Esophageal Cancer

Limited data exist on complications and treatment outcomes following brachytherapy after chemoradiation in esophageal cancer. This study aimed to assess complications and treatment outcomes after intraluminal brachytherapy post-definitive chemoradiation.

 This retrospective cohort study included esophageal cancer patients treated at Imam Reza Radiotherapy Center, Mashhad, Iran (2016-2023). Patients received chemoradiotherapy with paclitaxel-carboplatin, cisplatin-irinotecan, or cisplatin-5-FU (5-6 weeks), with a total radiation dose of ≥45 Gray. After a two-week rest, they underwent HDR brachytherapy with cobalt-60 and were followed monthly for one year.

A total of 125 patients (mean age: 71.08±10.67 years) were evaluated. The overall survival (OS) and disease-free interval (DFI) were 47.26 and 22.62 months, respectively. The most common tumor location was the middle esophagus, and the most common grade was G2. An ECOG score <2 was observed in 96 patients. No significant association was found between OS and DFI with tumor location, grade, dysphagia level, or functional index. However, brachytherapy dose, radiotherapy dose, and chemotherapy regimen were significantly associated with OS, but not with DFI. Post-treatment complications occurred in 98 patients, including local recurrence in 39 cases. Patients without complications had a mean DFI and OS of 54 and 55 months, respectively, while those with complications had 37 and 50 months. Complications were significantly associated with DFI but not with OS. Complete response was seen in 106 patients, significantly correlating with OS (P=0.003) and DFI (P<0.001). Patients with local and distant recurrence had an 11-fold higher mortality risk.

Intraluminal brachytherapy after definitive chemoradiation plays a crucial role in treatment management for esophageal cancer. It should be considered as a treatment option, but further studies with larger sample sizes are needed for routine implementation.

There is limited research available on the direct effect of opioid use on esophageal cancer. The objective of this systematic review and meta-analysis is to consolidate the results of previous studies and provide an estimate of the pooled relative risk or odds ratio associated with opioid use in relation to the occurrence of esophageal cancer. 

The PRISMA guidelines were utilized to establish a framework for conducting this systematic review and meta-analysis. A systematic search was conducted in international and national databases. PubMed, Web of Science, Scopus, and national electronic databases were searched up to February, 2024. The random-effects model was used to report the results at a 95% confidence interval (CI). Stata 11 was used for data analysis.

Out of the 648 retrieved articles, 11 studies remained in the final analysis (one cohort study and ten case-control studies). In all subgroups analyzed based on the type of odds ratios, no significant heterogeneity was observed. The pooled adjusted oddsratio of opium on esophageal cancer was 1.8 (95% CI: 1.24–2.61), and the pooled crude odds ratio of opium on esophageal was 1.82 (95% CI: 1.55–2.14).

The results of this systematic review and meta-analysis showed that there is a significant relationship between opium use and esophageal cancer, and opium can be a serious risk factor for esophageal cancer

To analyze the application value of multislice spiral CT in the diagnosis of esophageal cancer and the evaluation of radiotherapy efficacy.

A total of 90 esophageal cancer patients treated in our hospital from October 2022 to December 2023 were selected and underwent multislice spiral CT examination. Surgical pathology diagnosis results were used as the gold standard for this study. The diagnostic accuracy of multislice spiral CT for T and N staging of esophageal cancer patients was statistically analyzed. CT perfusion parameters [permeability surface (PS), mean transit time (MTT), blood volume (BV), blood flow (BF)] were compared between the complete remission (CR) group and the non-CR group after radiotherapy. ROC analysis was used to evaluate the predictive efficiency of CT perfusion parameters for CR.

The diagnostic accuracy of multislice spiral CT for T1, T2, T3, and T4 staging in esophageal cancer patients was 78.57%, 83.33%, 87.50%, and 95.00%, respectively. The diagnostic accuracy for N0 and N1 staging was 91.89% and 92.45%, respectively. The CR group had lower BV, BF, MTT, and PS compared to the non-CR group (P<0.05). Combined detection of BV, BF, MTT, and PS had a higher sensitivity (95.12%) for predicting CR than single detection methods (66.52%, 76.86%, 72.39%, 77.63%) (P<0.05), with no significant difference in specificity between combined (80.26%) and single detections (78.46%, 81.24%, 82.71%, 80.89%) (P>0.05).

