Department, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030-4009, USA.
| | - Marcelo F K Benveniste
- Thoracic Imaging Department, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030-4009, USA
| | - Diana P Palacio
- Department of Medical Imaging, The University of Arizona - Banner Medical Center, 1501 North Campbell Avenue, PO BOX 245067, Tucson, AZ 85724, USA
| | - Wayne L Hofstetter
- Cardiothoracic Department, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1489, Houston, TX 77030-4009, USA
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Lin D, Liu G, Jiang D, Yu Y, Wang H, Shi H, Tan L. The role of primary tumor SUVmax in the diagnosis of invasion depth: a step toward clinical T2N0 esophageal cancer. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:112. [PMID: 33569414 PMCID: PMC7867900 DOI: 10.21037/atm-20-4430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background The controversy regarding optimal clinical T2N0 esophageal cancer treatment ultimately stems from the clinical staging modalities’ inaccuracy. Because most inaccuracies lie in clinical T2 to pathological T1, it is vital to discriminate whether the muscularis propria is invaded. Methods We investigated the association between the primary tumor maximal standard uptake value (SUVmax), and the pathological features and overall survival. We attempted to construct a discriminative model through logistic regression analysis. Results A total of 140 cN0 esophageal squamous cell carcinoma (ESCC) patients were enrolled. Primary tumor SUVmax differed significantly in paired pathological T categories (P<0.05), but not pT2 vs. pT3 (P=0.648). Age (≤65 vs. >65), biopsy differentiation grades (well or moderately vs. poorly vs. unknown), and primary tumor SUVmax (continuous) were independent risk factors for invasion depth. Subsequently, the age categories, the biopsy differentiation grade categories, and the primary tumor SUVmax categories (≤7.4 vs. >7.4) were included in the logistic regression analysis to construct a discriminative model, showing a good performance in discriminating pT2–3 vs. pT1 in terms of accuracy 87.1%, sensitivity 93.6%, specificity 73.9%, and area under the curve (AUC) 0.887 [95% confidence interval (CI): 0.822 to 0.951]. Of these factors, biopsy differentiation grades and primary tumor SUVmax showed significant differences in overall survival (P<0.05), while the age categories did not. Conclusions The novel baseline model comprised of age, biopsy differentiation grades, and primary tumor SUVmax provide much discriminative performance in determining whether the muscularis propria is invaded. Further studies are necessary to validate the findings and guide clinical practice for cT2N0 esophageal cancer.
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Affiliation(s)
- Dong Lin
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Guobing Liu
- Department of Nuclear Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Dongxian Jiang
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yangli Yu
- Department of Radiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Hao Wang
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
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Nanda S, Mukherji A, Pradhan S. Precision radiotherapy in carcinoma esophagus: Does conformity translate into significant clinical outcomes? CANCER RESEARCH, STATISTICS, AND TREATMENT 2021. [DOI: 10.4103/crst.crst_245_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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López Sala P, Alberdi Aldasoro N, Fuertes Fernández I, Sáenz Bañuelos J. An updated review of the TNM classification system for cancer of the esophagus and its complications. RADIOLOGIA 2020. [PMID: 33268136 DOI: 10.1016/j.rx.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cancer of the esophagus is an aggressive cancer with high mortality. Because of the esophagus's lack of serosa and its peculiar lymphatic drainage, esophageal cancer is diagnosed in advanced stages. The eighth edition of the TNM (2017) aims to standardize care for esophageal cancer throughout the world; it includes not only patients treated with esophagectomy alone, but also those receiving neoadjuvant chemotherapy and/or radiotherapy. One new development in the eighth edition is that it establishes separate classifications for different time periods, with pathologic stage groups for prior to treatment (cTNM), after esophagectomy (pTNM), and after neoadjuvant therapy (ypTNM). The combined use of endoscopic ultrasound, CT, PET-CT, and MRI provides the greatest accuracy in determining the clinical stage, and these techniques are essential for planning treatment and for evaluating the response to neoadjuvant treatment. Esophagectomy continues to be the main treatment; it is also the elective gastrointestinal surgery that has the highest mortality, and it carries the risk of multiple complications, including anastomotic leaks, pulmonary complications, technical complications, and functional complications.
