Therapeutic options for esophageal cancer

Options for the treatment of esophageal cancer used to be very limited, with surgical resection and radiotherapy methods aimed at both cure or palliation, and, in those unfortunate patients with severe dysphagia, intubation with a plastic prosthesis to restore esophageal luminal patency. Progress in the management of this cancer in the past two decades includes refinement in surgical techniques and perioperative care, better radiological staging methods, enhanced means of planning and delivering radiotherapy, multimodality treatments, and better designs in esophageal prosthesis. For individual patients, a stage-directed therapeutic plan can be used. Long-term survival, however, remains suboptimal for this deadly disease. The current review presents an overview of the commonly employed therapeutic options for esophageal cancer at the beginning of the 21st century.     

老年肺癌全肺切除术的围手术期处理

目的探讨全肺切除术对≥60岁老年肺癌患者的影响、手术适应证和围手术期管理。方法对47例≥60岁行全肺切除术肺癌患者进行回顾分析。结果术后并发心律失常28例,肺部炎症4例,呼吸衰竭3例,支气管胸膜瘘1例,经对症治疗后均好转。本组47例无围手术期死亡。结论≥60岁老年肺癌患者行全肺切除术有较大的风险,要根据肺功能状态和病变范围并结合血气分析、心脏功能等因素综合分析,合理选择适应证和术式,并重视围手术期管理。经充分准备,部分老年患者能进行全肺切除术。     

老年食管癌患者生活质量影响因素分析

目的 研究不同因素对老年食管癌术后患者回归社区生活质量的影响. 方法 应用欧洲癌症研究和治疗组织研制的生活质量核心评定量表(EORTC QLQ-C30)和食管癌补充量表(QLQ-OES18),对216例回归社区的老年食管癌术后患者采用问卷调查法进行随访,分析不同影响因素对其生活质量的影响. 结果 本组患者总体生活质量得分为(35.2±22.1)分,低于Norwegian常模,其中认知功能、便秘、腹泻、气短、食欲下降领域的得分接近常模,躯体功能、情绪功能、角色功能和社会功能的评分均低于常模;疼痛、疲乏、恶心呕吐、失眠、经济困难评分高于常模.此外,老年男性患者总体生活质量得分高于女性患者(F=5.12,P=0.029),有配偶的患者高于无配偶的患者(F=5.61,P=0.016),无并发症的患者总体生活质量高于有并发症的患者(F=5.48,P=0.002),术后生存时间越长,患者在总体生活质量越好(F=3.68,P=0.003).各年龄组总体生活质量得分差异无统计学意义(F=4.23,P=0.212). 结论 社区老年食管癌术后患者的总体生活质量不理想,性别、婚姻状况、术后生存时间、有无并发症等对社区老年食管癌术后患者生活质量有影响.     

合并冠心病的食管癌患者围手术期管理研究

目的:总结合并冠心病的食管癌患者围手术期临床经验;方法:分析15例伴有冠心病的食管癌患者围手术期临床资料,对比同期普通食管癌患者病例29例,对术中及术后相关临床资料进行比较分析;结果:与同期普通食管癌患者相比,合并冠心病的食管癌患者在手术时间、术中失血、术后胸腔引流量及带管时间、胃液引流量、胃肠减压时间、术后住院时间等方面差异均无统计学意义;但围手术期出现心率失常3例及轻微心肌梗死事件1例,两组均无死亡病例出现;结论:当心功能正常时,伴有冠心病的食管癌患者开展手术治疗是安全可行的,围手术期停用阿司匹林时出现心血管事件是可以接受的风险。     

球囊导管扩张术治疗老年人食管癌术后吻合口狭窄的临床应用

目的进一步探讨治疗老年人食管癌术后吻合口狭窄的方法。方法经口或鼻腔置管球囊扩张术治疗老年人食管癌术后吻合口狭窄50例。结果显效率为87．8％,且无复发,远期疗效甚佳。结论球囊扩张术是治疗老年人食管癌术后吻合口狭窄的首选方法。     