Multislice spiral CT can accurately diagnose T and N staging in esophageal cancer patients. Combined detection of CT perfusion parameters BV, BF, MTT, and PS can improve the sensitivity of predicting CR, providing important reference value.

Molecular mechanism detection of stage I to stage II transition of esophageal squamous cell carcinoma via protein-protein interaction (PPI) network analysis is the main aim of this study.

Esophageal cancer (EC) is recognized as cancer with a very poor prognosis and malignancy. It is characterized by a high prevalence rate within the world and a very low survival rate, even with treatment.

To detect esophageal squamous cell carcinoma (ESCC) related genes, gene expression profiles (GEPs) of GSE161533 from the Gene Expression Omnibus (GEO) database were considered to be analyzed. Data was evaluated via the GEO2R program to explore the significant differential genes (DEGs) associated to stages I and II of esophageal squamous cell carcinoma. Each analysis's top 250 significant DEGs were evaluated, and the non-common genes were assessed via PPI network analysis. The hub-bottleneck DEGs were determined and enriched via gene ontology.

Results indicate 373 significant DEGs discriminate stage I from stage II. PPI network analysis associated with gene expression assessment showed that COL1A1, SERPINE1, PDGFRB, AURKA, TGFBI, LGALS3, BRCA1, and TFRC are the critical DEGs which are related to ESCC transition state from stage I to II of disease. A total of 13 biological processes and molecular functions were related to the crucial genes.

In conclusion, the Upregulation of COL1A1, SERPINE1, PDGFRB, AURKA, TGFB1, and LGALS3 and downregulation of BRCA1 and TFRC in stage II of ESCC relative to stage I were pointed out as the key events which are associated with promotion of stage I to stage II transition.

The objective of this study was to examine the impact of synchronous low-dose splenic irradiation (LDSR) on immune function in patients with esophageal cancer undergoing radiotherapy.

Twenty-one patients who were diagnosed with esophageal cancer were randomly allocated to either the control or experimental groups. The control group received routine radiotherapy alone, whereas the experimental group underwent simultaneous LDSR during radiotherapy. Low dosage radiation refers to a beam with a low linear energy transfer (LET) that delivers a dose of 0.2 Gy or less, or a high LET beam that delivers a dose of 0.05 Gy or less, while maintaining an exposure dose rate of 0.005 cGy/min. The lymphocyte subsets in the two groups were analyzed using flow cytometry at various time points during and after treatment. Additionally, complications and their occurrence times were recorded simultaneously.

Gradual decreases were observed in CD16+CD56+, CD3+CD4+, and CD4+/CD8+ ratios following radiotherapy in the control group (p < 0.05). However, no considerable differences were observed between the experimental groups in these ratios (p > 0.05). LDSR was found to induce immunological enhancement and counteract immune suppression caused by radiotherapy. Furthermore, the experimental group experienced larger cumulative dosages that led to problems compared to the control group, with a delayed onset. Despite receiving a higher cumulative dose, the experimental group exhibited lower levels of myelosuppression and radiation esophagitis than the control group (p < 0.05). Overall, the results suggest that synchronous LDSR can enhance immune function during radiotherapy in patients with esophageal cancer and reduce the adverse effects associated with routine radiotherapy.

Synchronous LDSR may induce immunological enhancement during radiotherapy in patients with esophageal cancer, reduce adverse reactions to routine radiotherapy, and enhance tolerance.

Esophageal cancer (EC) is the sixth most common cause of cancer-related mortality globally, due to the high frequency of early metastatic disease. In the past, the presence of metastasis was examined based on histological analysis using hematoxylin and eosin (HE) staining. A high percentage of patients experience recurrence after metastasectomy. Recurrence could be due to the presence of micro-metastasis (MM), which could be detected at sites such as lymph nodes or bone marrow using RT-PCR or immune-histochemical staining. Previous studies have reported inconsistent results with respect to the clinical significance of MM, its impact on survival, and how it is affected by chemotherapy. In this study, we reviewed the (1) clinical significance of MM, (2) methods of detection, (3) sites of occurrence, (4) the mechanism associated with MM, and (5) the role of chemotherapy and radiotherapy in patients with EC.

