食管癌PF方案时辰化学疗法的临床研究

目的对比研究食管癌放疗联合PF方案静脉化学疗法之时辰化学疗法与常规化学疗法,观察其疗效、临床不良反应的情况。方法所有病例均行食管癌癌放疗,辅以PF方案静脉化学疗法。静脉化学疗法分为时辰化学疗法与常规化学疗法2组,统计最常见不良反应发生率,治疗后复查以评价肿瘤控制情况。结果时辰化学疗法对最常见不良反应均有不同程度的减轻,而有效率则有一定程度的提高,两组有显著性差异。结论应用时辰化学疗法,可以在两方面受益,一是减少不良反应,提高生活质量;二是可以提高治疗效果。     

Gastrin stimulates epithelial cell proliferation in the oesophagus of rats

 Gastrin can induce mitotic stimulation in the oxyntic mucosa of the stomach, sometimes leading to abnormal growth. We examined whether gastrin was able to influence cell proliferation in the oesophageal epithelium. Rats were treated with gastrin, omeprazole or saline for 3 days, or were subjected to fundectomy or sham operation. Bromodeoxyuridine labelling (LI) and mitotic (MI) indices were counted in the proliferative zone of the squamous epithelium. Infusion of exogenous gastrin, treatment with omeprazole or fundectomy raised the LI and the MI values in the oesophageal epithelium, indicating that gastrin stimulates cell proliferation in the oesophageal mucosa in the rat. Received: 15 September 1997 / Accepted: 23 October 1997     

Circular myotomy and Belsey repair for acquired shortening of the oesophagus

Fourteen patients with shortening of the oesophagus due to chronic reflux oesophagitis have been treated by a combination of an oesophageal lengthening procedure with a standard anti-reflux repair. Their ages ranged from 18 to 78 years and eight were male. Thirteen patients had a reflux stricture (with additional penetrating ulcer in six) and one had a columnar-lined oesophagus. A complete circular myotomy was performed just below the level of the aortic arch, in combination with a Belsey Mark IV anti-reflux repair. There were no deaths post-operatively but one patient required re-operation for haemorrhage and one underwent oesophageal dilatation before discharge. All patients have now been followed up for over 5 years. Nine patients have required no further treatment for their oesophageal problems, two required two early dilatations each, two required multiple dilatations and one required oesophageal resection for stricture. We suggest that this combination merits further evaluation in the management of patients with short oesophagus due to reflux.     

Weight gain as an indicator of response to chemotherapy for oesophageal carcinoma

Patients with oesophageal carcinoma commonly present with dysphagia and weight loss, which may be related to the tumour burden and/or the physical obstruction to the passage of food. In this study we have examined the relationship between weight change and response to chemotherapy in 28 patients undergoing neo-adjuvant chemotherapy for squamous or anaplastic carcinoma. Two pulses of mitomycin, ifosfamide and cisplatin were given 3 weeks apart. Body weights were measured prior to the first pulse and 3 weeks after the second. Patients underwent oesophageal dilatation routinely at diagnostic endoscopy prior to chemotherapy, in order to permit oral nutrition. No dietary modifications were made. Tumour response was assessed on a barium swallow.Patients had a normal spread of weights on presentation. In the non-responding group (n = 9), eight patients lost weight and one gained weight. Of the partial responders (>50% tumour shrinkage; n = 11), five gained weight, five lost weight and one remained constant. In the complete response group (n = 8), six gained weight and two lost weight. Statistical analysis showed a significant difference (F = 4.61; P = 0.02) between change in weight expressed as a percentage of ideal weight in non-responders (mean −5.3%) versus partial responders (mean +2.4%), and in non-responders versus complete responders (mean +1.1%).Weight gain during chemotherapy is a good indication of response, although its absence does not preclude a response. In the majority of patients who respond to chemotherapy there will be an increase in weight with improvement in their general condition prior to operation.     