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Affiliation(s)
- P López Sala
- Residente del servicio de Radiodiagnóstico, Complejo Hospitalario de Navarra, Pamplona, España.
| | - N Alberdi Aldasoro
- Residente del servicio de Radiodiagnóstico, Complejo Hospitalario de Navarra, Pamplona, España
| | - I Fuertes Fernández
- FEA del servicio de Radiodiagnóstico, Complejo Hospitalario de Navarra, Pamplona, España
| | - J Sáenz Bañuelos
- FEA del servicio de Radiodiagnóstico, Complejo Hospitalario de Navarra, Pamplona, España
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Role of Imaging in Esophageal Cancer Management in 2020: Update for Radiologists. AJR Am J Roentgenol 2020; 215:1072-1084. [PMID: 32901568 DOI: 10.2214/ajr.20.22791] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE. The purpose of this article is to discuss the role of imaging in the management of esophageal cancer. CONCLUSION. A multimodality-based approach to imaging is essential in clinical practice to achieve the best possible outcome for patients with esophageal cancer. Radiologists must be aware of the strengths and limitations of different imaging modalities in various clinical settings. The role of a radiologist is to combine information from anatomic and functional imaging, assess metastatic disease and changes in the primary tumor during treatment, and identify anatomic complications after treatment.
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Li ZX, Li XD, Liu XB, Xing WQ, Sun HB, Wang ZF, Zhang RX, Li Y. Clinical evaluation of right recurrent laryngeal nerve nodes in thoracic esophageal squamous cell carcinoma. J Thorac Dis 2020; 12:3622-3630. [PMID: 32802441 PMCID: PMC7399419 DOI: 10.21037/jtd-20-774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The accuracy of clinical N staging of esophageal squamous cell carcinoma is suboptimal. As an important station of lymph node metastasis, station C201 (right recurrent laryngeal nerve nodes) has rarely been evaluated alone. We aimed to explore an effective way to evaluate the right recurrent laryngeal nerve nodes in thoracic esophageal squamous cell carcinoma. Methods We retrospectively analyzed 628 thoracic esophageal squamous cell carcinoma patients who underwent radical resection without neoadjuvant therapy from two Chinese cancer centers. The diameter of the short axis of the largest right recurrent laryngeal nerve node (DC201) was measured on contrast-enhanced multi-slice computed tomography (MSCT). Right recurrent laryngeal nerve nodes were examined by postoperative pathologic results. The receiver operating characteristic (ROC) curve was generated to assess the diagnostic capabilities of DC201 to determine the right recurrent laryngeal nerve nodes status. Results ROC curve analysis revealed that the optimal cut-off point of DC201 was 6 mm, with an area under curve (AUC), sensitivity, specificity, and Youden index of 0.896, 71.9%, 88.8%, and 0.607 respectively. When the cut-off point of DC201 was set to 10 mm, sensitivity, specificity and the Youden index were 14.1%, 99.6% and 0.137 respectively. Among 128 patients with right recurrent laryngeal nerve node metastasis, 71 and 108 patients had the largest right recurrent laryngeal nerve node located above the suprasternal notch level and in the tracheoesophageal groove respectively. Conclusions When DC201 ≥6.0 mm instead of DC201 ≥10 mm was used to dictate the right recurrent laryngeal nerve nodes metastasis, contrast-enhanced MSCT could evaluate the status of right recurrent laryngeal nerve nodes with high sensitivity and specificity. The largest right recurrent laryngeal nerve nodes were mainly located in the tracheoesophageal groove and/or above the suprasternal notch.
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Affiliation(s)
- Zhen-Xuan Li
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao-Dong Li
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Xian-Ben Liu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Wen-Qun Xing
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Hai-Bo Sun
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Zong-Fei Wang
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Rui-Xiang Zhang
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Yin Li
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China.,Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Tumor SUVs on 18F-FDG PET/CT and Aggressive Pathological Features in Esophageal Squamous Cell Carcinoma. Clin Nucl Med 2020; 45:e128-e133. [PMID: 31977480 DOI: 10.1097/rlu.0000000000002926] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Considerable discrepancies are observed between clinical staging and pathological staging after surgical resection in patients with esophageal squamous cell carcinoma (ESCC). In this study, we examined the relationships between tumor SUVs on FDG PET/CT and aggressive pathological features in resected ESCC patients. METHODS A total of 220 patients with surgically resected clinical stage I-II ESCC without neoadjuvant treatment were retrospectively analyzed. SUVmax of the primary tumor was measured on pretreatment FDG PET/CT. Pathological features included depth of tumor invasion, lymph node metastasis, tumor differentiation, lymphatic vessel tumor embolus, perineural invasion, Ki-67 index, and p53 protein expression. Receiver operating characteristic curve analysis was used to determine an optimal cutoff of SUVmax to predict pathologically advanced disease. Differences in pathological features associated with SUVmax were examined by t test or χ test. RESULTS The number of patients upstaged from clinical stage I-II to pathological stage III-IV was 43 (19.5%). Receiver operating characteristic curve analysis showed that the optimal cutoff SUVmax of 4.0 had good performance for predicting locally advanced disease (area under the receiver operating characteristic curve = 0.844, P < 0.001). Higher tumor SUVmax was significantly associated with advanced depth of tumor invasion (deeper than submucosa, P < 0.001), positive lymph node metastasis (P < 0.001), presence of lymphatic vessel tumor embolus (P < 0.001), presence of perineural invasion (P < 0.001), higher Ki-67 index (P = 0.025), and poor tumor differentiation (P = 0.039). CONCLUSIONS SUVmax measured on pretreatment FDG PET/CT is significantly associated with aggressive pathological features and may help clinicians identify patients at risk of advanced disease.