The therapeutic potential of Quercus infectoria (QI) gall, including its anti-inflammatory, antioxidant, and anticancer properties, is well-known. However, its impact on lung, gastric, and esophageal cancer cells remain unclear. This study aims to explore the effects of QI gall aqueous extract on cell viability, apoptosis, and gene expression in A549, BGC823, and KYSE-30 cell lines.

A549, BGC823, and KYSE-30 cells were seeded in complete medium and incubated with different concentrations of QI gall extract for 24 hours. Cell viability was measured by an MTT [3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide] assay. The induction of apoptosis was assessed through flow cytometric analysis after the adding FITC-conjugated Annexin V (Annexin V-FITC) and propidium iodide (PI). The mRNA expression levels of CCND1, TP53, BCL2, and BAX genes were determined using Real-time Quantitative Polymerase Chain Reaction analysis.

The MTT assay demonstrated that treatment with QI gall extract significantly reduced the number of viable cells in the A549, BGC823, and KYSE-30 cell lines at IC50 concentrations of 440.1, 437.1, and 465.2 mg/ml, respectively. Additionally, compared to untreated cell population, the percentages of early apoptosis, late apoptosis, and necrosis in the A549, BGC823, and KYSE-30 cells significantly increased following treatment with QI gall extract (P< 0.05). Also, the treatment with QI gall extract influenced the expression of CCND1, TP53, BCL2, and BAX genes.

The present findings indicated that the gall extract of QI can inhibit the growth of A549, BGC823, and KYSE-30 cells by inducing apoptosis, which may be mediated via mitochondria‑dependent pathway.

This paper aimed to investigate the radiation dosimetry and dose deposition to the surrounded organs at risk (OARs) with different radial and longitudinal margins based on the normal tissue complication probability (NTCP) and dose-volume histogram (DVH) methods.

Fifteen patients with histologically diagnosed esophageal cancer were retrospectively selected. From the clinical target volume (CTV), eight planning target volumes (PTV) were expanded for each patient, with one group of four radial margins (3mm, 5mm, 7mm, 10mm) and the other group of four longitudinal margins (3mm, 5mm, 7mm, 10mm). Then, eight plans with the prescription dose of 50.4Gy were designed in the tomotherapy system. Within each group, doses for the OARs and NTCP-based risk of pneumonitis and pericardial disease were compared.

Almost all the dose parameters in both groups, except for the Dmax (maximum dose) of the spinal cord in the longitudinal direction, showed significant linearly increasing trends with the expansion of margins. For same dose parameters, the increased slopes in the radial direction were larger than those in the longitudinal. Heart V30Gy (the percent volume of receiving 30Gy) grew fastest compared to other clinical constraint indexes in both groups, and the most significant difference in the risk of pneumonitis was observed in the radial group when the margin was expanded from 3 to 10mm.

In order to lower the likelihood of radiation-related toxicity, radial margin expansion should be more strictly controlled in the radiotherapy of esophageal cancer with tomotherapy.

We aim to present incidence rates and geographical distribution of most common early-onset gastrointestinal cancers (EOGICs), including early-onset esophageal cancer (EOEC), gastric cancer (EOGC) and colorectal cancer (EOCRC) in Iran, 2014- 2018.

Data on new cases of EOEC, EOGC and EOCRC were obtained from publicly available annual reports of the Iranian National Population-based Cancer Registry (INPCR). Incidence rates were calculated using the population data available from the Statistical center of Iran. We considered the World standard population for calculation of age-standardized incidence rates (ASR). We also calculated 95% confidence intervals (CIs) for ASR. All rates are presented per 100 000 person-years.

