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Comparison of adverse effects of proton and X-ray chemoradiotherapy for esophageal cancer using an adaptive dose-volume histogram analysis.
Makishima, H, Ishikawa, H, Terunuma, T, Hashimoto, T, Yamanashi, K, Sekiguchi, T, Mizumoto, M, Okumura, T, Sakae, T, Sakurai, H
Journal of radiation research. 2015;(3):568-76
Abstract
Cardiopulmonary late toxicity is of concern in concurrent chemoradiotherapy (CCRT) for esophageal cancer. The aim of this study was to examine the benefit of proton beam therapy (PBT) using clinical data and adaptive dose-volume histogram (DVH) analysis. The subjects were 44 patients with esophageal cancer who underwent definitive CCRT using X-rays (n = 19) or protons (n = 25). Experimental recalculation using protons was performed for the patient actually treated with X-rays, and vice versa. Target coverage and dose constraints of normal tissues were conserved. Lung V5-V20, mean lung dose (MLD), and heart V30-V50 were compared for risk organ doses between experimental plans and actual treatment plans. Potential toxicity was estimated using protons in patients actually treated with X-rays, and vice versa. Pulmonary events of Grade ≥2 occurred in 8/44 cases (18%), and cardiac events were seen in 11 cases (25%). Risk organ doses in patients with events of Grade ≥2 were significantly higher than for those with events of Grade ≤1. Risk organ doses were lower in proton plans compared with X-ray plans. All patients suffering toxicity who were treated with X-rays (n = 13) had reduced predicted doses in lung and heart using protons, while doses in all patients treated with protons (n = 24) with toxicity of Grade ≤1 had worsened predicted toxicity with X-rays. Analysis of normal tissue complication probability showed a potential reduction in toxicity by using proton beams. Irradiation dose, volume and adverse effects on the heart and lung can be reduced using protons. Thus, PBT is a promising treatment modality for the management of esophageal cancer.
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[A case of consciousness disorder induced by the syndrome of inappropriate secretion of antidiuretic hormone following cisplatin and 5-fluorouracil chemotherapy in a patient with esophageal cancer].
Endo, C, Takagawa, R, Chiba, T, Kawamoto, M, Konishi, T, Honma, Y, Minami, Y, Watanabe, J, Morita, T, Mogaki, M, et al
Gan to kagaku ryoho. Cancer & chemotherapy. 2013;(12):2130-2
Abstract
We report a case of consciousness disorder following the fourth course of chemotherapy with cisplatin (CDDP) and 5- fluorouracil (5-FU) in a patient with esophageal cancer. A 74-year-old man was admitted to our hospital to receive chemotherapy for esophageal cancer. Six days after chemotherapy, the patient showed impaired consciousness and his serum sodium concentration was found to be 125 mEq/L, but no edema or dehydration was noted. This hyponatremic state was diagnosed as CDDP-induced syndrome of inappropriate secretion of antidiuretic hormone (SIADH) on the basis of serum and urine hypo-osmolality. Accordingly, fluid intake was restricted and sodium supplements were administered, resulting in an appropriate increase in the serum sodium concentration to 132 mEq/L in 4 days.
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Metastasis of carcinosarcoma of oesophagus to gastrostomy site.
Hameed, H, Khan, YI
The British journal of oral & maxillofacial surgery. 2009;(8):643-4
Abstract
Patients with head and neck cancers need a percutaneous endoscopic gastrosotomy (PEG) before start of treatment to ensure adequate nutrition because worsening dysphagia during chemo radiation [Nicholson FB, Korman MG, Richardson MA. Percutaneous endoscopic gastrostomy: a review of indications, complications and outcome. J. Gastroenterol Hepatol 2000; 15: 21-5; Beer KT, Krause KB, Zuercher T, Stanga Z. Early percutaneous endoscopic gastrostomy insertion maintains nutritional state in patients with aerodigestive tract cancer. Nutr Cancer 2005; 52: 29-34.]. However implantation of original tumor to the gastrostomy exit site is rare but serious complication of this procedure and here we report a case of PEG site metastasis along with relevant review of literature.
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Primary amelanotic melanoma of the esophagus.
Stringa, O, Valdez, R, Beguerie, JR, Abbruzzese, M, Lioni, M, Nadales, A, Iudica, F, Venditti, J, San Roman, A
International journal of dermatology. 2006;(10):1207-10
Abstract
Primary melanoma of the esophagus (PME) is an uncommon malignancy with less than 250 cases reported in the literature. Amelanotic PME is exceedingly rare and accounts for 10-25% of melanomas of the esophagus. A 59-year-old male with a history of mild dysphagia, heartburn, moderate anorexia and weight loss for 1 month is described. Barium swallow examination and videogastroscopy showed a polypoid, ulcerated mass located 30-38 cm from the incisors. No skin or eye melanoma lesions were found. Five biopsy samples were obtained. Histological examinations revealed proliferation of large, loosely cohesive cells of variable shapes and prominent central nucleoli in the deep mucosa. Immunohistochemical findings included positive vimentin, protein S-100, Melan A, and HMB-45, and negative AE1/AE3, CD 17, and desmin. A total transhiatal esophagectomy with high cervical esophagogastric anastomosis was performed. Peritumoral lymph nodes revealed malignant invasion. A diagnosis of primary amelanotic melanoma of the esophagus was made. Fourteen months after diagnosis the patient developed disseminated PME.
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[Primary melanoma of the esophagus. Unusual case with Barrett's esophagus].
Cuesta-Mejías, T, de León-Bojorge, B, Arias-Gutiérrez, A, Decanini-Terán, C, Shueke-Esses, M
Revista de gastroenterologia de Mexico. 2001;(3):146-9
Abstract
OBJECTIVE To present a rare entity of difficult preoperative diagnosis. BACKGROUND Primary malignant melanoma of the esophagus represents 0.1% of all malignant tumors in this organ. It has been described in association with esophageal melanocytosis and melanosis with a clinic behavior similar to other neoplasm in the esophagus, but is more aggressive and fatal. By endoscopy, it usually appears as a vegetant, non-obstructive lesion, with dark pigmentation in the melanotic variant, the sole evidence that suggests the diagnosis prior to microscopic examination. Clinical exclusion of metastasis melanoma as a possibility is obligatory. METHODS We reviewed clinical, imagenologic, endoscopic, and anatomopathological aspects of an ulcerovegetant neoplasm on the esophago-gastric junction, surgically resected, in a 65 years-old man with progressive dysphagia, who was without tumoral relapse during 18 months after surgery. RESULTS The tumoral mass was an anaplastic cell tumor with very scant melanic pigmentation and diffuses stain for HMB-45 antigen and S100 protein, considering it to be a primary malignant melanoma. The neighboring mucous membrane showed a typical Barrett's esophagus and melanocytic hyperplasia. CONCLUSIONS 1) Endoscopy may suggest the possibility of esophagus melanoma when there is a vegetate, non-obstructive, pigmented tumor. 2) Immunohistochemistry confirms the entity if HMB-45 antigen and S100 protein are detected in the tumoral cells, while the negative results for keratin and leukocytic common antigen (LCA) eliminate carcinoma and lymphoma as possible diagnoses. 3) In our case, the presence of Barrett's esophagus is exceptional, because it has not been described previously in the literature reviewed.