To evaluate the sites and frequencies of overall and initial lymph node (LN) metastases (LNMs) of clinical T1N0 esophageal cancer.
The sites and frequencies of initial LNMs and sentinel LNs (SLNs) of ...esophageal cancer remain unclear.
The Japan Clinical Oncology Group JCOG0502 trial was a 4-arm prospective study that compared esophagectomy with chemoradiotherapy for clinical T1N0 esophageal cancer in both randomized and patient-preference arms. The preoperative diagnostic accuracy was evaluated for patients assigned to the surgery arm. Patients who withdrew consent and who were not treated were excluded. All patients underwent esophagectomy with D2 or greater LN dissection. From the pathologic findings, sites and frequencies of LNMs and SLNs were assessed and the frequency of skip LNMs was calculated.
In total, 211 patients underwent LNM and SLN analysis. Regarding N-factor accuracy, 57 (27.0%) of 211 clinical N0 cases had pathologic LNMs. The upper mediastinal and mediastinal/abdominal regions were frequent sites of LNMs in upper and lower thoracic cases, respectively. However, in middle thoracic cases, LNMs were observed in the neck, mediastinal, and abdominal regions, and pathologic SLN spread to all 3 fields. The frequency of skip LNMs was 36.7%.
A clinical diagnosis of T1N0 is not sufficiently accurate, and therefore, it is unacceptable to omit LN dissection or minimize the prophylactic radiation field. SLNs, which are not location restricted, should be surveyed in all 3 fields.
We report a rare case of benign esophageal schwannoma showing
18
F-fluorodeoxyglucose (FDG) uptake on positron emission tomography computed tomography (PET-CT). A 43-year-old woman diagnosed with ...left breast cancer was referred to our hospital for further treatment. Preoperative PET-CT showed a significant accumulation maximum standardized uptake value (SUV
max
) 2.5 in the upper thoracic esophagus. Endoscopy revealed a submucosal tumor about 40 mm in size in the upper thoracic esophagus. Endoscopic ultrasonography-guided fine-needle aspiration biopsy did not reveal the histological diagnosis. The patient underwent thoracoscopic enucleation of the tumor. The resected tumor measured 40 × 20 mm. Microscopically, the tumor consisted of spindle cells. Immunohistochemistry was positive for S-100 and vimentin and was negative for KIT (CD117) and CD34. The final diagnosis was benign esophageal schwannoma.
During thoracic cavity operations, it is difficult to obtain sufficient working space and good operative field visibility in patients with pectus excavatum because the space between the vertebral ...bodies and sternum is very narrow. Here, we report the successful treatment of esophageal cancer in a patient with pectus excavatum. A 77-year-old man with esophageal cancer was referred to our hospital for further treatment. He was diagnosed with multiple early esophageal squamous cell carcinomas. The patient had pectus excavatum, but because it was asymptomatic, a video-assisted thoracoscopic radical esophagectomy in the left lateral decubitus position without pectus excavatum repair was selected. Despite the patient's unusual anatomy, video-assisted thoracoscopic esophagectomy in the left decubitus position allowed for good operative field visibility, as the videoscope was inserted from the side of the diaphragm. This operative procedure is useful in patients with esophageal cancer who also have pectus excavatum. To the best of our knowledge, this is the second report of video-assisted thoracoscopic esophagectomy in an esophageal cancer patient with pectus excavatum.
It is important for clinics and hospitals to cooperate in treating cancer patients in the community health. We are treating cancer patients in cooperation with five general hospitals in Shizuoka and ...about 100 clinics in the same community. In this system, it is required that pharmacists in the community should have knowledge about beneficial effects and adverse events of anticancer drugs as do hospital pharmacists, and furthermore they should have good communication with cancer patients. The expectation for pharmacists is great in community medicine especially in the treatment of cancer patients.