Overall, 19,679 new cases of EOGIC were registered by the INPCR between 2014 and 2018. The ASRs (95% CI) of EOEC, EOGC and EOCRC were 0.49 (95% CI: 0.47–0.51), 1.67 (1.63–1.71), and 3.07 (3.01–3.13) per 100,000 person-years, respectively. Our findings indicate decreasing and constant trends in the ASR of EOEC and EOGC during the study period, 2014-2018. There was an increasing trend in the ASR of EOCRC. We also found geographical disparities in the incidence rates of EOGICs across provinces of Iran, suggesting the highest ASRs of EOEC in Golestan (1.3), EOGC in Ilam (2.99) and EOCRC in Ilam (4.49).

Our findings suggested that the incidence rate of EOCRC is consistently increasing. We also found variations in the incidence of EOGICs among different provinces. Further investigations are recommended to clarify the time trends and risk factors of EOGICs in Iran.

Splenosis occurs as a result of autotransplantation of splenic tissue following splenic injury or splenectomy. A 56-year-old man with esophageal cancer underwent thoracoscopic-assisted subtotal esophagectomy accompanied by three-field lymph node dissection, and retrosternal gastric tube reconstruction. The spleen was injured during the surgery and was removed. A retrosternal nodule of 12 mm in diameter was detected near the reconstructed gastric tube on computed tomography (CT) performed 3 years and 6 months postoperatively.Retrospectively, the nodule was observed in the same area on early postoperative CT and gradually increased in size. No accessory spleen was identified on the preoperative CT. Splenosis was suspected, and 99mTc-Sn-colloid single photon emission computed tomography (SPECT)/CT was performed. It revealed intense uptake in the retrosternal nodule, consistent with the diagnosis of thoracic splenosis. Subsequently, the patient has been under observation without treatment. 99mTc-labeled colloid SPECT/CT allowed confident diagnosis of thoracic splenosis following esophageal cancer surgery. This examination is considered valuable for the evaluation of ectopic splenic tissue.

One of the top causes of cancer-related deaths globally is esophageal cancer. In investigations of cell toxicity, the MTT test is one of the most often used cell viability/cytotoxicity assays for cellular metabolic activity. Nowadays, lactobacilli with probiotic effectiveness are now acknowledged as a prophylactic agent against cancer. The anti-tumor product of these bacteria have been designated in numerous studies. This investigation examined the probiotic Lactobacillus casei's in vivo impact on esophageal cancer. The MTT technique was used in this work to evaluate the cytotoxicity of L. casei (supernatant and full cell culture) to 5fu on the cancer cell line Kyse30. L. casei was able to decrease cell survival in supernatant and full cell culture (Kyse30). The possible impact of L. casei, particularly their supernatant, on esophageal cancer was initially evaluated in this research. As a result, lactobacilli species show promise for future research and development as cancer treatments.

Esophageal cancer is a research priority due to its invasive nature and poor prognosis. It ranks sixth in mortality among all forms of cancer and esophagectomy is the most conventional treatment. Jejunostomy tube feeding can reduce complications in patients and hospital costs. This study aimed to evaluate the cost-effectiveness of jejunostomy tube feeding, as opposed to the common nutritional method.

A retrospective case-control study was conducted at a teaching hospital in Iran in 2015. The sample of the study included 100 candidates for esophagectomy. In the case group (enteral), a Jejunostomy tube was inserted for 50 patients undergoing esophagectomy. The control group (parenteral) consisted of 50 patients undergoing esophagectomy without jejunostomy tube.  

The median oral intake was on the third day in the case group, with a shorter hospital stay (P=0.02) compared to the control group. The mean total costs of hospitalization per patient in the case group and in the control group were 2228 and 3666 US dollars, respectively. The cost-effectiveness ratio of the jejunostomy tube against the common nutritional method was about 40 US dollars per day of the median decrease in oral intake.  

According to our findings, jejunostomy tube is cost-effective and preferable to the common nutritional method with a decreased median of oral intake start day, a decreased span of hospitalization, fewer complications in the nutritional support of the patients undergoing esophagectomy, and finally, more comfort for patients. The decrease in the average length of stay in hospitals is also important from the point of view of policymaking. So, this method can be a cost-effective alternative to the common nutritional method.