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Smith AP, Dueber JC, Allison DB. A diagnostic review of carcinomas and sarcomas of the mediastinum: making the diagnosis on fine-needle aspiration and core needle biopsy specimens. Semin Diagn Pathol 2020; 37:187-198. [PMID: 32532552 DOI: 10.1053/j.semdp.2020.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 11/11/2022]
Abstract
The mediastinum is a complex anatomic region that can pose many diagnostic challenges on fine-needle aspiration (FNA) and core needle biopsy (CNB). With the recent technological advancements in EBUS-TBNA and EUS-guided procedures, FNA/CNB is being increasingly utilized to obtain the initial and, in many cases, the only diagnosis. As a result, it is imperative to have an understanding of the pearls and pitfalls associated with both the more common and rarer malignancies that occur at this site. Although the vast majority of mediastinal malignancies encountered in routine clinical practice are metastatic carcinomas to mediastinal lymph nodes, primary tumors and tumors that directly extend into the mediastinum are also encountered. As always, a multimodal approach with clinical and radiographic correlation, a targeted IHC panel, and molecular testing when indicated are indisposable and necessary tools in the diagnostic workup of mediastinal malignancies. This review focuses on the salient diagnostic features of malignancies of epithelial and mesenchymal origin, excluding tumors of neurogenic, thymic, hematolymphoid, and germ cell origins, which are discussed in separate articles of this issue.
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Affiliation(s)
- Alexander P Smith
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, 800 Rose Street, MS 117, Lexington, KY 40536, USA
| | - Julie C Dueber
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, 800 Rose Street, MS 117, Lexington, KY 40536, USA
| | - Derek B Allison
- Department of Pathology and Laboratory Medicine, Markey Cancer Center, University of Kentucky, 800 Rose Street, MS 117, Lexington, KY 40536, USA.
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Lee HN, Kim JI, Shin SY, Kim DH, Kim C, Hong IK. Combined CT texture analysis and nodal axial ratio for detection of nodal metastasis in esophageal cancer. Br J Radiol 2020; 93:20190827. [PMID: 32242741 DOI: 10.1259/bjr.20190827] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess the accuracy of a combination of CT texture analysis (CTTA) and nodal axial ratio to detect metastatic lymph nodes (LNs) in esophageal squamous cell carcinoma (ESCC). METHODS The contrast-enhanced chest CT images of 78 LNs (40 metastasis, 38 benign) from 38 patients with ESCC were retrospectively analyzed. Nodal axial ratios (short-axis/long-axis diameter) were calculated. CCTA parameters (kurtosis, entropy, skewness) were extracted using commercial software (TexRAD) with fine, medium, and coarse spatial filters. Combinations of significant texture features and nodal axial ratios were entered as predictors in logistic regression models to differentiate metastatic from benign LNs, and the performance of the logistic regression models was analyzed using the area under the receiver operating characteristic curve (AUROC). RESULTS The mean axial ratio of metastatic LNs was significantly higher than that of benign LNs (0.81 ± 0.2 vs 0.71 ± 0.1, p = 0.005; sensitivity 82.5%, specificity 47.4%); namely, significantly more round than benign. The mean values of the entropy (all filters) and kurtosis (fine and medium) of metastatic LNs were significantly higher than those of benign LNs (all, p < 0.05). Medium entropy showed the best performance in the AUROC analysis with 0.802 (p < 0.001; sensitivity 85.0%, specificity 63.2%). A binary logistic regression analysis combining the nodal axial ratio, fine entropy, and fine kurtosis identified metastatic LNs with 87.5% sensitivity and 65.8% specificity (AUROC = 0.855, p < 0.001). CONCLUSION The combination of CTTA features and the axial ratio of LNs has the potential to differentiate metastatic from benign LNs and improves the sensitivity for detection of LN metastases in ESCC. ADVANCES IN KNOWLEDGE The combination of CTTA and nodal axial ratio has improved CT sensitivity (up to 87.5%) for the diagnosis of metastatic LNs in esophageal cancer.