It is important for clinics and hospitals to cooperate in treating cancer patients in the community health. We are treating cancer patients in cooperation with five general hospitals in Shizuoka and ...about 100 clinics in the same community. In this system, it is required that pharmacists in the community should have knowledge about beneficial effects and adverse events of anticancer drugs as do hospital pharmacists, and furthermore they should have good communication with cancer patients. The expectation for pharmacists is great in community medicine especially in the treatment of cancer patients.
Abstract Aim The optimal second-line regimen for treating advanced gastric cancer (AGC) remains unclear. While irinotecan (CPT-11) plus cisplatin (CDDP) combination therapy and CPT-11 monotherapy ...have been explored in the second-line setting, the superiority of second-line platinum-based therapies for AGC patients initially treated with S-1 monotherapy has not yet been evaluated; therefore, we aimed to examine the survival benefit of CPT-11/CDDP combination over CPT-11 monotherapy. Methods AGC patients showing progression after S-1 monotherapy for advanced cancer or recurrence within 6 months after completion of S-1 adjuvant therapy were randomly allocated to CPT-11/CDDP (CPT-11, 60 mg/m2 ; CDDP, 30 mg/m2 , q2w) or CPT-11 (150 mg/m2 , q2w). Results Sixty-eight advanced and 95 recurrent cases were evaluated. The median overall survivals were 13.9 (95% confidence interval CI: 10.8–17.6) and 12.7 (95% CI: 10.3–17.2) months for CPT-11/CDDP and CPT-11, respectively (hazard ratio: 0.834; 95% CI: 0.596–1.167, P = 0.288). No significant differences were observed in the secondary end-points, including progression-free survival (4.6 95% CI: 3.4–5.9 versus 4.1 95% CI: 3.3–4.9 months) and response rate (16.9% 95% CI: 8.8–28.3 versus 15.4% 95% CI: 7.6–26.5). The incidences of grade 3–4 anaemia (16% versus 4%) and elevated serum lactate dehydrogenase levels (5% versus 0%) were higher for CPT-11/CDDP than for CPT-11. Exploratory subgroup analysis revealed that CPT-11/CDDP was significantly more effective for intestinal-type AGC, compared with CPT-11 (overall survival: 15.8 versus 14.0 months; P = 0.019). Conclusion No survival benefit was observed upon adding CDDP to CPT-11 after S-1 monotherapy failure.
Second-line chemotherapy (SLC) improves survival in advanced gastric cancer (AGC). Patients receiving SLC are categorized into two disease status groups: tumour progression after first-line ...chemotherapy and early recurrence after adjuvant chemotherapy. Differences between these groups have not yet been clarified.
A total of 163 eligible patients registered in the randomized phase III TRICS trial evaluating SLC for patients with AGC was classified into the progressive disease (PD) group (n = 55) or the early relapse (ER) group (n = 108). We compared overall survival (OS), progression-free survival (PFS), overall response rate (ORR), and safety. Adjusted OS and adjusted PFS were estimated using inverse probability of treatment weighting (IPTW).
The ER group had a lower median age than the PD group (66 vs. 72 years; P = 0.016), performance status (PS) 0 was more frequently seen in the ER group (87% vs. 71%; P = 0.012). The adjusted median OS was 13.7 months in the ER group and 13.6 months in the PD group (IPTW hazard ratio HR: 1.023; P = 0.854). The adjusted median PFS was 4.9 months in the ER group and 4.4 months in the PD group (IPTW HR: 0.707; P = 0.004). ORR was significantly better in the ER group than the PD group (21.3% vs. 4.9%; P = 0.020). No significant differences were observed in the incidence of adverse events.
ER was associated with improved PFS and better ORR than PD, although no difference in survival was demonstrated. From the viewpoint of treatment outcome, it seems appropriate to treat patients with ER in the same way as patients with PD.
UMIN 000002571.