We aimed to report demographic features, tumor characteristics, and survival outcomes of the patients with esophageal cancer (EC) in the Eastern Anatolian Region of Turkey, where upper gastrointestinal tumors are endemic.

Our retrospective investigation was performed on patients with EC treated in Erzurum Regional Training and Research Hospital Clinics of Medical and Radiation Oncology between 2005 and 2017. The patients with stage IIA-IV disease and completed at least one treatment modality (surgery/ definitive chemoradiotherapy(CRT)/palliative chemotherapy(CT) or radiotherapy(RT)) had enrolled in the study. The demographic and clinicopathological characteristics, TNM stage, oncological treatment modalities applied, and survival outcomes were statistically analyzed.

Our study consisted of 251(women, 57.4%) patients with EC with a female/male ratio of 1.34/1. The median age of the patients was determined as 62 years. The primary tumor was frequently localized in the middle(46.6%) and lower(46.2%) part of the esophagus, and the majority had squamous cell carcinoma histopathological subtype(86.1%). The median follow-up period and overall survival (OS) time were 21.2 and 19.0 months, respectively. A five-year OS rate was detected as 19.3%. As a result of multivariate analysis; grade, stage and concurrent CRT were determined as independent prognostic factors (p=0.004, p=0.019, and p=0.014, respectively). The median OS of stage II-III and IV patients were 25.79 versus 10.02 months (p<0.001). Among stage II-III patients, the best median OS was in the surgery+ adjuvan RT/CRT group(37.02 months). In stage IV patients, the median OS of female patients was found to be statistically significantly higher than that of males(15.77 versus 9.29 months p=0.007).

EC is a significant health problem in the Eastern Anatolian Region of Turkey. Differences were detected according to age and gender, tumor characteristics, histological subtype, and disease stage rates in patients with EC living in this region, but the survival rate was similar with the literture. Surgery+ adjuvant RT/CRT provided better OS in the non-metastatic patients than other treatment modalities.

Esophageal cancer is an invasive tumor with rapid growth and a poor prognosis. The annual incidence of esophageal cancer in the United States is 6 per 100 000 men and 1.6 per 100 000 women. This is different in the case of Iran, and the number of patients in the country is higher than in other countries. In this evaluation, the researchers present the experience with open Transhiatal Esophagectomy (Orringer) technique outcomes.

This study aimed at evaluating the Orringer technique and its complications in patients with esophageal cancer for 25 years at the Cancer Research Center of Shahid Beheshti University of Medical Sciences.

This is a descriptive study conducted from the beginning of 1988 to 2016. In this study, 114 patients with a mean age of 55 years and a gender classification of 60% male and 40% female were evaluated.

After resection, more than 98% of patients were in the T3 N1 - N3 stage. There were 4 mortalities: 2 were due to descending aorta tearing, 1 was due to tracheobronchial tearing, and 1 was pneumonia From 40 cases of pleural effusion, only 5 cases (12.5%) needed a thoracotomy tube. Only 2 patients needed intervention from 30 patients with dysphagia; 1 case was relieved by balloon dilatation and the other needed a free jejunal flap. Five-year survivals were 30% and 20% versus 48% and 23% in the neoadjuvant and non-neoadjuvant groups, respectively.

The present studyandother experiencesshowedthat non-radical surgery such as the Orringer technique is acceptable and compassable compared to radical surgery in 3 fields.

Esophageal cancer is one of the main causes of cancer mortality in the world. Golestan province, in the northern part of Iran, has the highest esophageal cancer rate in the world. The north and south districts of Golestan province can be classified as low and high-risk areas for esophageal cancer. One of the potential risk factors for esophageal cancer in this population is a nutrientdeficient diet. Dietary antioxidant compounds such as selenium, vitamin E, vitamin A, and β-carotene are reactive oxygen species (ROC) scavengers that play a key role in cellular responses to oxidative stress and preventing DNA damage. This study aims to compare the serum levels of selenium, vitamin E, and vitamin A in healthy individuals in high and low-risk areas of esophageal cancer.