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Affiliation(s)
- Han Na Lee
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jung Im Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - So Youn Shin
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Dae Hyun Kim
- Department of Thoracic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Chanwoo Kim
- Department of Nuclear Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Il Ki Hong
- Department of Nuclear Medicine, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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PET in Gastrointestinal, Pancreatic, and Liver Cancers. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Does PET/CT give incremental staging information in cancer oesophagus compared to CECT? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0114-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Wongwaiyut K, Ruangsin S, Laohawiriyakamol S, Leelakiatpaiboon S, Sangthawan D, Sunpaweravong P, Sunpaweravong S. Pretreatment Esophageal Wall Thickness Associated with Response to Chemoradiotherapy in Locally Advanced Esophageal Cancer. J Gastrointest Cancer 2019; 51:947-951. [PMID: 31758468 DOI: 10.1007/s12029-019-00337-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE A multimodality approach using concurrent chemoradiotherapy (CRT) followed by esophagectomy has been the standard treatment in patients with locally advanced esophageal squamous cell carcinoma (ESCC). Computed tomography (CT) is widely utilized to evaluate esophageal cancer before and after CRT. This study evaluated the utility of pretreatment maximal esophageal wall thickness on CT scans to predict treatment outcomes after CRT in patients with locally advanced ESCC. METHODS Eighty-one patients with T3 locally advanced ESCC, whom were treated completely with CRT with and without surgery, and had available CT scans before and after CRT at a university hospital between 2005 and 2015, were retrospectively reviewed. RESULT Twenty patients (24.7%) had esophagectomy after neoadjuvant CRT and sixty-one patients (75.3%) had definitive CRT. The maximal esophageal wall thicknesses were measured retrospectively and correlated with the response and survival after treatment. A total of 40% of neoadjuvant CRT patients achieved a pCR. There was a significant difference in pretreatment maximal esophageal wall thickness between the pCR and non-pCR groups (mean 11.9 ± 5.3 mm versus 16.9 ± 3 mm; p = 0.01). Pretreatment maximal esophageal wall thickness < 10 mm was significantly related to better overall survival than ≥ 10 mm (median survival 79 months versus 15 months; HR 3.21, 95%CI 1.14-9; p = 0.02). The neoadjuvant CRT group had significantly better survival than the definitive CRT group (median survival 51 months versus 14.5 months; HR 0.46; 95%CI 0.25-0.85; p = 0.01). CONCLUSION In our study, pretreatment esophageal wall thickness of T3 locally advanced ESCC is a useful indicator for predicting survival and pCR after treatment.
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Affiliation(s)
- Kraipop Wongwaiyut
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkla, 90110, Thailand
| | - Sakchai Ruangsin
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkla, 90110, Thailand
| | | | - Siriporn Leelakiatpaiboon
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkla, 90110, Thailand
| | - Duangjai Sangthawan
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkla, 90110, Thailand
| | - Patrapim Sunpaweravong
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, 90110, Thailand
| | - Somkiat Sunpaweravong
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkla, 90110, Thailand.
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Ajani JA, D'Amico TA, Bentrem DJ, Chao J, Corvera C, Das P, Denlinger CS, Enzinger PC, Fanta P, Farjah F, Gerdes H, Gibson M, Glasgow RE, Hayman JA, Hochwald S, Hofstetter WL, Ilson DH, Jaroszewski D, Johung KL, Keswani RN, Kleinberg LR, Leong S, Ly QP, Matkowskyj KA, McNamara M, Mulcahy MF, Paluri RK, Park H, Perry KA, Pimiento J, Poultsides GA, Roses R, Strong VE, Wiesner G, Willett CG, Wright CD, McMillian NR, Pluchino LA. Esophageal and Esophagogastric Junction Cancers, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 17:855-883. [PMID: 31319389 DOI: 10.6004/jnccn.2019.0033] [Citation(s) in RCA: 669] [Impact Index Per Article: 111.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Esophageal cancer is the sixth leading cause of cancer-related deaths worldwide. Squamous cell carcinoma is the most common histology in Eastern Europe and Asia, and adenocarcinoma is most common in North America and Western Europe. Surgery is a major component of treatment of locally advanced resectable esophageal and esophagogastric junction (EGJ) cancer, and randomized trials have shown that the addition of preoperative chemoradiation or perioperative chemotherapy to surgery significantly improves survival. Targeted therapies including trastuzumab, ramucirumab, and pembrolizumab have produced encouraging results in the treatment of patients with advanced or metastatic disease. Multidisciplinary team management is essential for all patients with esophageal and EGJ cancers. This selection from the NCCN Guidelines for Esophageal and Esophagogastric Junction Cancers focuses on recommendations for the management of locally advanced and metastatic adenocarcinoma of the esophagus and EGJ.