•This analysis was comparing progressive disease and early relapse for second-line advanced gastric cancer.•We estimated by inverse probability of treatment weighting (IPTW) method for adjust.•Response rate was significantly better in ER group than in progressive disease (PD) group (21.3, 4.9%).•Progression-free survival (PFS) and adjusted PFS was longer in ERG than in PDG (hazard ratio HR: 0.65) (IPTW HR: 0.71).•There was no significant difference in OS and adjusted OS (HR: 0.76, IPTW HR: 1.02).
•A small polypoid lesion in the small bowel was detected by virtual enteroscopy (VE).•VE imaging technique provides surgeons with data on the location, number, and size of polypoid lesions.•Based on ...VE findings, a 5.5 × 5.0 mm pyrogenic granuloma was resected successfully by laparoscopic-assisted surgery.
Virtual enteroscopy (VE) has been developed to explore the entire small bowel. We have previously reported that VE can reveal elevated lesions measuring >10 mm in diameter. However, data on the existence of smaller polypoid lesions is scarce. This study aimed to report a case of pyogenic granuloma in the ileum detected by VE.
A 55-year-old woman presented to our hospital with iron deficiency anemia. Esophagogastroduodenoscopy, colonoscopy, and abdominal contrast-enhanced computed tomography did not indicate any bleeding sources. Video capsule endoscopy revealed a small polypoid lesion in the small bowel. VE was subsequently performed and a polypoid lesion was detected at 119 cm from the ileocecal valve. Its size was estimated to be 6 mm. Based on VE findings, laparoscopic-assisted surgery for the small bowel tumor was performed. During surgery, the polypoid lesion, at 120 cm from the end of the ileum, was barely palpable. The resected specimen showed a 5.5 × 5.0 mm polypoid lesion. Microscopically, the polypoid lesion was diagnosed as pyogenic granuloma.
We detected a 5.5 × 5.0 mm polypoid lesion in the small bowel, and this is the minimum size of the lesion visualized on VE. This imaging technique provides surgeons with data on the location, number, and size of polypoid lesions.
VE is a new useful tool for the preoperative collection of data on small polypoid lesions in the small bowel.
Neoadjuvant chemotherapy (NAC) is increasingly used for resectable locally advanced gastric cancer (LAGC). JCOG1302A investigated the diagnostic criteria of LAGC patients with cT3–4/N1–3 to minimize ...contamination of pathological stage I as a candidate for NAC. In JCOG1302A, 77.2% of cT3–4 tumors diagnosed via a combination of endoscopy and computed tomography (CT) were pT3–4. However, the role of endoscopic ultrasonography (EUS) and additional diagnostic procedures/modalities remains unclear. Here, we investigated whether EUS, thin-slice CT, and foaming agent (FA) in CT contribute to accurate diagnosis of AGC invasion depth.
Using JCOG1302A study data, we compared positive predictive value (PPV), negative predictive value (NPV), and kappa index (KI) between conventional and additional diagnostic procedures to identify pT3–4: conventional endoscopy (CE) with versus without EUS, 1-mm versus 5-mm CT slice, and CT with versus without FA.
We analyzed 1232 patients’ data. PPV, NPV, and KI were 79.2%/73.7%, 59.2%/58.8%, and 0.38/0.39 (CE alone/CE with EUS), 77.8%/75.5%, 62.9%/71.2%, and 0.38/0.39 (5-mm CT/1-mm CT), and 78.6%/75.1%, 60.9%/69.7%, and 0.38/0.40 (CT without FA/CT with FA), respectively. Overall, there were no remarkable differences in any comparison. More specifically, PPV and KI were slightly higher with CE alone rather than CE with EUS. Although NPV was higher for 1-mm CT and CT with FA, PPV was rather higher for 5-mm CT and CT without FA.
Additional diagnostic procedures/modalities, like EUS, 1-mm slice CT, or FA in CT may not improve the diagnostic accuracy of invasion depth in resectable LAGC.
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