This study is a population of 242 healthy individuals. Serum selenium levels were assessed by atomic absorption spectroscopy. Vitamin E and A were assessed by reversed-phase high-performance liquid chromatography.

Vitamin E levels of healthy individuals in high-risk areas were significantly lower than in low-risk areas, while there was no significant difference between the selenium and vitamin A levels of healthy individuals in high-risk areas and low-risk areas. Also, there was no significant difference between selenium, vitamin E, and vitamin A levels in urban and rural areas and men and women in Golestan province.

High levels of selenium with lower levels of vitamin E, along with other risk factors, may be associated with esophageal squamous cell carcinoma in highrisk areas of Golestan province.

The Herat province of Afghanistan is located on the Asian Esophageal Cancer Belt (AECB), a wide area in Central and Eastern Asia where very high rates of esophageal cancer (EC) have been observed. Several risk factors have been reported in the AECB Region by previous studies. Considering lack of information in Afghanistan on this issue, a study was conducted to determine the major risk factors related to EC in order to guide protective measures.

A population-based case-control study was performed from July 2015 to August 2016 among 657 EC patients in the Herat Province and 180 histopathological confirmed cases and 189 controls were interviewed. A structured questionnaire was used and face-to-face interviews were conducted.

Low body mass index (BMI), low socio-economic status, family history of EC, consumption of dark tea, very hot beverage and qulurtoroosh were found to be statistically significant for EC and esophageal squamous cell carcinoma (ESCC) in univariate analyses. According to multivariate analyses, sex (OR=2.268; 95% CI=1.238–4.153), very hot beverages (OR=2.253; 95% CI=1.271– 3.996), qulurtoroosh (OR=5.679; 95% CI=1.787–18.815), dark tea (OR=2.757; 95% CI=1.531–4.967), high previous BMI (OR=0.215; 95% CI=0.117–0.431) and low socio-economic status (OR=1.783; 95% CI=1.007–3.177) were associated with ESCC. Being male was found to increase the risk of ESCC with OR=2.268 (95% CI=1.238–4.153).

Consuming very hot beverages dark tea and a local food, qulurtoroosh, were found as important risk factors for EC. Our findings warrant further studies and necessitate the implementation of protective measures for EC which is one of the leading cancers in the region.

 Flourine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan is employed for initial staging and restaging of esophageal cancer patients.

 The present study aimed to assess the value of a semi-quantitative parameter of 18F-FDG PET/CT scan, that is, maximum standardized uptake value (SUVmax), to determine its correlation with patient survival in two subtypes of esophageal cancer, including squamous cell carcinoma (SCC) and adenocarcinoma.

 This cross-sectional study was performed on patients with esophageal SCC and adenocarcinoma, undergoing 18F-FDG PET/CT scan for initial staging before any treatment. The 18F-FDG PET/CT semi-quantitative parameter (SUVmax) was determined by reviewing the PET/CT images. The patients were reevaluated using 18F-FDG PET/CT scan for restaging within 12 - 24 months.

 No significant difference was observed in the SUVmax values of the primary tumor, metastatic lymph nodes, or distant metastasis between the adenocarcinoma and SCC groups, regardless of response to treatment. Similarly, no significant association was found between the short-term survival of patients with adenocarcinoma and the SUVmax values of the primary tumor, metastatic lymph nodes, or distant metastasis. Based on the survival curve, one- and two-year survival rates were estimated at 75% and 63.9% in patients with SCC and at 80% and 60% in patients with adenocarcinoma, respectively. In the SCC group, a significantly higher SUVmax was detected in deceased patients with distant metastatic lesions compared to cancer survivors. According to the area under the ROC curve, the SUVmax of metastatic lesions showed high potential for predicting the mortality of SCC patients.

 The assessment of SUVmax in distant metastatic lesions by 18F-FDG-PET/CT may help predict the survival of patients with esophageal SCC. However, 18F-FDG-PET/CT findings were not associated with the survival of esophageal adenocarcinoma; therefore, further evaluations on a larger sample size and a longer follow-up are required.