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Affiliation(s)
| | | | - David J Bentrem
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - Prajnan Das
- The University of Texas MD Anderson Cancer Center
| | | | | | | | - Farhood Farjah
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | | | | | | | | | | | | | - Rajesh N Keswani
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | - Michael McNamara
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Mary F Mulcahy
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Haeseong Park
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Kyle A Perry
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Robert Roses
- Abramson Cancer Center at the University of Pennsylvania
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Wang Q, Zhang WC, Zhang BZ, Zhang HL, Zhang JQ, Pang QS, Wang P. Application of the proposed eighth edition of the American Joint Committee on Cancer/Union of International Cancer Control esophageal cancer staging system in esophageal cancer patients. PRECISION RADIATION ONCOLOGY 2019. [DOI: 10.1002/pro6.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Qi Wang
- Department of Radiation Oncology; Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin, Tianjin's Clinical Research Center for Cancer; Tianjin China
| | - Wen-cheng Zhang
- Department of Radiation Oncology; Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin, Tianjin's Clinical Research Center for Cancer; Tianjin China
| | - Bao-zhong Zhang
- Department of Radiation Oncology; Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin, Tianjin's Clinical Research Center for Cancer; Tianjin China
| | - Hua-lei Zhang
- Department of Radiation Oncology; Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin, Tianjin's Clinical Research Center for Cancer; Tianjin China
| | - Jia-qi Zhang
- Department of Radiation Oncology; Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin, Tianjin's Clinical Research Center for Cancer; Tianjin China
| | - Qing-song Pang
- Department of Radiation Oncology; Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin, Tianjin's Clinical Research Center for Cancer; Tianjin China
| | - Ping Wang
- Department of Radiation Oncology; Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin, Tianjin's Clinical Research Center for Cancer; Tianjin China
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Gupta DR, Liu Y, Jiang R, Walid S, Higgins K, Landry J, McDonald M, Willingham FF, El-Rayes BF, Saba NF. Racial Disparities, Outcomes, and Surgical Utilization among Hispanics with Esophageal Cancer: A Surveillance, Epidemiology, and End Results Program Database Analysis. Oncology 2019; 97:49-58. [PMID: 31108497 DOI: 10.1159/000499716] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/05/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hispanic patients with esophageal cancer (EC) have racially disparate survival outcomes compared with white patients. OBJECTIVES We explored the impact on survival of racial differences in socioeconomic factors, tumor characteristics, and rates of surgical utilization in patients with EC. METHOD Using the SEER (Surveillance, Epidemiology, and End Results) registry, we identified 22,531 cases of EC in Hispanic and white patients between the ages of 18 and 65 years in 2003-2014. Of these, 6,250 cases had locoregional EC. Patients were categorized according to age, gender, education, tumor grade, histology, primary tumor site, and surgical status. Postdiagnosis survival was examined over time and compared by race and stratified by surgical status. RESULTS Compared with whites, Hispanics with EC had significantly higher unadjusted mortality (hazard ratio [HR] 1.11; 95% confidence interval [CI] 1.06-1.17; p < 0.001) as did Hispanics with locoregional EC (HR 1.15; 95% CI 1.03-1.29; p = 0.01). In the multivariate analysis, several socioeconomic and tumor factors were found to be independently associated with survival by race, including county of residence income and prevalence of smoking, tumor grade, stage, and primary site, and surgical utilization. After adjusting for demographic and tumor characteristics, surgical utilization in patients with locoregional EC had a significant interaction with race on overall mortality (p = 0.01). Hispanics with locoregional EC were significantly less likely to receive surgery than whites (46 vs. 60%; p < 0.001) and not receiving surgery was associated with a significantly lower overall survival (HR 2.84; 95% CI 2.65-3.04; p < 0.001). CONCLUSIONS A lower rate of surgery among Hispanics with potentially resectable esophageal cancer was associated with a decreased survival rate when compared to whites, even when adjusting for relevant socioeconomic and tumor factors. These data support the need to better address patient barriers to surgical treatment and the systemic biases present in medical care.
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Affiliation(s)
- Dave R Gupta
- Department of Internal Medicine, Emory University, Atlanta, Georgia, USA
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Renjian Jiang
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Shaib Walid
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Kristin Higgins
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Jerome Landry
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Mark McDonald
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Field F Willingham
- Division of Digestive Diseases, Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bassel F El-Rayes
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA,
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Schizas D, Mastoraki A, Kirkilesis GI, Sioulas AD, Papanikolaou IS, Misiakos EP, Arkadopoulos N, Liakakos T. Neuroendocrine Tumors of the Esophagus: State of the Art in Diagnostic and Therapeutic Management. J Gastrointest Cancer 2018; 48:299-304. [PMID: 28656561 DOI: 10.1007/s12029-017-9978-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms composed of cells containing dense-core neuroendocrine secretory granules in their cytoplasm. NETs of the esophagus are exceedingly uncommon, with a parallel absence of data published on clinical features, prognosis, and proposed treatment strategies. METHODS As relevant classification is not well-established, knowledge acquired in NETs of lung and gastrointestinal sites usually guides esophageal NET management. Associated subtypes are divided based upon shared neuroendocrine features into small and large cell NET, typical and atypical carcinoid. RESULTS Common presenting symptoms include dysphagia, abdominal discomfort, weight loss, melena, and on occasion, signs of carcinoid syndrome. Endoscopic findings describe a polypoid, nodular elevated lesion with an overlying surface depicted as mostly smooth and glistening. Disease metastasis is assessed using anatomical imaging, including computed tomography (CT), endoscopic ultrasonography (EUS), and positron emission tomography (PET)-CT. Prognosis is influenced by the extent of lymph node metastasis and potential lymphovascular invasion. Furthermore, proliferative activity, estimated using mitotic count or Ki-67 immunostaining, has been suggested as a significant prognostic parameter. CONCLUSION Therapeutic approach depends on clinical staging. Nevertheless, currently, a specific treatment algorithm for esophageal NETs has not been elucidated. Endoscopic resection has been proposed in NETs less than 1 cm in size with absence of regional lymph node metastasis, while surgical excision combined with adjuvant chemotherapy remains the treatment of choice.