球囊导管扩张术治疗老年人食管癌术后吻合口狭窄的临床应用

目的进一步探讨治疗老年人食管癌术后吻合口狭窄的方法。方法经口或鼻腔置管球囊扩张术治疗老年人食管癌术后吻合口狭窄５０例。结果显效率为８７．８％，且无复发，远期疗效甚佳。结论球囊扩张术是治疗老年人食管癌术后吻合口狭窄的首选方法。     

Prognostication for patients with esophageal cancer

The ability to predict both short-term and long-term outcome after esophagectomy for cancer is invaluable. It helps us to select the appropriate patients for esophagectomy, to modify surgical procedures or perioperative care to lessen the chance of adverse events, and to decide if neoadjuvant or adjuvant therapies are of value. Predictors of morbidity and mortality after esophagectomy can include many individual factors or their combinations in the form of mathematical scores. Long-term prognosis depends to a large extent on disease stage, but the surgeon can play a major role as well, by minimizing postoperative complications and by performing a R0 resection with extended lymphadenectomy. The accuracy of prediction is improving as technology advances and understanding of the disease becomes more thorough. Information gained should be used for better individualized patient care.     

放疗与低剂量奈达铂化疗联合治疗老年食管癌的临床研究

目的探讨放疗与低剂量奈达铂化疗联合治疗老年食管癌的临床效果。方法选取124例老年中晚期食管癌患者为研究对象,按随机数字表法将患者分为三组:单纯放疗的患者为单放组40例,放疗联合低剂量(20 mg/m2)奈达铂治疗的患者为放化1组42例,放疗联合高剂量(30 mg/m2)奈达铂治疗的患者为放化2组42例。治疗2个月后比较三组临床近期疗效,并观察三组治疗期间毒副反应发生情况。结果三组近期疗效比较差异有统计学意义(P0.05),其中放化1组疗效最佳,放化2组次之,单放组疗效最差。三组Ⅰ~Ⅱ度、Ⅲ~Ⅳ度恶心或呕吐、Ⅰ~Ⅱ度放射性肺炎、Ⅰ~Ⅱ度放射性食管炎发生率比较差异有统计学意义(P0.05),其中放化2组发生率明显高于单放组和放化1组(P0.05);放化2组Ⅲ~Ⅳ度食欲减退、Ⅲ~Ⅳ度放射性食管炎、Ⅲ~Ⅳ度骨髓抑制发生率明显高于单放组(P0.05);而放化1组仅Ⅲ~Ⅳ度食欲减退、Ⅲ~Ⅳ度骨髓抑制发生率明显高于单放组(P0.05);单放组和放化1组毒副反应以Ⅰ~Ⅱ为主,经对症治疗干预后均可明显缓解。结论与单纯放疗、放疗联合高剂量奈达铂化疗相比,放疗同步低剂量奈达铂化疗治疗老年食管癌近期疗效更显著,毒副反应轻微,更安全可靠。     

Therapeutic experience of 289 elderly patients with biliary diseases

AIM To present clinical characteristics, diagnosis and treatment strategies in elderly patients with biliary diseases.METHODS A total of 289 elderly patients with biliary diseases were enrolled in this study. The clinical data relating to these patients were collected in our hospital from June 2013 to May 2016. Patient age, disease type, coexisting diseases, laboratory examinations, surgical methods, postoperative complications and therapeutic outcomes were analyzed. RESULTS The average age of the 289 patients with biliary diseases was 73.9 ± 8.5 years(range, 60-102 years). One hundred and thirty-one patients(45.3%) had one of 10 different biliary diseases, such as gallbladder stones, common bile duct stones, and cholangiocarcinoma. The remaining patients(54.7%) had two types of biliary diseases. One hundred and seventy-nine patients underwent 9 different surgical treatments, including pancreaticoduodenectomy, radical resection of hilar cholangiocarcinoma and laparoscopic cholecystectomy. Ten postoperative complications occurred with an incidence of 39.3%(68/173), and hypopotassemia showed the highest incidence(33.8%, 23/68). One hundred and sixteen patients underwent non-surgical treatments, including anti-infection, symptomatic and supportive treatments. The cure rate was 97.1%(168/173) in the surgical group and 87.1%(101/116) in the non-surgical group. The difference between these two groups was statistically significant(χ2 = 17.227, P 0.05). CONCLUSION Active treatment of coexisting diseases, management of indications and surgical opportunities, appropriate selection of surgical procedures, improvements in perioperative therapy, and timely management of postoperative complications are key factors in enhancing therapeutic efficacy in elderly patients with biliary diseases.     