35. Die Technik der proximal-selektiven Vagotomie

ZusammenfaBung Es wird eine standardisierte Technik der proximal-selektiven Vagotomie beschrieben, die sich in breiter klinischer Anwendung durch eine Vielzahl von Operateuren als zuverläBig und komplikationsarm erwiesen hat. Der Eingriff verläuft insechs Schritten: 1. Bestimmung der Antrum-Corpus-Grenze auf anatomischer Grundlage, 2. preliminärer, vagomotorischer Elektrotest, 3. Identifikation und Anschlingen der zu erhaltenden Nervenstrukturen, 4. Skelettieren der kleinen Kurvatur von distal nach proximal, 5. Freipräparieren der Cardia und Denudieren des intraabdominalen Oesophagus bis 6 cm proximal der Cardia, 6. Intraoperative Vollständigkeitskontrolle mit dem vagomotorischen Elektrotest. Grundsätzlich wird auf eine Drainageoperation verzichtet.     

Rhabdomyosarcoma of the oesophagus

Summary A 61-year-old man was operated for a large tumor, 12×4 cm in size, in the lower third of the oesophagus. The tumor had the appearance of a pleomorphic rhabdomyosarcoma showing cross striations by light microscopy and typical sarcomeres by electron microscopy. This is the fifth undisputed oesophageal rhabdomyosarcoma described in the literature and the first examined using electron microscope.     

食管多原发癌的临床及影像学分析

目的:总结食管多原发癌的临床特点及影像学检查的诊断价值。方法:回顾性分析30例经病理证实为食管多原发癌患者的临床及影像学检查资料。结果:30例食管多原发癌,临床主要表现为进行性吞咽困难、咽下梗阻伴疼痛;影像学检查病变表现为食管多段不规则狭窄,病变范围以食管中段及下段最多。结论:结合临床、影像学检查及内镜检查对食管多原发癌能作出全面正确诊断。     

妊娠中肾细胞因子mRNA在人食管癌组织中的表达

目的 研究妊娠中肾细胞因子（midkine, MK)mRNA在食管癌组织中的表达。方法 用Trizol提取食管癌组织和相应癌旁正常组织RNA，经RT－PCR获得扩增的MK cDNA，溴化乙锭琼脂糖凝胶电泳检测PCR产物。结果 6例食管癌组织在450bp处均出现一条MK的特征条带，其中1例低分化食管癌MK条带最深。6例癌旁正常组织均检测不出MK mRNA。此外，2例食管癌组织除显示MK的特征条带外，在280bp处出现一条截短型MK（tMK)区带。结论 MK在食管癌组织特异表达，表达程度可能与细胞分化程度相关。     

Adding external beam to intra-luminal brachytherapy improves palliation in obstructive squamous cell oesophageal cancer: A prospective multi-centre randomized trial of the International Atomic Energy Agency

Background

Whether the combination of high dose-rate brachytherapy (HDRBT) and External Beam Radiation Therapy (EBRT) is superior to HDRBT alone for the palliation of oesophageal cancer has only been explored in a previous IAEA pilot randomized trial.

Methods

Two hundred and nineteen patients were randomized to adding EBRT or not, after receiving two fractions of HDRBT within 1 week. Each HDRBT consisted of 8 Gy prescribed at 1 cm from source centre. Patients randomized to EBRT received 30 Gy in 10 fractions. The primary outcome was dysphagia-relief experience (DRE). Additional outcomes included various scores, performance status, weight and adverse events. A majority of charts, imaging and radiotherapy plans were externally audited.

Results

Median follow-up was 197 days, with a median OS of 188 days and an 18% survival rate at 1 year. DRE was significantly improved with combined therapy, for an absolute benefit of +18% at 200 days from randomization (p = 0.019). In longitudinal regression analyses, scores for dysphagia (p = 0.00005), odynophagia (p = 0.006), regurgitation (p = 0.00005), chest pain (p = 0.0038) and performance status (p = 0.0015) were all significantly improved. In contrast, weight, toxicities and overall survival were not different between study arms.

Conclusion

Symptom improvement occurs with the addition of EBRT to standard HDRBT. The combination is well tolerated and relatively safe.