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Affiliation(s)
- Dimitrios Schizas
- 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Aikaterini Mastoraki
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens, Greece.
| | - George I Kirkilesis
- 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Athanasios D Sioulas
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens, Greece
| | - Ioannis S Papanikolaou
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens, Greece
| | - Evangelos P Misiakos
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens, Greece
| | - Nikolaos Arkadopoulos
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens, Greece
| | - Theodore Liakakos
- 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
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Long-term survival improvement in oesophageal cancer in the Netherlands. Eur J Cancer 2018; 94:138-147. [PMID: 29571082 DOI: 10.1016/j.ejca.2018.02.025] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 02/14/2018] [Accepted: 02/16/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Treatment for oesophageal cancer has evolved due to developments including the centralisation of surgery and introduction of neoadjuvant treatment. Therefore, this study evaluated trends in stage distribution, treatment and survival of oesophageal cancer patients in the last 26 years in the Netherlands. PATIENTS AND METHODS Patients with oesophageal cancer diagnosed in the period 1989-2014 were selected from the Netherlands Cancer Registry. Patients were divided into two groups: non-metastatic (M0) and metastatic (M1). Trends in stage distribution, treatment and relative survival rates were evaluated according to histology. RESULTS Among all 35,760 patients, the percentage of an unknown tumour stage decreased from 34% to 10% during the study period, whereas the percentage of patients with metastatic disease increased from 21% to 34%. Among surgically treated patients 32% underwent a resection in a high-volume hospital in 2005 which increased to 92% in 2014. Use of neoadjuvant chemoradiotherapy increased in non-metastatic oesophageal adenocarcinoma (OAC) and squamous cell carcinoma (OSCC) patients from respectively 4% and 2% in 2000-2004 to 43% and 26% in 2010-2014. Five-year relative survival increased from 8% to 22% for all patients; from 12% to 36% for non-metastatic OAC and from 9% to 27% for non-metastatic OSCC over 26 years. Median overall survival of metastatic patients improved from 18 to 22 weeks. CONCLUSION In the Netherlands, survival for oesophageal cancer patients improved significantly, especially in the period 2005-2014 which might be the result of better treatment related to the centralisation of surgery and introduction of neoadjuvant chemoradiotherapy.
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Jelvehgaran P, Alderliesten T, Weda JJA, de Bruin M, Faber DJ, Hulshof MCCM, van Leeuwen TG, van Herk M, de Boer JF. Visibility of fiducial markers used for image-guided radiation therapy on optical coherence tomography for registration with CT: An esophageal phantom study. Med Phys 2017; 44:6570-6582. [DOI: 10.1002/mp.12624] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 09/14/2017] [Accepted: 10/03/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Pouya Jelvehgaran
- Department of Biomedical Engineering and Physics; Academic Medical Center; University of Amsterdam; Amsterdam AZ 1105 The Netherlands
- Department of Radiation Oncology; Academic Medical Center; University of Amsterdam; Amsterdam AZ 1105 The Netherlands
- Institute for Laser Life and Biophotonics Amsterdam; Physics and Astronomy; VU University Amsterdam; Amsterdam HV 1081 The Netherlands
| | - Tanja Alderliesten
- Department of Radiation Oncology; Academic Medical Center; University of Amsterdam; Amsterdam AZ 1105 The Netherlands
| | - Jelmer J. A. Weda
- Institute for Laser Life and Biophotonics Amsterdam; Physics and Astronomy; VU University Amsterdam; Amsterdam HV 1081 The Netherlands
| | - Martijn de Bruin
- Department of Biomedical Engineering and Physics; Academic Medical Center; University of Amsterdam; Amsterdam AZ 1105 The Netherlands
- Department of Urology; Academic Medical Center; University of Amsterdam; Amsterdam AZ 1105 The Netherlands
| | - Dirk J. Faber
- Department of Biomedical Engineering and Physics; Academic Medical Center; University of Amsterdam; Amsterdam AZ 1105 The Netherlands
| | - Maarten C. C. M. Hulshof
- Department of Radiation Oncology; Academic Medical Center; University of Amsterdam; Amsterdam AZ 1105 The Netherlands