营养监测对老年食管癌术后病人生活质量的影响

目的探讨营养监测对老年食管癌术后病人营养状态及生活质量的影响。方法选择2016年1月至2019年5月辽宁省肿瘤医院胸外科收治的96例老年食管癌病人,按照随机数字表将病人分为2组对照组(48例)术后给予常规肠内营养支持;观察组(48例)术后给予营养监测指导下营养支持治疗。2组均干预至出院。比较2组干预前后营养指标[血清白蛋白(ALB)、血清前白蛋白(PA)、Hb、转铁蛋白(TRF)、上臂三头肌肌围(AMC)]和生活质量评分的变化。结果观察组的术后住院时间明显短于对照组,并发症发生率明显低于对照组,差异均有统计学意义(P<0.05)。干预后,观察组ALB、PA、Hb、TRF、AMC水平均显著高于对照组和干预前(P<0.05),对照组ALB、PA、Hb、TRF、AMC水平较干预前无明显变化(P>0.05);2组健康状况调查简表(SF-36)各维度评分均高于干预前,且观察组SF-36各维度评分均显著高于对照组,差异有统计学意义(均P<0.05)。结论营养监测指导下的营养支持干预可更好地改善老年食管癌病人术后营养状态,提高其生活质量。     

Therapeutic choices in cancer of the elderly

Pathologies related to aging, including cancer, became of greater social and medical importance. The first dilemma is whether to treat elderly cancer patients and perform antitumoral therapy. Surgery is the first approach in tumors regardless of age, but a chemotherapy protocol must also be programmed to prepare the patient to surgical removal and reduce the size of the tumour. Radiotherapy is efficacious to treat many malignancies and in pain relief in advanced stages of the disease. Regarding medical therapy, different administration strategies can be adopted in the elderly. The use of high doses of antitumoral drugs achieves the highest number of objective responses, but may cause severe toxic side effects necessitating suspension of treatment. In the patients presenting good initial conditions, the dose intensity strategy is the most suitable. Targeted strategy can be defined as an alternative strategy where the patient receives drug over a longer period in function of the symptoms heralding recurrence. Low dose strategy is based on uninterrupted administration of one or more drugs at lower doses, regardless of the disappearance of persistence of the main symptoms of the disease. In situations calling for only palliative treatment, support therapy seems to be the best strategy. Furthermore, immunotherapy with interleukin-2 and/or interferons seems to demonstrate a great efficacy in solid tumors and malignancies of the blood. In conclusion, treatment of cancer in the elderly is similar to that applied to adults. Moreover, a less aggressive strategy seems achieve adequate quality of life for the remaining years.     

高龄高血压患者健康管理的效果评估

高龄高血压患者由于衰老、疾病等因素,血压变化有其特殊性,使防治工作极为复杂。我们对72例高龄高血压患者进行了为期3年的健康管理,旨在发现健康管理对高龄高血压患者的效果。     

Therapeutic management of patients with gastroenteropancreatic neuroendocrine tumours

Patients with neuroendocrine tumours (NETs) are best managed in a specialist centre as part of a multidisciplinary team comprising gastroenterologists, oncologists, endocrinologists, gastrointestinal and hepatopancreaticobiliary surgeons, pathologists, nuclear medicine physicians and technicians, radiologists, specialist nurses, pharmacists, biochemists and dieticians. This should ideally be led by a clinician with experience and interest in NETs. Although the number of medical treatments and clinical trials has increased in the decade, there is still a lack of prospective randomised trials; thus, management is mainly based on limited often single-centre studies, although there are now formal guidelines based on consensus expert opinion. We have outlined the current optimal management of patients with NETs. We have reviewed therapeutic options including surgery, somatostatin analogues and other biotherapies and peptide receptor-targeted therapy. We have discussed the challenge in managing hepatic metastases including hepatic artery embolisation, ablation and orthotopic liver transplant. In addition, we have briefly reviewed the emerging therapies such as the mammalian target of rapamycin and angiogenic inhibitors and the newer somatostatin analogues.     

老年人食管癌单纯放射治疗的生存率及其影响因素分析

目的探讨单纯放射治疗老年食管癌患者的生存率及其影响因素。方法采用８ＭＶＸ射线体外照射，常规分割，总剂量４９．０～７９．５Ｇｙ，治疗２４０例老年人食管癌，回顾分析单纯放射治疗的疗效，并与文献报道非放射治疗老年人食管癌的疗效进行对照分析。结果全组１、３、５年生存率分别为６０．８％、１５．８％、１０．０％。老年人食管癌的单纯放射治疗疗效与非老年患者相似。病变长度在３～５ｃｍ者预后较好，Ｘ射线分型以蕈伞型预后为好，不同部位病变预后无明显差别。结论对体质尚好、能耐受的老年食管癌患者给予根治量（６０～７０Ｇｙ放射治疗），可获得较好的疗效     

Multidisciplinary approach for patients with esophageal cancer

Patients with esophageal cancer have a poor prognosis because they often have no symptoms until their disease is advanced. There are no screening recommendations for patients unless they have Barrett’s esophagitis or a significant family history of this disease. Often, esophageal cancer is not diagnosed until patients present with dysphagia, odynophagia, anemia or weight loss. When symptoms occur, the stage is often stage III or greater. Treatment of patients with very early stage disease is fairly straight forward using only local treatment with surgical resection or endoscopic mucosal resection. The treatment of patients who have locally advanced esophageal cancer is more complex and controversial. Despite multiple trials, treatment recommendations are still unclear due to conflicting data. Sadly, much of our data is difficult to interpret due to many of the trials done have included very heterogeneous groups of patients both histologically as well as anatomically. Additionally, studies have been underpowered or stopped early due to poor accrual. In the United States, concurrent chemoradiotherapy prior to surgical resection has been accepted by many as standard of care in the locally advanced patient. Patients who have metastatic disease are treated palliatively. The aim of this article is to describe the multidisciplinary approach used by an established team at a single high volume center for esophageal cancer, and to review the literature which guides our treatment recommendations.     

A phase I dose escalation study of S-1 with concurrent radiotherapy in elderly patients with esophageal cancer

Background

Concurrent chemoradiotherapy (CRT) with 5-fluorouracil (5-FU) and cisplatin (CDDP) are often associated with significant incidence of toxic effects in elderly patients with esophageal cancer. This phase I trial was designed to determine the maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) of S-1, an oral 5-FU derivative, when given with radiotherapy in elderly patients.

Methods

Patients who were age of 70 years or older with histologically confirmed esophageal cancer, and had an Eastern Cooperative Oncology Group (ECOG) score of 0–2 were eligible for this study. Radiotherapy was administered in 1.8 Gy fractions 5 times weekly to a total dose of 54 Gy. S-1 was administered on days 1–14 and 29–42 at the following dosages: 60, 70, and 80 mg/m²/day. Trial registration: {"type":"clinical-trial","attrs":{"text":"NCT01175447","term_id":"NCT01175447"}}NCT01175447 (ClinicalTrials.gov).

Results

Twelve previously untreated patients were enrolled in this study. No grade 3 or 4 toxicity was observed in six patients treated at the 60 and 70 mg/m² dose levels. DLT was observed in four of six patients treated at the 80 mg/m² dose level. Two patients developed grade 3 esophagitis, one patient developed grade 3 esophagitis and pneumonitis, and one patient developed grade 3 thrombocytopaenia. Endoscopic complete response (CR) was observed in eight patients (66.7%). The median progression free survival (PFS) was 20 months and median overall survival was 29 months.

Conclusions

The MTD of S-1 was 80 mg/m², and the recommended dose (RD) for phase II studies was 70 mg/m². This regimen was well tolerated and active in elderly patients with esophageal cancer, meriting further investigation in phase II studies.