| | - Ton G. van Leeuwen
- Department of Biomedical Engineering and Physics; Academic Medical Center; University of Amsterdam; Amsterdam AZ 1105 The Netherlands
| | - Marcel van Herk
- Department of Biomedical Engineering and Physics; Academic Medical Center; University of Amsterdam; Amsterdam AZ 1105 The Netherlands
- Institute of Cancer Sciences; University of Manchester; Manchester UK
| | - Johannes F. de Boer
- Institute for Laser Life and Biophotonics Amsterdam; Physics and Astronomy; VU University Amsterdam; Amsterdam HV 1081 The Netherlands
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Vellayappan BA, Soon YY, Ku GY, Leong CN, Lu JJ, Tey JCS, Cochrane Upper GI and Pancreatic Diseases Group. Chemoradiotherapy versus chemoradiotherapy plus surgery for esophageal cancer. Cochrane Database Syst Rev 2017; 8:CD010511. [PMID: 28829911 PMCID: PMC6483706 DOI: 10.1002/14651858.cd010511.pub2] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Please see Appendix 4 for a glossary of terms.The outcome of patients with esophageal cancer is generally poor. Although multimodal therapy is standard, there is conflicting evidence regarding the addition of esophagectomy to chemoradiotherapy. OBJECTIVES To compare the effectiveness and safety of chemoradiotherapy plus surgery with that of chemoradiotherapy alone in people with nonmetastatic esophageal carcinoma. SEARCH METHODS We performed a computerized search for relevant studies, up to Feburary 2017, on the CENTRAL, MEDLINE, and Embase databases using MeSH headings and keywords. We searched five online databases of clinical trials, handsearched conference proceedings, and screened reference lists of retrieved papers. SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing chemoradiotherapy plus esophagectomy with chemoradiotherapy alone for localized esophageal carcinoma. We excluded RCTs comparing chemotherapy or radiotherapy alone with esophagectomy. DATA COLLECTION AND ANALYSIS Two authors independently selected studies, extracted data, and assessed risk of bias and the quality of the evidence, using standardized Cochrane methodological procedures. The primary outcome was overall survival (OS), estimated with Hazard Ratio (HR). Secondary outcomes, estimated with risk ratio (RR), were local and distant progression-free survival (PFS), quality of life (QoL), treatment-related mortality and morbidity, and use of salvage procedures for dysphagia. Data were analyzed using a random effects model in Review Manager 5.3 software. MAIN RESULTS From 2667 references, we identified two randomized studies, in six reports, that included 431 participants. All participants were clinically staged to have at least T3 and/or node positive thoracic esophageal carcinoma, 93% of which was squamous cell histology. The risk of methodological bias of the included studies was low to moderate.High-quality evidence found the addition of esophagectomy had little or no difference on overall survival (HR 0.99, 95% CI 0.79 to 1.24; P = 0.92; I² = 0%; two trials). Neither study reported PFS, therefore, freedom from loco-regional relapse was used as a proxy. Moderate-quality evidence suggested that the addition of esophagectomy probably improved freedom from locoregional relapse (HR 0.55, 95% CI 0.39 to 0.76; P = 0.0004; I² = 0%; two trials), but low-quality evidence suggested it may increase the risk of treatment-related mortality (RR 5.11, 95% CI 1.74 to 15.02; P = 0.003; I² = 2%; two trials).The other pre-specified outcomes (quality of life, treatment-related toxicity, and use of salvage procedures for dysphagia) were reported by only one study, which found very low-quality evidence that use of esophagectomy was associated with reduced short-term QoL (MD 0.93, 95% CI 0.24 to 1.62), and low-quality evidence that it reduced use of salvage procedures for dysphagia (HR 0.52, 95% CI 0.36 to 0.75). Neither study compared treatment-related morbidity between treatment groups. AUTHORS' CONCLUSIONS Based on the available evidence, the addition of esophagectomy to chemoradiotherapy in locally advanced esophageal squamous cell carcinoma, provides little or no difference on overall survival, and may be associated with higher treatment-related mortality. The addition of esophagectomy probably delays locoregional relapse, however, this end point was not well defined in the included studies. It is undetermined whether these results can be applied to the treatment of adenocarcinomas, tumors involving the distal esophagus and gastro-esophageal junction, and to people with poor response to chemoradiation.
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Affiliation(s)
- Balamurugan A Vellayappan
- National University HospitalDepartment of Radiation Oncology1E Kent Ridge RoadNUHS Tower Block, Level 7SingaporeSingapore119228
| | - Yu Yang Soon
- National University HospitalDepartment of Radiation Oncology1E Kent Ridge RoadNUHS Tower Block, Level 7SingaporeSingapore119228
| | - Geoffrey Y Ku
- Memorial Sloan‐Kettering Cancer CenterGastrointestinal Oncology Service300 East 66th StreetNew YorkNYUSA10065
| | - Cheng Nang Leong
- National University HospitalDepartment of Radiation Oncology1E Kent Ridge RoadNUHS Tower Block, Level 7SingaporeSingapore119228
| | - Jiade J Lu
- Shanghai Proton and Heavy Ion Center (SPHIC)4365 Kang Xin RoadPudong New DistrictShanghaiChina201321
| | - Jeremy CS Tey
- National University HospitalDepartment of Radiation Oncology1E Kent Ridge RoadNUHS Tower Block, Level 7SingaporeSingapore119228
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Goel R, Subramaniam RM, Wachsmann JW. PET/Computed Tomography Scanning and Precision Medicine: Esophageal Cancer. PET Clin 2017; 12:373-391. [PMID: 28867110 DOI: 10.1016/j.cpet.2017.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Esophageal cancer commonly has a poor prognosis, which requires an accurate diagnosis and early treatment to improve outcome. Other modalities for staging, such as endoscopic ultrasound imaging and computed tomography (CT) scans, have a role in diagnosis and staging. However, PET with fluorine-18 fluoro-2-deoxy-d-glucose/CT (FDG PET/CT) scanning allows for improved detection of distant metastatic disease and can help to prevent unnecessary interventions that would increase morbidity. FDG PET/CT scanning is valuable in the neoadjuvant chemotherapy assessment and predicting survival outcomes subsequent to surgery. FDG PET/CT scanning detects recurrent disease and metastases in follow-up.
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Affiliation(s)
- Reema Goel
- Department of Radiology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA
| | - Rathan M Subramaniam
- Department of Radiology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA; Department of Clinical Sciences, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA; Department of Biomedical Engineering, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA; Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA; Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA
| | - Jason W Wachsmann
- Department of Radiology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA.
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Support Vector Machines Model of Computed Tomography for Assessing Lymph Node Metastasis in Esophageal Cancer with Neoadjuvant Chemotherapy. J Comput Assist Tomogr 2017; 41:455-460. [PMID: 27879527 PMCID: PMC5457826 DOI: 10.1097/rct.0000000000000555] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective The aim of this study was to diagnose lymph node metastasis of esophageal cancer by support vector machines model based on computed tomography. Materials and Methods A total of 131 esophageal cancer patients with preoperative chemotherapy and radical surgery were included. Various indicators (tumor thickness, tumor length, tumor CT value, total number of lymph nodes, and long axis and short axis sizes of largest lymph node) on CT images before and after neoadjuvant chemotherapy were recorded. A support vector machines model based on these CT indicators was built to predict lymph node metastasis. Results Support vector machines model diagnosed lymph node metastasis better than preoperative short axis size of largest lymph node on CT. The area under the receiver operating characteristic curves were 0.887 and 0.705, respectively. Conclusions The support vector machine model of CT images can help diagnose lymph node metastasis in esophageal cancer with preoperative chemotherapy.
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Chen T, Zhou PH, Chu Y, Zhang YQ, Chen WF, Ji Y, Yao LQ, Xu MD. Long-term Outcomes of Submucosal Tunneling Endoscopic Resection for Upper Gastrointestinal Submucosal Tumors. Ann Surg 2017; 265:363-369. [PMID: 28059965 DOI: 10.1097/sla.0000000000001650] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate the long-term outcomes of a large series of patients treated with submucosal tunneling endoscopic resection (STER). BACKGROUND STER is a newly developed treatment for upper gastrointestinal submucosal tumors originating from the muscularis propria layer. Recently, reports about STER are increasing, but a large study with long-term follow-up is little known. METHODS In a retrospective study, a total of 180 patients with upper gastrointestinal submucosal tumors undergoing STER were included from June 2011 to May 2013. Clinicopathological, endoscopic, and follow-up data were collected and analyzed. RESULTS The en bloc resection was achieved in 90.6% of patients and the complications rate was 8.3%. Based on statistical analysis, tumors with irregular shape and greater size were the significant contributors to piecemeal resection and long operative times. Besides tumor shape and size, tumor in deep muscularis propria and long operative time were also risk factors of complications. The median hospitalization time was 3.2 days. All of the complications were cured by conservative treatment. A median follow-up of 36 months was available and all patients were free from local recurrence or distant metastasis during the study period. CONCLUSIONS STER is an effective and safe methodology for the resection of upper gastrointestinal submucosal tumors. Tumor size and shape impact on the piecemeal resection rate and procedural difficulty. STER for large tumors with irregular shape in the deep muscularis propria is also feasible but associated with relatively high risks of piecemeal resection and complications.
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Affiliation(s)
- Tao Chen
- *Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China †Endoscopy Research Institute of Fudan University, Shanghai, China ‡Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
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